Ensuring that all Americans have a medical home is a first step toward creating a patient-centered health system, say Davis and colleagues. A package of patient-centered services—such as e-mail visits, automated patient reminders, access to electronic medical records, same-day appointments or walk-in hours—could be supported, they argue, through a fixed monthly fee. In addition pay-for-performance contracts similar to those employed in the United Kingdom could encourage primary care practices to measure and improve the quality of care delivered. Demonstration projects could test the viability of such models and develop a "business case" for patient-centered care.

Two Fund-supported projects are beginning to respond to the challenge put forth in the "2020 Vision" paper. Under one grant, the National Committee for Quality Assurance is developing and testing a comprehensive set of measures to assess a patient-centered practice. These measures will enable accrediting agencies and other organizations to determine the extent to which physicians provide such care—a necessary first step toward establishing a reward or incentive program. A second project led by Dana Safran, Sc.D., of Tufts-New England Medical Center is examining the strength of the relationship between patient experience and clinical performance at the individual physician and practice levels. The results from this work will provide much-needed information to help motivate a greater investment in and commitment to patient-centered care.

In the upcoming year, the Patient-Centered Primary Care Initiative will be seeking a better understanding of which features of a patient-centered practice are meaningful to patients and associated with high-quality care. Policy analysis and demonstration projects sponsored by the program will also ensure that patients' experiences are featured in efforts to improve quality and efficiency.