title: Structuring payment to medical homes after the affordable care act.
abstract: The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings.
authors.affiliation: Section of General Internal Medicine, Veterans Affairs (VA) Boston Healthcare System, Boston, MA, USA.
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Edwards
authors.forename: Melinda K
authors.initials: MK
authors.lastname: Abrams
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Baron
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berenson
authors.forename: Eugene C
authors.initials: EC
authors.lastname: Rich
authors.forename: Gary E
authors.initials: GE
authors.lastname: Rosenthal
authors.forename: Meredith B
authors.initials: MB
authors.lastname: Rosenthal
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
mesh_terms: D018588:Fee-for-Service Plans / Q000191:economics* / Q000639:trends; D006801:Humans; D058991:Patient Protection and Affordable Care Act / Q000191:economics* / Q000639:trends; D018802:Patient-Centered Care / Q000191:economics* / Q000639:trends; D014481:United States