What is the Business Model for the PCMH?
Payment
The major primary care physician groups and the Patient-Centered Primary Care Collaboratvie (PCPCC) believe that the most effective way to re-align payment incentives to support the PCMH would be to combine traditional fee-for-service for office visits with a three-part model that includes:
A monthly care coordination payment (“bundled care coordination fee” that is risk adjusted and reflective of the practice’s service capability based on the NCQA PPC-PCMH recognition process) for the physician and non-physcian work that falls outside of a face-to-face visit and for the system infrastucture (e.g. heath information technologies) needed to achieve better outcomes.
A visit-based fee-for-service component that recognizes visit-based services that are currently paid under the present fee-for-service payment system and maintains an incentive for the physician to see the patient in an office-visit when appropriate.
A performance-based component that recognizes achievement of quality and efficiency goals.
A more detailed description of this payment model can be found in: A System in Need of Change: Restructuring Payment Policies to Support Patient-Centered Care
(an ACP policy paper).
Cost
The cost for a practice to implement these services will vary based on several factors, such as practice size, existing practice capabilities, the costs of new capabilities required to “ramp up” to be a qualified PCMH, availability of low-cost or subsidized practice and patient-support resources, and characteristics of the patient population being treated. More complete information is currently being developed through the following sources:
A research study
sponsored by the American College of Physicians with support from the Commonwealth Fund.Efforts of the American Medical Association’s Relative Value Update Committee (RUC) to evaluate the work and practice expense values of services to be provided within the Medicare Medical Home demonstration project.
Data from the multiple private sector PCMH demonstration projects throughout the country currently under development or in progress (more information on these projects).
What is the Patient Centered Medical Home?
Who Supports the PCMH Care Model?
Relationship of the PCMH to Specialty Physicians
Where are PCMH Demonstration Projects Happening?
Resources for the PCMH
ACP Advocacy Efforts for the PCMH
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