Joining Primary Care and Accountable Care

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<p>With much of the health reform debate focused on insurance coverage, relatively little attention has been paid to reforming the health care delivery system. According to a <a href="">"Perspective&quot; column</a> in the current issue of the <em>New England Journal of Medicine</em>, two promising models of care delivery—the patient-centered medical home and the accountable care organization—are "synergistic models of delivery-system reform that, together, promise to redirect the U.S. delivery system toward reduced cost growth and improved quality."</p>
<p>By providing patients comprehensive, continuous primary care services with the help of high-tech tools like electronic medical records, medical homes can improve the quality of care while helping to lower costs over the long run. But they face some tall challenges that lie beyond the control of the primary care practice—a lack of direct incentives to encourage other providers to work with the medical home practice, or a mechanism to allow the practices to share in savings gained from the decreased need for emergency room care, among other services.</p>
<p>That's where accountable care organizations come in, say authors Diane Rittenhouse, M.D., Stephen M. Shortell, Ph.D., and Elliott S. Fisher, M.D., who were informed by a Commonwealth Fund–sponsored meeting with leading health care thought leaders. ACOs—which can include physician–hospital organizations, multispecialty practice groups, and other organized forms of care delivery—emphasize accountability across the continuum of patient care and the alignment of provider incentives.</p>
<p>But just as medical homes need the support of larger entities, like ACOs, to achieve their full potential, ACOs cannot succeed "without a strong foundation of high-performing primary care," the authors caution. It is therefore critical, they say, to find a way to ensure adequate support for primary care and "ensure the full realization of the [medical home] model."</p>