Comparing accountable care solutions to Patient Centered Medical Homes
But accountable care solutions have an even broader, far-reaching goal: Coordinate care across the entire care continuum, from physicians to hospitals to other clinicians.
The structure of a PCMH makes it an essential component of accountable care: Primary care provides access, disease prevention and management, and care coordination services that leverage overall cost savings for the system. But, as described by the American Academy of Family Physicians, accountable care solutions look to other components as well: specialty care, imaging, laboratory services, hospital care and information technology support. For an ACO, each of these components must be integrated, coordinated and part of the overall efficiency.
The Center for Healthcare Quality & Payment Reform illustrates another fundamental difference between a PCMH and accountable care solutions: When a primary care practice becomes certified as a Patient-Centered Medical Home, it does not need to accept any accountability for the costs of patient care or for population-level quality outcomes. Many of the resources and tools being developed and used by Medical Homes—including electronic health records (EHR), patient registries, patient education and more responsive scheduling—can help improve quality and reduce total costs. But physicians in the PCMH model are not accountable or incentivized for doing so.
Primary care practices seeking to become ACOs should consider the PCMH as a key framework to succeeding under an accountable care solution. According to the American Academy of Family Physicians, “Moving your practice to the PCMH model is a great way to assure that you can demonstrate both quality and efficiency to any ACO in your community seeking primary care services.”2
1 Longworth, D.L. (September 2011.) Accountable care organizations, the patient-centered medical home, and health care reform: What does it all mean? Cleveland Clinic Journal of Medicine Vol. 78 9 571-582. Available at: http://ccjm.org/content/78/9/571.full.
2 American Academy of Family Physicians. Frequently Asked Questions About ACOs. Available at: http://www.aafp.org/practice-management/payment/acos/faq.html.