Abstract
The U.S. health care system too often falls short in delivering effective primary care, especially for patients with chronic conditions. One potential solution is the patient-centered medical home, a model that has shown success in individual demonstrations. Evidence from seven of the largestmedical home pilots shows that four factors are essential: dedicated care managers; expanded access; performance management tools; and effective incentive payments. Federal policy, including implementation of health insurance reform legislation, should consider how to include these core elements and offer guidance and incentives for executing them effectively.