Skyrocketing costs and the uneven quality of patient care challenge the US health care system. Some health insurance companies are exploring patient-centered medical homes as a way to change incentives and transform the health care delivery system by increasing primary care providers’ accountability for care coordination and outcomes. Horizon Healthcare Services, Inc., New Jersey’s oldest and largest health insurance company, developed medical home programs that include financial incentives with essential support tools.
The Colorado Multipayer Patient-Centered Medical Home Pilot, which ran from May 2009 through April 2012, was one of the first voluntary multipayer medical home pilot projects in the country. Six health plans, the state’s high-risk pool carrier, and sixteen family or internal medicine practices with approximately 100,000 patients participated. Although a full analysis is currently under way, preliminary results show that the pilot significantly reduced emergency department visits and also reduced hospital admissions, particularly for patients with multiple chronic conditions.
The patient-centered medical home has emerged as a promising solution to address the significant fragmentation, poor quality, and high costs that afflict the U.S. health care system. The medical home model includes core components of primary and patient-centered care, recent innovations in practice redesign and health information technology, and changes to the way practices and providers are paid. There are initiatives across the country testing the promise of the medical home model.
An Accountable Care Organization (ACO) is any organization that takes on the responsibility for achieving the triple aim-improving the quality, affordability and experience of care for the population it serves. A typical ACO can consist of primary care groups, multispecialty groups or integrated delivery systems, like a multi-specialty hospital system. The key is that the group directly provides or coordinates the majority of their patients’ care.
For decades, employers have been among the first to test the waters in new health care design, implementing creative employee benefit structures in an effort to improve the value of health care delivered to employees—in effect, to balance the quality and cost equation. In recent years, many employers have embraced advanced primary care models and the patient-centered medical home (PCMH) in their latest efforts to improve value; some employers are successfully linking value-based benefit design in those innovative programs.
