Building the affordable medical home.

Medical homes and accountable care organizations have become the great hope for many health industry stakeholders and policy makers seeking to reconstitute fragmented healthcare delivery within a coordinated cost-conscious framework. The need to increase coordination has been evident to analysts for many years and, in the past, has resulted in developments such as capitation and disease management. The hope of these reforms is that through changes in risk/reward to providers or by layering in external programs to improve patient coordination the system will improve patient outcomes and reduce total cost. This article describes a pilot project to create a medical home that is built upon changing existing payment incentives but tying these incentives directly to the outcomes of care experienced by patients. It is at variance with most proposals to create medical homes in that it is self-funded, allowing rapid scaling, and is largely agnostic toward the precise practice pattern employed. Put succinctly, it encourages practice patterns that improve patient outcomes without dictating what they should be.