Patient-Centered Medical Home Initiatives Expanded In 2009–13: Providers, Patients, And Payment Incentives Increased

Abstract

Patient-centered medical home initiatives are central to many efforts to reform the US health care delivery system. To better understand the extent and nature of these initiatives, in 2013 we performed a nationwide cross-sectional survey of initiatives that included payment reform incentives in their models, and we compared the results to those of a similar survey we conducted in 2009. We found that the number of initiatives featuring payment reform incentives had increased from 26 in 2009 to 114 in 2013. The number of patients covered by these initiatives had increased from nearly five million to almost twenty-one million. We also found that the proportion of time-limited initiatives--those with a planned end date--was 20 percent in 2013, a decrease from 77 percent in 2009. Finally, we found that the dominant payment model for patient-centered medical homes remained fee-for-service payments augmented by per member per month payments and pay-for-performance bonuses. However, those payments and bonuses were higher in 2013 than they were in 2009, and the use of shared-savings models was greater. The patient-centered medical home model is likely to continue both to become more common and to play an important role in delivery system reform.

Cost of Transformation among Primary Care Practices Participating in a Medical Home Pilot

“…These expenditures are less than the "care management fees" paid to practices participating in other medical home pilots (which have averaged $7 per member per month) and the $40 per member per month that Medicare now pays to provide enhanced care management services for beneficiaries with two or more chronic conditions. 15,21,22 Two key factors may account for the difference between the prevailing care management fees and the care management costs incurred by practices participating in our study. First, our perpatient costs are based on all patients in a practice's panel, rather than just those who have a specific payer (e.g., a payer participating in a medical home initiative who might need to crosssubsidize patients of non-participating payers) or who have multiple chronic conditions (e.g., those eligible for Medicare care management fees).…”

“…15,16 But within such interventions, there is little published evidence on the size of transformation-associated costs to practices. Without estimates of these costs, payers and policymakers risk under-funding practice transformation, thereby reducing the attractiveness and effectiveness of medical home interventions.…”

Racial/Ethnic Differences in Primary Care Experiences in Patient-Centered Medical Homes among Veterans with Mental Health and Substance Use Disorders

“…1 Primary care is often a first step in the treatment of MHSUDs, 2,3 and this is increasing with new paradigms of primary care, including Patient-Centered Medical Homes (PCMHs). [4][5][6] PCMHs use an integrated, team-based approach to delivering primary care services that are comprehensive, patient-centered, accessible, and quality driven. 7 This model is thought to be particularly helpful in managing care and addressing social determinants of health for vulnerable patients, such as those with MHSUDs.…”

Walking the Walk in Team-Based Education: The Crimson Care Collaborative Clinic in Family Medicine

“…The US medical system is undergoing a paradigm shift from traditional "one doctor, one patient" interactions, largely limited to addressing acute issues, to a chronic care model within patient-centered medical homes in order to more effectively address a spectrum of needs for each patient at each visit [1,2]. Compared to intermittent, one-on-one interactions, interdisciplinary teams have demonstrated improved outcomes in patients with chronic disease [3][4][5][6][7][8] and effective population-based prevention strategies [9][10][11][12].…”