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COMMENTARY Building the Patient-Centered Medical Home in Ontario cians with typical annual net earnings increasing from about Richard H. Glazier, MD Can$162 000 to about Can$207 000. Government nego- Donald A. Redelmeier, MD tiators likely underestimated the distinct popularity of capi- tation, which is now expected to overtake all other models HE CONCEPT OF THE PATIENT-CENTERED MEDICAL during 2010. The estimated annual incremental total di- home is gaining traction in debates about rect physician expenditures for capitated medical homes has expanding access, improving quality, and been at least Can$160 million. Trestraining the cost of health care. These homes Publicly funded health care aims to support patients in include physician-led multidisciplinary teams that pro- most need, but negotiations in Ontario resulted in models vide comprehensive primary care, expanded hours (with that somewhat compromised this outcome. Parties in- possible open-access scheduling), integrated evidence- volved in the negotiations could not agree on case-mix or based quality measurement, better communication for socioeconomic adjustments (in turn, capitation payments the patient experience, and modern health information were adjusted for age and sex alone). Without finer case- technology. The timing seems right in the United States mix adjustment, practices in the healthier and wealthier areas and
JAMA – American Medical Association
Published: Jun 2, 2010
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