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Delivery and Payment Models
The Affordable Care Act has been a catalyst for developing new health care delivery and payment systems that will improve outcomes, decrease cost, and restructure reimbursements.
Patient Centered Medical Homes (PCMH) and Accountable Care Organizations (ACO) are two of the new models that are being tested across the country. The Centers for Medicare and Medicaid Services (CMS) are also awarding "innovation grants" to health care organizations, academic institutions and not for profits who are testing other models of care and reimbursement.
ACP's Center for Practice Improvement and Innovation (CPII) is an important resource for anyone who wants to better understand these models and can be your partner in working through an implementation.
We have provided a broad array of resources on Patient Centered Medical Home, Accountable Care Organizations and the CMS Innovation Grant process.
Patient-Centered Medical Home
The Patient Centered Medical Home is a care delivery model whereby patient treatment is coordinated through the primary care physician to ensure patients receive the necessary care when and where they need it, in a manner they can understand.
Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
Accountable Care Organizations
An Accountable Care Organization (ACO) is a formally organized entity, consisting of physicians, hospitals and other relevant health service professionals that have elected to join together and are responsible through contracts with payers for providing a broad set of health care services to their Medicare patients.
Direct Patient Contracting
A direct patient contracting model is one in which a patient contracts directly with a physician, clinician, or practice to pay directly out-of-pocket for some or all medical services that are provided by the clinician or practice. Direct patient contracting models include a number of different arrangements including direct primary care and concierge care.
Other Care Models
Under the Affordable Care Act, Congress created the Center for Medicare & Medicaid Innovation (CMMI) with the authority and direction to “test innovative payment and service delivery models to reduce program expenditures, while preserving or enhancing the quality of care” for those who get Medicare, Medicaid or CHIP benefits.
Evaluating Payment Contracts
AMA and RAND created two resources to help physician practices when evaluating bundled or episode-based and pay-for-performance agreements. (Note: Accessing these resources may require registration on the AMA site.)