Milbank-Supported Report

Advanced Primary Care: A Key Contributor to Successful ACOs

August 13, 2018

Program:  Multi-Payer Primary Care Transformation

Patient-centered medical homes (PCMHs) and accountable care organizations (ACOs) were often considered to be competing models for reforming health care delivery. Not now. It’s increasingly apparent that one helps the other.

That’s the main finding from the new Patient-Centered Primary Care Collaborative (PCPCC) 2018 evidence report, “Advanced Primary Care: A Key Contributor to Successful ACOs,” the first study of its kind to look at how the role of advanced primary care, such as the PCMH, may contribute to the success or failure of ACOs. The report was published with support from the Milbank Memorial Fund for the fifth time.

While these two leading models are transforming health care delivery and payment, little research has been done on how these models interact to promote lower costs and better quality for populations. Using qualitative and quantitative methods, researchers at the Robert Graham Center and IBM Watson Health found that

  • The attributes of successful ACOs are necessary to transform the practice of primary care.
  • Successful ACOs are more likely to be built on the basis of high-quality primary care:
    • Medicare ACOs with a higher proportion of PCMH primary care physicians were more likely to generate savings;
    • Medicare ACOs with a higher proportion of PCMH primary care physicians demonstrated higher quality scores, including on a significant number of process and outcome measures.

While further research is needed, the report findings suggest that a strong foundation of primary care as embodied in the PCMH is critical to the success of care delivery reform. With 10% of the US population in ACOs and growing, and more than 20% of primary care physicians practicing in PCMHs, the findings have widespread applicability for public and private policymakers who should consider evolving both these programs to increase their effectiveness and improve our health care system.