Reform in Action

The patient-centered medical home (PCMH) is a model for delivering enhanced primary care that relies on a team-based approach to coordinate, track, and improve care and focuses on orienting doctors’ offices more toward patients’ needs. The PCMH makes it easier for patients to have access to health care through extended hours, greater use of phone calls and emails, and more staff coordination in managing all aspects of their care.

Although the PCMH model has been gathering momentum for several years and is being tested nationwide with thousands of practices currently recognized as medical homes, it is soon expected to gain even greater prominence as the Affordable Care Act (ACA) includes several provisions that encourage adoption of the medical home model, including:

  • PCMH influence in accountable care organizations (ACO). Although the ACO provisions do not explicitly mention medical homes, many believe primary care practices belonging to an ACO will need to adopt many of the key attributes of a PCMH to keep their patients healthy and generate savings.
  • Testing of medical homes through the Innovation Center. The new Center for Medicare and Medicaid Innovation will test the effectiveness of medical homes–along with other payment and delivery system reforms–in bringing down costs and increasing quality.
  • Allowing Medicaid to cover PCMH services. Medicaid programs will have the option of covering services provided to patients with certain chronic conditions by 'health homes' with the federal government matching 90 percent of state funds spent on these services in the first two years.
  • Allowing private medical home plans. Health plans are permitted to provide coverage through a PCMH plan if it meets certain criteria and coordinates with the qualified health plan.
  • Requiring insurers to report if they cover medical homes. The U.S. Department of Health and Human Services is required to establish guidelines for payment structures that incentivize desirable patient outcomes, including through the use of a PCMH.

As the PCMH movement continues to grow and expand, many will look to existing pilot programs for lessons learned and key insights, such as those being implemented by the alliances in 16 communities across America participating in the Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q) initiative. In many AF4Q communities, medical practices are adopting the PCMH model to improve care coordination and ultimately improving outcomes