Payments in Support of Effective Primary Care for Chronic Conditions

Abstract

Risk adjustment models can establish appropriate payments and incentives for delivering superior primary care, particularly to people with chronic conditions, through health-based capitation and performance assessment in a patient-centered medical home (PCMH). The practical issues and administrative structures for implementing bundled PCMH payment that we discuss are relevant for single-payer Scandinavian countries as well as the US. Feasibility is supported by the “virtual all-payer” PCMH pilot of one US health plan.