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Structuring Payment to Medical Homes After the Affordable Care Act

  • Health Policy
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The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings.

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  1. Stange KC, Nutting PA, Miller WL, et al. Defining and measuring the patient-centered medical home. J Gen Intern Med. 2010;25(6):601–12. doi:10.1007/s11606-010-1291-3.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Berenson RA, Rich EC. How to buy a medical home? Policy options and practical questions. J Gen Intern Med. 2010;25(6):619–24. doi:10.1007/s11606-010-1290-4.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Berenson RA, Rich EC. US approaches to physician payment: the deconstruction of primary care. J Gen Intern Med. 2010;25(6):613–8. doi:10.1007/s11606-010-1295-z.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bitton A, Martin C, Landon BE. A nationwide survey of patient centered medical home demonstration projects. J Gen Intern Med. 2010;25(6):584–92. doi:10.1007/s11606-010-1262-8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Merrell K, Berenson RA. Structuring payment for medical homes. Health Aff (Millwood). 2010;29(5):852–8. doi:10.1377/hlthaff.2009.0995.

    Article  Google Scholar 

  6. Fisher ES, McClellan MB, Bertko J, et al. Fostering accountable health care: moving forward in Medicare. Health Aff (Millwood). 2009;28(2):w219–31. doi:10.1377/hlthaff.28.2.w219.

    Article  Google Scholar 

  7. McClellan M, McKethan AN, Lewis JL, Roski J, Fisher ES. A national strategy to put accountable care into practice. Health Aff (Millwood). 2010;29(5):982–90. doi:10.1377/hlthaff.2010.0194.

    Article  Google Scholar 

  8. Landon BE. Keeping score under a global payment system. N Engl J Med. 2012;366(5):393–5. doi:10.1056/NEJMp1112637.

    Article  PubMed  CAS  Google Scholar 

  9. Fisher ES, Shortell SM, Kreindler SA, Van Citters AD, Larson BK. A framework for evaluating the formation, implementation, and performance of accountable care organizations. Health Aff (Millwood). 2012;31(11):2368–78. doi:10.1377/hlthaff.2012.0544.

    Article  Google Scholar 

  10. McWilliams JM, Chernew ME, Zaslavsky AM, Hamed P, Landon BE. Delivery system integration and health care spending and quality for Medicare beneficiaries. JAMA Intern Med. 2013;1–9. doi:10.1001/jamainternmed.2013.6886.

  11. Harbrecht MG, Latts LM. Colorado’s Patient-Centered Medical Home Pilot met numerous obstacles, yet saw results such as reduced hospital admissions. Health Aff (Millwood). 2012;31(9):2010–7. doi:10.1377/hlthaff.2012.0359.

    Article  PubMed  Google Scholar 

  12. Reid RJ, Fishman PA, Yu O, et al. Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation. Am J Manag Care. 2009;15(9):e71–87.

    PubMed  Google Scholar 

  13. Rittenhouse DR, Shortell SM, Fisher ES. Primary care and accountable care–two essential elements of delivery-system reform. N Engl J Med. 2009;361(24):2301–3. doi:10.1056/NEJMp0909327.

    Article  PubMed  CAS  Google Scholar 

  14. Goroll AH, Schoenbaum SC. Payment reform for primary care within the accountable care organization: a critical issue for health system reform. JAMA. 2012;308(6):577–8.

    Article  PubMed  CAS  Google Scholar 

  15. Larson BK, Van Citters AD, Kreindler SA, et al. Insights from transformations under way at four Brookings-Dartmouth accountable care organization pilot sites. Health Aff (Millwood). 2012;31(11):2395–406. doi:10.1377/hlthaff.2011.1219.

  16. Steiner BD, Denham AC, Ashkin E, Newton WP, Wroth T, Dobson LA. Community care of North Carolina: improving care through community health networks. Ann Fam Med. 2008;6(4):361–7. doi:10.1370/afm.866.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Steele GD, Haynes JA, Davis DE, et al. How Geisinger’s Advanced Medical Home Model argues the case for rapid-cycle innovation. Health Aff (Millwood). 2010;29(11):2047–53. doi:10.1377/hlthaff.2010.0840.

    Article  PubMed  Google Scholar 

  18. Reid RJ, Coleman K, Johnson EA, et al. The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Aff (Millwood). 2010;29(5):835–43. doi:10.1377/hlthaff.2010.0158.

    Article  Google Scholar 

  19. Bielaszka-DuVernay C. Vermont’s Blueprint for medical homes, community health teams, and better health at lower cost. Health Aff (Millwood). 2011;30(3):383–6. doi:10.1377/hlthaff.2011.0169.

    Article  Google Scholar 

  20. Takach M. About half of the States are implementing patient-centered medical homes for their medicaid populations. Health Aff (Millwood). 2012;31(11):2432–40. doi:10.1377/hlthaff.2012.0447.

    Article  Google Scholar 

  21. Mechanic R, Zinner DE. Many large medical groups will need to acquire new skills and tools to be ready for payment reform. Health Aff (Millwood). 2012;31(9):1984–92. doi:10.1377/hlthaff.2012.0127.

    Article  Google Scholar 

  22. Weissman JS, Bailit M, D'Andrea G, Rosenthal MB. The design and application of shared savings programs: lessons from early adopters. Health Aff (Millwood). 2012;31(9):1959–68. doi:10.1377/hlthaff.2012.0383.

    Article  Google Scholar 

  23. Friedberg MW, Buendia AM, Lauderdale KE, Hussey PS. Option pricing: a flexible tool to disseminate shared savings contracts. Am J Manag Care. 2013;19(8):e285–92.

    PubMed  Google Scholar 

  24. Lee TH, Bothe A, Steele GD. How Geisinger structures its physicians’ compensation to support improvements in quality, efficiency, and volume. Health Aff (Millwood). 2012;31(9):2068–73. doi:10.1377/hlthaff.2011.0940.

    Article  Google Scholar 

  25. Chen AH, Murphy EJ, Yee HF. eReferral—a new model for integrated care. N Engl J Med. 2013;368(26):2450–3. doi:10.1056/NEJMp1215594.

    Article  PubMed  CAS  Google Scholar 

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This manuscript was created by the working group on payment reform for a research conference on the PCMH organized by the Society of General Internal Medicine, the Society of Teachers of Family Medicine and the Academic Pediatric Association that took place in Washington, DC, on 22 June 2013. This article reflects the consensus that emerged from the discussion and should not be taken to be the perspective of any specific individual or organization.

Conflict of Interest

The authors declare that they do not have a conflict of interest or financial disclosure to report.

Funding Sources

Support for this work and for the conference from which the work originated was provided by the Agency for Healthcare Research and Quality, the Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs, and the Commonwealth Fund.

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Correspondence to Bruce E. Landon MD, MBA.

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Edwards, S.T., Abrams, M.K., Baron, R.J. et al. Structuring Payment to Medical Homes After the Affordable Care Act. J GEN INTERN MED 29, 1410–1413 (2014).

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