Structuring Payment to Medical Homes After the Affordable Care Act
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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.
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.
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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