“Congress is rapidly advancing Medicare physician payment reform legislation that rewards value over volume for patient-centered medical homes and patient-centered specialty practices,” said Margaret O'Kane, NCQA president.
O'Kane noted that the legislation—as well as the 2014 Medicare physician fee schedule—include measures that would reward practices for services typically associated with medical homes such as non-face-to-face care-management services for patients with two or more chronic conditions.
The NCQA has recognized 6,550 practices as medical homes, and O'Kane said medical homes and patient-centered specialty practices could serve as platforms for “alternative payment models” that move healthcare away from fee for service.
The private sector is moving faster than the government—particularly in the area of financially rewarding oncology practices that operate as medical homes.
Last year, Grand Rapids, Mich.-based health plan Priority Health teamed up with oncology health information technology provider ION Solutions and others to form a three-practice oncology medical home demonstration project. More recently, Hartford, Conn.-based Aetna launched similar programs in Pennsylvania and Texas.
“We are exploring a number of different reimbursement models,” said Dr. Michael Kolodziej, Aetna's national medical director for oncology strategy. He added that these new models, such as primary-care and specialty-practice medical homes, move healthcare payment away from its “traditional transactional model” and toward a system with more built-in quality measures and accountability.
Aetna is building a network of community oncologists “who have the same skill set” as those involved in the Pennsylvania and Texas programs, Kolodziej said. The oncology medical homes, he said, could better manage the treatment of side effects and reduce unnecessary readmissions to the hospital. “It's going to improve quality and the extra special bonus is that I think it will control costs.”