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Making Medical Homes Self-Sustaining

Karen Minich-Pourshadi, for HealthLeaders Media, August 1, 2011

In the future health insurance companies may reward patients who maintain their health through employee health programs that pay people to get active. For now, however, the future of reimbursements lies within the provider's ability to keep a patient healthy.

That is why the medical home, has become the model to add to your hospital, health system or practice. Indeed, there are results (and dare I say an opportunity for revenue) in this patient-centric model, even now, before the reimbursement system changes occur.

Earning revenue from this model requires the help of the payer. For instance, six New York health plans – Aetna, CDPHP, the Hudson Health Plan, MVP Health Care, UnitedHealthcare and Empire BlueCross Blue Shield recently provided $1.5 million in incentive payments to 236 separate primary care physicians in 11 practices for achieving patient-centered medical home recognition by the NCQA.

They aren't the only ones, either. More and more health plans nationwide are offering some sort of incentive or bonus to providers who create a medical home—so if you haven't checked with your payers you may want to do so.

Unfortunately, not every hospital, health system, or practice that opts for a medical home will get the benefit of incentive dollars. In these instances, the trick is to create at least a self-sustaining medical home that functions under the current reimbursement structure, and doesn't lose money. Because providers of all sizes will want to have a medical home in place within the next couple of years, however, you don't want to create it at the financial expense of your current practice.

How is this accomplished? In a highly motivated practice where there is enough traffic that wellness can be practiced, practices can take on more cases, do more preventative care visits, and the dollars that come in can help support the program.

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