The Future of Patient Centered Medical Homes and Accountable Care

Improving health care in the United States is not an easy venture. With high and rising costs and room for improvement in the quality of care delivered, national, state, and local efforts have engendered a renewed focus on primary care: in particular, person-centered accountable care. And for good reason—investment in primary care makes sense. The 2010 National Ambulatory Medical Care Survey indicated that of the almost 1.1 billion physician office visits each year, more than 560 million (55.5%) were to a primary care physician.1 This figure will continue to rise with coverage expansions from the 2010 Affordable Care Act and the ever-increasing number of eligible Medicare beneficiaries.2 Moreover, for most people, the primary care physician (PCP) is their gateway into a highly technical and complex medical community. It is with their PCP that individuals establish a long-term, trusting relationship, and a focus on accountable primary care fosters health and wellbeing, beyond the provision of sick care.

Many policy initiatives in both the public and private sectors are attempting to forge forward a path to create a healthier America. The 2010 passage of the Affordable Care Act stimulated the formation of more Accountable Care Organizations (ACOs), and private payers are engaging practices and hospital systems in ACOs and similar innovative care delivery and payment models. The Patient-Centered Medical Home (PCMH) is one such model that is well-aligned to be an impactful first step in reforming US health care. Recently, the Patient-Centered Primary Care Collaborative (PCPCC), with support from the Milbank Memorial Fund, released a comprehensive report on the current state and future of PCMHs in U.S. health care.

Care Delivery in a PCMH

An exact definition of a PCMH is illusory because the model is continually evolving. Nevertheless, the four major primary care societies designed and endorsed the Joint Principles of the Patient-Centered Medical Home, which outlined the general characteristics of a PCMH. These include:

• Personal physician care
• Physician-directed medical practice
• Whole person orientation
• Coordinated and/or integrated care
• High quality and safety in care
• Enhanced access to care
• Payment that supports enhanced services

Coordinating high quality and safe care across providers with a person-centered focus is the ultimate goal of the physician-led care team in a PCMH. But are PCMHs better than traditional care models? To appropriately answer this question, it is important to assess whether care in a PCMH is better for the patient and whether care in a PCMH is better for the health system at-large. The preponderance of evidence suggests yes to both questions, though more and more-robust studies are necessary to be more-conclusive.