Any move to pay for care management would also make primary care a more attractive field for medical students, Stream says. "It sends an important message to medical students that we are trying to get people to choose primary care specialties," he says. "We don't want them to have that financial barrier of their educational debt and the serious discrepancy between subspecialty and primary care pay to be a disincentive to choose primary care."
Stream says a number of initiatives announced over the last several months by the federal government and private payers indicate that the patient-centered medical home model may soon expands beyond pilot project status.
He notes that at the end of September the Center for Medicare & Medicaid Innovation announced a primary care initiative that includes a similar care management fee for Medicare and Medicaid patients in a half-dozen test markets.
"The idea in those five to seven pilot markets to get to at least 60% of their patients in the practice covered under that payment model, including the care management fee that supports the services that are part of the patient-centered medical home," he says. "I'm not sure how they came up with that 60% number but it seems like a reasonable tipping point to get the practice and enough of its payers aligned with that to make it meaningful."