Making margin with the medical home

Under healthcare reform, the payment structure will move from fee-for-service to a pay-for-outcome model, such as bundled payments, medical homes, or accountable care organizations (ACO). However, the change to a new payment model is going to be a bumpy and expensive one-and few organizations have the margins to lose reimbursement dollars during the transition period. With most providers having little margin to put toward a pilot program, and with an expectation of losing reimbursements once it's under way, a medical home is unappealing under the current payment system. However, there are pathways to making margin in the medical home.