Private Payers Promote Development of Patient-Centered Medical Homes

By Stephen Siegel

Patient centered medical homes (“Medical Homes”) are likely to be an integral part of a successful accountable care organization. However, Medical Homes   represent a primary care delivery model that stands on its own. Unfortunately, the Medicare program has yet to develop a reimbursement mechanism that addresses the unique costs and services Medical Homes provide. However, private payers are already recognizing the increased quality and lower cost of health care items and services that can these facilities can achieve.

Private payers already are realizing the benefits of having their insureds primary care services delivered by a Medical Home. On January 27, 2012 WellPoint announced the results of a Medical Home study it had conducted. According to Dr. Harlan Levine, the company’s Executive Vice President: “Our medical home pilots have proven to make a meaningful difference in patient quality, outcomes and cost. Some of our pilots have experienced an 18 percent decrease in acute inpatient admissions and a 15 percent decrease in total ER visits while improving compliance with evidence-based treatment and preventative care guidelines.”

In light of these findings, WellPoint announced that it will incentivize primary care physicians to develop Medical Home delivery systems that meet requirements and standards adopted by this insurer and by accreditation organizations such as the National Committee on Quality Assurance (“NCQA”). WellPoint announced that practices meeting these requirements and standards could earn 30%-50% more than they currently are receiving from the insurer. The company announced its goal is to implement this program nationwide by the end of 2014.

Primary care physicians should carefully investigate the feasibility of developing a Medical Home, both for its own sake and as a stepping stone to ACO affiliation.

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