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The Patient Centered Medical Home has the potential to become the central alternative “payment” model (APM). The objective of APM's, at the most evolved and sophisticated level, is to transition from “fee for service” to a population based, full provider risk financing model. The journey of “delivery” models to an incentivized payment model design is just beginning and the variety of delivery models cannot be expected to evolve at the same rate. The PCMH operating as a value based delivery model, will face barriers to value, as all organizations will, in grappling with new forays into the MACRA space. All agree health care is at a cusp of dynamic change, poised to aggressively move on cost linked to quality. Many processes have taken hold, on the ground, in all delivery models, and primarily related to automation of the health record. Over the last decade this necessary transition from paper to an automated and electronic record has not delivered on the promise of interoperability; nor does it serve as a foundation for clinical research or population health in a quantifiable and/or observational form. In short the automation has become a barrier to value. Other barriers have become apparent; from the business models of integrated provider networks, to the technical issues of patient centered care and precision medicine, where the single patient has become lost in the average of populations.

The Patient Centered Medical Home, alone in the organizational forms of the Alternative Payment Model, has a design that may have the greatest flexibility (pursuant to Federal regulations) in overcoming barriers to value. The source of this flexibility is the grounding of the mission of the PCMH at the patient level. Though the payment aspects are from benchmarks reflective of mini attributed populations, the primary care emphasis, by its nature, can be inclusive of all health care services at the patient level.

I will be presenting the “Pyramid of Value” in the Poster Hall of the 2017 PCMH Congress, November 3rd & 4th, Regency Ballroom, Hyatt Orlando Florida.