Structuring payment to medical homes after the Affordable Care Act
Open accessAbstract
The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Although different financial models have been proposed and are incorporated in some PCMH models, evaluations do not specifically address the effectiveness of these strategies, nor have most studies demonstrated overall short-term cost savings.
“Although different financial models have been proposed and are incorporated in some PCMH models, evaluations do not specifically address the effectiveness of these strategies, nor have most studies demonstrated overall short-term cost savings (100).”
From The CardioMetabolic Health Alliance (2015) · cites this paper as [100]
Most studies have not demonstrated overall short-term cost savings of PCMH strategies.
“do not specifically address the effectiveness of these strategies, nor have most studies demonstrated overall short-term cost savings (100).”
From The CardioMetabolic Health Alliance (2015) · cites this paper as [100]
Cites
Reid, R. J., Coleman, K., Johnson, E. A., Fishman, P. A., Hsu, C., Soman, M. P., Trescott, C. E., Erikson, M., & Larson, E. B. (2010) · Health Affairs · doi:10.1377/hlthaff.2010.0158 · Cited by 567 · see citing works
Defining and Measuring the Patient-Centered Medical Home
Stange, K. C., Nutting, P. A., Miller, W. L., Jaén, C. R., Crabtree, B. F., Flocke, S. A., & Gill, J. M. (2010) · Journal of General Internal Medicine · doi:10.1007/s11606-010-1291-3 · Cited by 516 · see citing works
A National Strategy To Put Accountable Care Into Practice
McClellan, M., McKethan, A., Lewis, J. L., Roski, J., & Fisher, E. S. (2010) · Health Affairs · doi:10.1377/hlthaff.2010.0194 · Cited by 385 · see citing works
Reid, R. J., Fishman, P. A., Yu, O., Ross, T. R., Tufano, J. T., SOMAN, M. P., & Larson, E. B. (2009) · PubMed · Cited by 377 · see citing works
Primary Care and Accountable Care — Two Essential Elements of Delivery-System Reform
Rittenhouse, D. R., Shortell, S. M., & Fisher, E. S. (2009) · New England Journal of Medicine · doi:10.1056/nejmp0909327 · Cited by 363 · see citing works
Fostering Accountable Health Care: Moving Forward In Medicare
Fisher, E. S., McClellan, M., Bertko, J. M., Lieberman, S. M., Lee, J. J., Lewis, J. L., & Skinner, J. (2009) · Health Affairs · doi:10.1377/hlthaff.28.2.w219 · Cited by 272 · see citing works
A Nationwide Survey of Patient Centered Medical Home Demonstration Projects
Bitton, A., Martin, C., & Landon, B. E. (2010) · Journal of General Internal Medicine · doi:10.1007/s11606-010-1262-8 · Cited by 222 · see citing works
eReferral — A New Model for Integrated Care
Chen, A. H., Murphy, E. J., & Yee, H. F. (2013) · New England Journal of Medicine · doi:10.1056/nejmp1215594 · Cited by 173 · see citing works
Community Care of North Carolina: Improving Care Through Community Health Networks
Steiner, B. D., Denham, A. C., Ashkin, E., Newton, W. P., Wroth, T. H., & Dobson, L. A. (2008) · The Annals of Family Medicine · doi:10.1370/afm.866 · Cited by 167 · see citing works
Fisher, E. S., Shortell, S. M., Kreindler, S. A., Citters, A. D. V., & Larson, B. K. (2012) · Health Affairs · doi:10.1377/hlthaff.2012.0544 · Cited by 141 · see citing works
US Approaches to Physician Payment: The Deconstruction of Primary Care
Berenson, R. A., & Rich, E. C. (2010) · Journal of General Internal Medicine · doi:10.1007/s11606-010-1295-z · Cited by 140 · see citing works
Delivery System Integration and Health Care Spending and Quality for Medicare Beneficiaries
McWilliams, J. M., Chernew, M. E., Zaslavsky, A. M., Hamed, P., & Landon, B. E. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.6886 · Cited by 102 · see citing works
Vermont’s Blueprint For Medical Homes, Community Health Teams, And Better Health At Lower Cost
Bielaszka-DuVernay, C. (2011) · Health Affairs · doi:10.1377/hlthaff.2011.0169 · Cited by 78 · see citing works
Larson, B. K., Citters, A. D. V., Kreindler, S. A., Carluzzo, K. L., Gbemudu, J. N., Wu, F. M., Nelson, E. C., Shortell, S. M., & Fisher, E. S. (2012) · Health Affairs · doi:10.1377/hlthaff.2011.1219 · Cited by 72 · see citing works
How Geisinger’s Advanced Medical Home Model Argues The Case For Rapid-Cycle Innovation
Steele, G. D., Haynes, J., Davis, D. E., Tomcavage, J. F., Stewart, W. F., Graf, T. R., Paulus, R. A., Weikel, K. M., & Shikles, J. L. (2010) · Health Affairs · doi:10.1377/hlthaff.2010.0840 · Cited by 66 · see citing works
Takach, M. (2012) · Health Affairs · doi:10.1377/hlthaff.2012.0447 · Cited by 60 · see citing works
Lee, T. H.-Y., Bothe, A., & Steele, G. D. (2012) · Health Affairs · doi:10.1377/hlthaff.2011.0940 · Cited by 51 · see citing works
Harbrecht, M. G., & Latts, L. (2012) · Health Affairs · doi:10.1377/hlthaff.2012.0359 · Cited by 51 · see citing works
Structuring Payment For Medical Homes
Merrell, K., & Berenson, R. A. (2010) · Health Affairs · doi:10.1377/hlthaff.2009.0995 · Cited by 49 · see citing works
How to Buy a Medical Home? Policy Options and Practical Questions
Berenson, R. A., & Rich, E. C. (2010) · Journal of General Internal Medicine · doi:10.1007/s11606-010-1290-4 · Cited by 44 · see citing works
Keeping Score under a Global Payment System
Landon, B. E. (2012) · New England Journal of Medicine · doi:10.1056/nejmp1112637 · Cited by 40 · see citing works
Payment Reform for Primary Care Within the Accountable Care Organization
Goroll, A. H., & Schoenbaum, S. C. (2012) · JAMA · doi:10.1001/jama.2012.8696 · Cited by 25 · see citing works
The Design And Application Of Shared Savings Programs: Lessons From Early Adopters
Weissman, J. S., Bailit, M. H., D’Andrea, G., & Rosenthal, M. B. (2012) · Health Affairs · doi:10.1377/hlthaff.2012.0383 · Cited by 19 · see citing works
Many Large Medical Groups Will Need To Acquire New Skills And Tools To Be Ready For Payment Reform
Mechanic, R. E., & Ƶinner, D. E. (2012) · Health Affairs · doi:10.1377/hlthaff.2012.0127 · Cited by 11 · see citing works
Option pricing: a flexible tool to disseminate shared savings contracts.
Friedberg, M. W., Buendia, A. M., Lauderdale, K. E., & Hussey, P. S. (2013) · PubMed · Cited by 5 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
The CardioMetabolic Health Alliance
Sperling, L. S., Mechanick, J. I., Neeland, I. J., Herrick, C. J., Després, J.-P., Ndumele, C. E., Vijayaraghavan, K., Handelsman, Y., Puckrein, G. A., Araneta, M. R. G., et al. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.06.1328 · Cited by 294 · see citing works
Recognition and Management of Medical Complexity
Kuo, D. Z., & Houtrow, A. J. (2016) · PEDIATRICS · doi:10.1542/peds.2016-3021 · Cited by 238 · see citing works
Inequities In Health Care Needs For Children With Medical Complexity
Kuo, D. Z., Goudie, A., Cohen, E., Houtrow, A. J., Agrawal, R., Carle, A. C., & Wells, N. (2014) · Health Affairs · doi:10.1377/hlthaff.2014.0273 · Cited by 199 · see citing works
“With appropriate up-front payment support, such as per member per month fees to support encounters that are not face to face, and with system integration that supports primary care within accountable care organizations,[30] comprehensive care frameworks such as the medical home[31] or additional tertiary care programs…”
BackgroundCare Coordination for Children With Medical Complexity: Whose Care Is It, Anyway?
Kuo, D. Z., McAllister, J. W., Rossignol, L., Turchi, R. M., & Stille, C. J. (2018) · Pediatrics · doi:10.1542/peds.2017-1284g · Cited by 182 · see citing works
Kuo, D. Z., Berry, J. G., Glader, L. J., Morin, M. J., Johaningsmeir, S. A., & Gordon, J. B. (2015) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2015.10.010 · Cited by 91 · see citing works
Effects of Health Care Payment Models on Physician Practice in the United States
Friedberg, M. W., Chen, P., White, C., Jung, O., Raaen, L., Hirshman, S. D., Hoch, E., Stevens, C., Ginsburg, P. Β., Casalino, L. P., et al. (2015) · Rand health quarterly · doi:10.7249/rhq-05-01-08 · Cited by 82 · see citing works
Patient centered care: A path to better health outcomes through engagement and activation
MILLER, K. L. (2016) · Neurorehabilitation · doi:10.3233/nre-161378 · Cited by 76 · see citing works
“lower hospital admission and re-admission rates) by providing integrated care delivery, moving from reactive to proactive population health management (Edwards et al., 2014; Rosenberg, Peele, Keyser, McAnallan, & Holder, 2012).”
Analysis of Risk Factors for Patient Readmission 30 Days Following Discharge From General Surgery
McIntyre, L. K., Arbabi, S., Robinson, E. F., & Maier, R. V. (2016) · JAMA Surgery · doi:10.1001/jamasurg.2016.1258 · Cited by 71 · see citing works
Care system redesign for preterm children after discharge from the NICU
Kuo, D. Z., Lyle, R. E., Casey, P. H., & Stille, C. J. (2017) · Pediatrics · doi:10.1542/peds.2016-2969 · Cited by 59 · see citing works
Comparison of Health Care Spending and Utilization Among Children With Medicaid Insurance
Kuo, D. Z., Hall, M., Agrawal, R., Cohen, E., Feudtner, C., Goodman, D. M., Neff, J. M., & Berry, J. G. (2015) · PEDIATRICS · doi:10.1542/peds.2015-0871 · Cited by 59 · see citing works
Incorporating shared savings programs into primary care: from theory to practice
Hayen, A. P., van den Berg, M. J., Meijboom, B. R., Struijs, J. N., & Westert, G. P. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-1250-0 · Cited by 30 · see citing works
“argue that the financial incentives that follow from a shared savings program are best suited to the needs of a strengthened primary care setting, and urge to incorporate shared savings programs directly into enhanced primary care initiatives [9, 17].”
BackgroundCuellar, A. E., Helmchen, L. A., Gimm, G. W., Want, J., Burla, S., Kells, B. J., Kicinger, I. M., & Nichols, L. M. (2016) · Journal of General Internal Medicine · doi:10.1007/s11606-016-3814-z · Cited by 30 · see citing works
Health-care spending and utilization for children discharged from a neonatal intensive care unit
Kuo, D. Z., Berry, J. G., Hall, M., Lyle, R. E., & Stille, C. J. (2018) · Journal of Perinatology · doi:10.1038/s41372-018-0055-5 · Cited by 29 · see citing works
How Evolving United States Payment Models Influence Primary Care and Its Impact on the Quadruple Aim
Park, B., Gold, S. B., Bazemore, A., & Liaw, W. R. (2018) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2018.04.170388 · Cited by 27 · see citing works
The Patient-Centered Medical Home's Impact on Cost and Quality
Nielsen, M., Gibson, A., Grundy, P., Grumbach, K., & Olayiwola, J. N. (2015) · Cited by 27 · see citing works
Vickery, K. D., Shippee, N. D., Menk, J. S., Owen, R. A., Vock, D. M., Bodurtha, P. J., Soderlund, D. M., Hayward, R. A., Davis, M. M., Connett, J. E., et al. (2018) · Medical Care Research and Review · doi:10.1177/1077558718769481 · Cited by 21 · see citing works
“Furthermore, part of the HH care model focuses on connecting enrollees with primary care medical homes as a mechanism to deliver accountable care (Edwards et al., 2014).”
BackgroundA Neighborhood-Based Approach to Population Health in the Pediatric Medical Home
Brown, C. L., Perkins, J., Blust, A., & Kahn, R. S. (2014) · Journal of Community Health · doi:10.1007/s10900-014-9885-z · Cited by 19 · see citing works
Effects of Health Care Payment Models on Physician Practice in the United States: Follow-Up Study
Friedberg, M. W., Chen, P., Simmons, M. M., Sherry, T. B., Mendel, P. J., Raaen, L., Ryan, J., Orr, P., Vargo, C., Carlasare, L. E., et al. (2018) · Rand health quarterly · doi:10.7249/rhq-09-01-01 · Cited by 16 · see citing works
The Patient Protection and Affordable Care Act
Adkinson, J. M., & Chung, K. C. (2014) · Hand Clinics · doi:10.1016/j.hcl.2014.05.002 · Cited by 15 · see citing works
“There are currently more than 350 ACOs participating in Medicare (31).”
BackgroundBerenson, R. A., Burton, R. A., & McGrath, M. (2016) · Healthcare · doi:10.1016/j.hjdsi.2016.02.011 · Cited by 15 · see citing works
Fung, C. H., Martin, J. L., Hays, R. D., Rodriguez, J. C., Igodan, U., Jouldjian, S., Dzierzewski, J. M., Kramer, B. J., Josephson, K. R., & Alessi, C. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.01.019 · Cited by 12 · see citing works
“An increasing number of patient-centered care efforts are underway to enable patients with sleep disorders to more easily report on the status of their physical, mental, and social health and humanity of their care (eg, dignity, waiting time) [1–4].”
BackgroundImproving Asthma Care by Building Statewide Quality Improvement Infrastructure
Dolins, J. C., Powell, J., Wise, E., Giuliano, K., Stemmler, P., Stubblefield, W., White, P. C., Wiley, J. A., & Kuo, D. Z. (2017) · PEDIATRICS · doi:10.1542/peds.2016-1612 · Cited by 12 · see citing works
“Optimal asthma care is a composite measure for which (1) a physician assesses asthma control using a standardized instrument, (2) the patient or family has an up-to-date asthma action plan, (3) the stepwise approach to initiate or adjust therapy is used, and (4) asthma patients with persistent asthma are prescribed a…”
BackgroundMethodInfluentialSathe, N. A., Nocon, R. S., Hughes, B. L., Peek, M. E., Chin, M. H., & Huang, E. S. (2016) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(16)42002-7 · Cited by 11 · see citing works
Reporting From the Front Lines
Cottrell, E., Hall, J. D., Kautz, G., Angier, H. E., Likumahuwa-Ackman, S., Sisulak, L., Keller, S., Cameron, D. C., DeVoe, J. E., & Cohen, D. J. (2017) · Journal of Ambulatory Care Management · doi:10.1097/jac.0000000000000198 · Cited by 10 · see citing works
“…of the Patient Protection and Affordable Care Act (ACA), led some states to experiment with alternative payment methodologies as a way to achieve the triple aim of reducing utilization and costs while improving the quality and experience of care (Edwards et al., 2014; Kocot et al., 2013).”
BackgroundBeyond PCMHs and Accountable Care Organizations: Payment Reform That Encourages Customized Care
Colla, C. H., & Fisher, E. S. (2014) · Journal of General Internal Medicine · doi:10.1007/s11606-014-2928-4 · Cited by 10 · see citing works
Katongole, S. P., Akweongo, P., Anguyo, R., Kasozi, D. E., & Adomah-Afari, A. (2022) · Clinical Audit · doi:10.2147/ca.s370393 · Cited by 9 · see citing works
Rich, W. D., Tillman, D., & Adams, M. L. (2017) · Journal of Education Society and Behavioural Science · doi:10.9734/bjesbs/2017/31932 · Cited by 7 · see citing works
“The PCMH model has demonstrated efficacy with reduced cost, enhanced community health, and positive patient outcomes as the result of the integration and coordination of health professionals in a sustained partnership [4,5].”
BackgroundCantiello, J. (2022) · Journal of Ambulatory Care Management · doi:10.1097/jac.0000000000000434 · Cited by 6 · see citing works
“The flexibility of the PCMH model allows for a smaller primary care practice to integrate measures that are most effective for their specific setting, without compromising the autonomy of the organization (Edwards et al., 2014).”
BackgroundInfluentialAdolescents' Receipt of Care in a Medical Home: Results From a National Survey
Adams, S. H., Park, M. J., Brindis, C. D., & Irwin, C. E. (2023) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2023.05.019 · Cited by 6 · see citing works
Meeker, W. C., Watkins, R., Kranz, K. C., Munsterman, S. D., & Johnson, C. D. (2014) · Journal of Chiropractic Humanities · doi:10.1016/j.echu.2014.09.002 · Cited by 6 · see citing works
Unpacking the patient‐centered medical home
Domino, M. E. (2021) · Health Services Research · doi:10.1111/1475-6773.13661 · Cited by 5 · see citing works
Xie, Z., Yadav, S., Larson, S. A., Mainous, A. G., & Hong, Y. (2021) · Medicine · doi:10.1097/md.0000000000026119 · Cited by 5 · see citing works
Affordable Care Act: Patient-Centered Medical Homes and Implications for Mental Health
Sahasranaman, V. (2016) · American Journal of Psychiatry Residents Journal · doi:10.1176/appi.ajp-rj.2016.110901 · Cited by 4 · see citing works
Changes in the Mixed Fee-Based Payment System in Primary Care: Cases and Implications
Lee, H. (2023) · Korean Journal of Family Practice · doi:10.21215/kjfp.2023.13.1.2 · Cited by 3 · see citing works
After the “Doc Fix”: Implications of Medicare Physician Payment Reform for Academic Medicine
Rich, E. C., & Reschovsky, J. D. (2016) · Academic Medicine · doi:10.1097/acm.0000000000001242 · Cited by 3 · see citing works
Diabetes and Aging: Meeting the Needs of a Burgeoning Epidemic in the United States
Zeytinoglu, M., & Huang, E. S. (2015) · Health Systems & Reform · doi:10.1080/23288604.2015.1037042 · Cited by 2 · see citing works
“the cost and improving the quality of care provided to a given group of patients.(62) In this model, savings that are”
BackgroundEder, M., Jacobsen, R., PETERSON, K. A., & Solberg, L. I. (2022) · PLoS ONE · doi:10.1371/journal.pone.0278410 · Cited by 2 · see citing works
Ziegler, C. H. (2015) · doi:10.18297/etd/2024 · Cited by 2 · see citing works
“ACOs reflect different provider groups who work together to reduce costs and increase quality of care for a designated patient group.(173) PCMHs would entail practices employing PCPs, while an ACO employs both PCPs and specialist.”
BackgroundInfluentialHealthcare Provision Shifts Under DIP Reform: From Conventional Medicine to Traditional Medicine
Pan, X., Dai, Z., Xiao, Y., Ma, C., Wang, D., & Wu, J. (2026) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/00469580261436361 · Cited by 1 · see citing works
Lin, Y., Du, Y., Gomez, C., & Ortiz, J. (2017) · Population Health Management · doi:10.1089/pop.2017.0096 · Cited by 1 · see citing works
“Edwards et al.(37) observed that PCMH and ACO are complementary health care reform models.”
Hearld, L. R., & Kelly, R. J. (2021) · Journal of Hospital Management and Health Policy · doi:10.21037/jhmhp-21-45 · Cited by 1 · see citing works
“Complementary roles of ACos and medical homes ACOs and medical homes are argued to play complementary roles (18,33).”
BackgroundJackson, J. L. (2015) · Journal of General Internal Medicine · doi:10.1007/s11606-015-3397-0
Tachinardi, U., & Embí, P. J. (2021) · Springer eBooks · doi:10.1007/978-3-030-66726-9_6
The Specialty and Scope of Complex Care Pediatrics
Murphy, N., Alvey, J. C., Brinton, J., Darro, N. H., Fox, J., Hill, E. A., Irby, K., Robertson, A., & Smals-Murphy, L. (2025) · SpringerBriefs in public health · doi:10.1007/978-3-031-93347-9_2
Ou, T.-S., & Lin, H. (2026) · International Journal of Healthcare Management · doi:10.1080/20479700.2026.2643863
- Authors
- Edwards, S. T., Abrams, M. K., Baron, R. J., Berenson, R. A., Rich, E. C., Rosenthal, G. E., Rosenthal, M. B., & Landon, B. E.
- Affiliations
- VA Boston Healthcare System (US)
- Commonwealth Fund (US)
- American Board of Internal Medicine (US)
- Urban Institute (US)
- Mathematica Policy Research (US)
- University of Iowa (US)
- Harvard University (US)
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Landon, Bruce E.
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2014-04-01
- Volume
- 29
- Issue
- 10
- Pages
- 1410-1413
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC4175661
- OpenAlex
- W2095397701
- Cited by
- 46
- References
- 25
- Citations by year
- 2026: 2 · 2025: 1 · 2023: 2 · 2022: 3 · 2021: 4 · 2018: 5 · 2017: 5 · 2016: 8 · 2015: 11 · 2014: 5
- FWCI
- 17.50
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Mathematica Policy Research Reports (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Keywords
- patient-centered medical home, accountable care organizations, physician remuneration, Affordable Care Act, care coordination, payment incentives
- MeSH terms
- Humans, United States, Fee-for-Service Plans, Patient-Centered Care, Patient Protection and Affordable Care Act
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
