Journal of General Internal Medicine

, Volume 29, Issue 10, pp 1410–1413 | Cite as

Structuring Payment to Medical Homes After the Affordable Care Act

  • Samuel T. Edwards
  • Melinda K. Abrams
  • Richard J. Baron
  • Robert A. Berenson
  • Eugene C. Rich
  • Gary E. Rosenthal
  • Meredith B. Rosenthal
  • Bruce E. Landon
Health Policy


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.

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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Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Samuel T. Edwards
    • 1
    • 2
    • 3
  • Melinda K. Abrams
    • 4
  • Richard J. Baron
    • 5
  • Robert A. Berenson
    • 6
  • Eugene C. Rich
    • 7
  • Gary E. Rosenthal
    • 8
    • 9
  • Meredith B. Rosenthal
    • 10
  • Bruce E. Landon
    • 11
    • 12
  1. 1.Section of General Internal MedicineVeterans Affairs (VA) Boston Healthcare SystemBostonUSA
  2. 2.Massachusetts Veteran’s Epidemiology Research and Information CenterVA Boston Healthcare SystemBostonUSA
  3. 3.Harvard Medical SchoolBostonUSA
  4. 4.The Commonwealth FundNew YorkUSA
  5. 5.American Board of Internal MedicinePhiladelphiaUSA
  6. 6.The Urban InstituteWashingtonUSA
  7. 7.Mathematica Policy ResearchWashingtonUSA
  8. 8.University of Iowa Carver College of MedicineIowa CityUSA
  9. 9.Iowa City VA Health Care SystemIowa CityUSA
  10. 10.Department of Health Policy and ManagementHarvard School of Public HealthBostonUSA
  11. 11.Division of General Medicine and Primary CareBeth Israel Deaconess Medical CenterBostonUSA
  12. 12.Department of Health Care PolicyHarvard Medical SchoolBostonUSA

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