Structuring Payment to Medical Homes After the Affordable Care Act

The patient-centered medical home (PCMH) model aims to transform primary care practice through the use of multidisciplinary teams and a shift from "reactive visit-based care to proactive population health management." Currently, medical home providers are reimbursed with a blend of fee-for-service payments and additional compensation for services provided outside of office visits, including care coordination. Writing in the Journal of General Internal Medicine, Harvard Medical School’s Samuel T. Edwards, M.D., and colleagues consider how the PCMH payment model could evolve to keep pace with health care payment reforms launched by the Affordable Care Act, most notably the "shared savings" approach used by many accountable care organizations (ACOs).

What the Study Found

PCMHs and ACOs are complementary approaches to improving care delivery. Medical homes require strong links to specialists and hospitals, while ACOs—which are accountable for the full continuum of health services—require a strong grounding in primary care. The authors suggest the following payment approaches to promote integration of PCMHs and ACOs:

• ACO contracts could include dedicated payments to support enhanced primary care services.
• ACOs could invest in PCMHs by hiring more primary care providers, expanding office hours, developing information technology and care coordination infrastructure, supporting coaching and learning collaboratives, and dedicating resources to urgent care.
• ACOs could align physician performance and resource allocation to support PCMHs. For example, measures of care coordination and communication could be considered when assessing physician performance. Primary care physicians could be paid according to the size and complexity of their patient panels, and specialists could be given incentives to work with medical homes.