Designing model homes for the changing medical neighborhood: a multi-payer pilot offers lessons for ACO and PCMH construction.

Washington State is in the midst of a multi-payer model home test with implications for the nascent national effort to construct new health care payment and delivery systems. The model homes are redesigned primary care medical practices. Their structural supports include additional upfront payments, potential shared savings, and other elements reflective of “accountable care.” Accountable care, in its basic blueprint, requires an affiliated group of health care providers to accept responsibility for the overall costs and quality of care for a defined population. Accountable care requires a solid primary care foundation. And that foundation might well be a Patient-Centered Medical Home (PCMH). Indeed, in some formulations, a PCMH is a necessary part of any well-functioning Accountable Care Organization (ACO). The