Structuring payment for medical homes.
Despite widespread interest in the medical home model, there has been a lack of careful assessment of alternative methods to pay practices that serve as medical homes. This paper examines four specific payment approaches: enhanced fee-for-service payments for evaluation and management; additional codes for medical home activities within fee-for-service payments; per patient per month medical home payments to augment fee-for-service visit payments; and risk-adjusted, comprehensive per patient per month payments. Payment policies selected will affect both the adoption of the model and its longer-term evaluation. Evaluations of ongoing demonstrations should focus on payment design as well as on care--and cost.
Merrell
Katie
K
Center for Health Research and Policy, Social and Scientific Systems Inc., Silver Spring, MD, USA. kmerrell@s-3.com
Berenson
Robert A
RA
D014487:Centers for Medicare and Medicaid Services, U.S.; D018588:Fee-for-Service Plans; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D012051:Reimbursement Mechanisms; D014481:United States