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Structuring Payment to Medical Homes After the Affordable Care Act

  • Health Policy
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

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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Acknowledgements

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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Authors and Affiliations

  1. Section of General Internal Medicine, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, USA

    Samuel T. Edwards MD

  2. Massachusetts Veteran’s Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA

    Samuel T. Edwards MD

  3. Harvard Medical School, Boston, MA, USA

    Samuel T. Edwards MD

  4. The Commonwealth Fund, New York, NY, USA

    Melinda K. Abrams MS

  5. American Board of Internal Medicine, Philadelphia, PA, USA

    Richard J. Baron MD

  6. The Urban Institute, Washington, DC, USA

    Robert A. Berenson MD

  7. Mathematica Policy Research, Washington, DC, USA

    Eugene C. Rich MD

  8. University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Gary E. Rosenthal MD

  9. Iowa City VA Health Care System, Iowa City, IA, USA

    Gary E. Rosenthal MD

  10. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA

    Meredith B. Rosenthal Ph.D.

  11. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Bruce E. Landon MD, MBA

  12. Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, USA

    Bruce E. Landon MD, MBA

Authors
  1. Samuel T. Edwards MD
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  2. Melinda K. Abrams MS
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  3. Richard J. Baron MD
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  4. Robert A. Berenson MD
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  5. Eugene C. Rich MD
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  6. Gary E. Rosenthal MD
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  7. Meredith B. Rosenthal Ph.D.
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  8. Bruce E. Landon MD, MBA
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Corresponding author

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). https://doi.org/10.1007/s11606-014-2848-3

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  • DOI: https://doi.org/10.1007/s11606-014-2848-3

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