The Emergence Of Specialty Medical Homes In The U.S. Health Care System: Initial Financial Performance Data & The Financial Implications For Provider Organizations

Abstract

The U.S. health care system is in the midst of significant change in both service delivery model and financing. Rising costs are driving payers – public and private alike – to rethink the current financing and care management strategies. One significant shift in policy is around the structure of care coordination for insured individuals – particularly individuals with complex health service and social support needs. These individuals, while small in number, are responsible for a large proportion of health care spending.

Traditionally, the care of individuals with complex conditions has been left to a wide range of medical specialists – and rarely been coordinated across all specialties. But in the past four years, health payers have moved toward ‘integrating’ care coordination with a health care team responsible for all services regardless of specialty. This integrated care coordination model – referred to as a medical home – has been rapidly adopted by many payers. And, a specialized version of the medical home model – referred to as a heatlh home or specialty medical home – has been developed for consumers with complex needs. The model has changed both the relationship of the insured individual to the payer and to their medical specialists.

It is early in the adoption of specialty medical homes and two key financial questions are yet unanswered. The first, do specialty medical homes reduce health care spending for complex consumers. The second, what are the financial implications of a specialty medical home model for heatlh care provider organizations. This research examines the available research literature and other published data for preliminary answers to these questions of financial impact of this emerging heatlh care system model.