<p>The rapid proliferation of medical home initiatives in the United States in the past few years has been marked by experimentation and evolution in both practice transformation strategies and in payment models. One central challenge has been and continues to be how best to structure payment arrangements. Designers of Patient-Centered Medical Home initiatives have typically sought to address two objectives through payment design.</p>
In recent years, public and private employers have experimented with numerous strategies to achieve dual objectives of controlling costs and improving employee health. Two widely discussed innovations are value-based insurance design (VBID) and the patient-centered medical home (medical home). Both approaches have been written about extensively, and research is emerging on their effectiveness at optimizing clinical outcomes and restraining cost growth.
Dozens of medical home demonstration projects across the country are exploring ways to implement better care coordination, meaningful use of health information technology, better communication access between patients and providers and a team approach to care. But efforts to transform health care delivery depend heavily on introducing sustainable new models to finance the medical home. Without changing the way health care is purchased, providers will have no incentive to move away from a system that promotes health care volume to one that rewards health care value.
