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Primary Care and Accountable Care—Two Essential Elements of Delivery System Reform

Health IT

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In a commentary in the New England Journal of Medicine, Diane Rittenhouse, M.D., M.P.H., of the University of California, San Francisco, and colleagues make the case for uniting two critical elements of delivery system reform: the patient-centered medical home (PCMH) and the accountable care organization (ACO). By combining the core tenets of primary care with high-tech practice innovations like electronic medical records, the PCMH model can improve quality of care and lower costs. However, it faces several challenges. How can it provide incentives for outside providers to work collaboratively with primary care clinicians? And, how can primary care practices share in the savings that result from decreased need for such services as hospitalizations or emergency room treatment?

These limitations, Rittenhouse says, could be addressed by implementing the PCMH model in a larger entity, like an ACO. The ACO model—which can take many forms, like a physician–hospital organization or multispeciality practice group—emphasizes alignment of incentives and accountability of providers across the continuum of care. But, regardless of structure, ACOs cannot succeed without a strong foundation of high-performance primary care, making an investment in the PCMH model critical. As both models move forward, the authors say it will be important to align the accreditation and certification processes, develop a common set of primary care performance measures, and align financial incentives to increase accountability for total costs of care while ensuring a sufficient investment in primary care capacity. The authors met with health care thought leaders, including staff from The Commonwealth Fund, to develop the concepts in this article.

Publication Details



D. R. Rittenhouse, S. M. Shortell, E. S. Fisher, "Primary Care and Accountable Care—Two Essential Elements of Delivery-System Reform," New England Journal of Medicine, published online Oct. 28, 2009.