Designing Model Homes for the Changing Medical Neighborhood: A Multi-Payer Pilot Offers Lessons for ACO and PCMH Construction

Abstract

Elements of the Affordable Care Act function as a rezoning effort, allowing and encouraging development of new health care structures. Among these structures is the Patient-Centered Medical Home (PCMH), a form of enhanced primary care that is “not far removed in principle” from the Accountable Care Organization (ACO). Indeed, in some formulations a PCMH is a necessary part of any well-functioning ACO. This article focuses on a state-directed, multi-payer medical home pilot that includes accountable care features such as upfront payments, possible shared savings, quality targets, and downside financial risk.

This pilot’s design and early construction thus offer ideas for others attempting similar delivery system remodels. And ideas are especially useful as to this type of remodel because, while construction proceeds around the country, we do not yet have many generalizable results and “unrealistic expectations...abound.” As with any fast-track construction project, mid-development blueprint revisions are to be expected. This article considers key questions about accountable care in general and the PCMH in particular, with a focus on how these redesigned homes could fit into a rezoned, “high-performing medical neighborhood.”

Keywords: Affordable Care Act, Accountable Care Organization, Patient-Centered Medical Home, Medical Home, Health Reform, Shared Savings, ACO, PCMH, ACA