The Adirondack Region Medical Home Pilot is a collaborative effort by health care providers and public and private insurers to transform the health care delivery system in this rural, upstate New York region.
This “medical home” isn’t a place; it’s a model for care that centers on the patient and increases the role of the primary care provider. It’s based on two ideas about health care delivery:
- A coordinated, team approach, with a primary care physician in the lead, is the best way to keep patients healthy, especially for those with chronic conditions.
- Keeping people as healthy as possible costs less than treating them late in the disease.
Under the terms of the pilot, primary care providers will receive increased payment for services in exchange for expanded responsibility for coordinating care, providing preventive care and managing chronic diseases. The increased reimbursement is expected to be offset by decreased costs from fewer hospital admissions, fewer referrals to specialists, lower prescription costs, and overall better health.
The pilot’s reimbursement model will include a fee-for-service component, a care coordination fee, and a performance-based payment that reflects improved clinical outcomes.
The pilot has a five-year window to demonstrate that these changes in the delivery of care have improved patient health and contained costs.