Magazine article Medical Economics

Patient-Centered Medical Homes and Accountable Care Organizations: A CLOSER LOOK

Magazine article Medical Economics

Patient-Centered Medical Homes and Accountable Care Organizations: A CLOSER LOOK

Article excerpt

Among the many emerging alternatives to fee-for-service payments for medical care, the best known are the Patient-Centered Medical Home (PCMH) and the accountable care organization (ACO).The PCMH replaces episodic care with a sustained relationship between patient and physician and involves payer partnerships with medical groups as a "medical home" for patients. The PCMH model is designed to address patients' needs based on medical evidence and patient preferences in care decisions.

ACOs rely on payer partnerships with organizations of healthcare providers who agree to be held accountable for the quality, cost, and overall care for a defined population of patients, and who are eligible to share in cost savings if they meet certain quality and cost goals. Below are examples of PCMHs and ACOs being put into practice around the country.

Patient-Centered Medical Home

CareFirst Blue Cross and Blue Shield

A network-wide PCMH demonstration project evaluates provider performance based on clinical quality, efficiency, and patient satisfaction. Base reimbursement is enhanced with care coordination payments, technology grants, accreditation reimbursement, and outcome incentives.

Humana

A partnership with WellStar Health System integrates care delivery and data to coordinate care. The PCMH has seen decreases in inpatient and emergency department (ED) expenses of 12% and 17%, respectively, and a 15% decrease in ED visits.

United Healthcare

A PCMH model provides primary care medical groups a prospective care management fee and performance incentive payments as part of their reimbursement. …

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