Abstract
In this paper, we describe a range of payment options to support the PCMH, identifying their conceptual strengths and weaknesses. These include enhanced FFS payment for office visits to the PCMH; paying additional FFS for “new” PCMH services; variations of traditional FFS combined with new PCMH-oriented per patient per month capitation; and combined capitation payments for traditional primary care medical services as well as new medical home services. In discussing options for PCMH payment reform we consider issues in patient severity adjustment, performance payment, and the role of payments to community service organizations to collaborate with the PCMH. We also highlight some of the practical challenges that can complicate reimbursement reform for primary care and the PCMH. Through this discussion we identify key dimensions to provider payment reform relevant to promoting enhanced primary care through the patient centered medical home. These consist of paying for the basic medical home services, rewarding excellent performance of medical homes, incentivizing medical home connections to other community health care resources, and overcoming implementation challenges to medical home payments. Each of these overarching policy issues invokes a substantial subset of policy relevant research questions that collectively comprise a robust research agenda. We conclude that the conceptual strengths and weaknesses of available payment models for medical home functions invoke a complex array of options with varying levels of real-world feasibility. The different needs of patients and communities, and varying characteristics of practices must also be factors guiding PCMH payment reform. Indeed, it may be that different circumstances will require different payment approaches in various combinations.
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Acknowledgements
This work is adapted from material presented at the conference “Patient Centered Medical Home: Setting a Policy Relevant Research Agenda” held July 27–28, 2009, at the Fairfax at Embassy Row, Washington, D.C. This conference was developed through a collaboration of the Society of General Internal Medicine (SGIM), the Society of Teachers of Family Medicine (STFM) and the Academic Pediatrics Association (APA). This work was supported by grants to SGIM from the American Board of Internal Medicine Foundation, the Commonwealth Fund, and the Agency for Health Care Research and Quality. The Commonwealth Fund also funded Dr. Berenson’s work that went into this paper.
The authors would like to thank Dr. Michael Chernew and Dr. Lori Heim for their thoughtful comments on an earlier draft of these papers; thanks as well for the comments and suggestions from the participants in the conference, “Patient Centered Medical Home: Setting a Policy Relevant Research Agenda.”
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Berenson, R.A., Rich, E.C. How to Buy a Medical Home? Policy Options and Practical Questions. J GEN INTERN MED 25, 619–624 (2010). https://doi.org/10.1007/s11606-010-1290-4
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DOI: https://doi.org/10.1007/s11606-010-1290-4