The similarities and differences of ACOs and PCMHs

August 10, 2012

Can't figure out the difference betweena an ACO and a PCMH? Here's a guide to the two models.

Key Points

Healthcare is moving away from a fee-for-service model, and some experts believe it will help strengthen the role of primary care physicians (PCPs) in healthcare delivery overall.

Accountable care organizations (ACOs) and Patient-Centered Medical Homes (PCMHs) are two of the most hyped practice models of recent years that seek to move beyond a strictly fee-for-service payment model. Each holds the potential of driving higher-quality care and lower costs, largely by improving care coordination among different types of health providers who often operate in separate worlds.

It's helpful to think of the PCMH as the core of the ACO, but the two are not the same. The PCMH is founded on a team-based model of care in which PCPs are responsible for coordinating and tracking care across specialists and other providers. The model is facilitated by information technology, patient registries, and nonphysician personnel such as nutritionists and care coordinators.

At this point, the PCMH concept is more widespread than that of the ACO. The National Committee for Quality Assurance has recognized more than 4,300 practices as PCMHs. The American Academy of Family Physicians (AAFP) has recommended that all of its members move in the direction of establishing themselves as PCMHs, so that number could grow rapidly in the coming years.

The Centers for Medicare and Medicaid Services (CMS) has been a major driver behind ACOs, too, which were a key component of federal health reform. The federal ACO program has thus far enrolled 154 organizations, and each ACO must cover 5,000 or more Medicare beneficiaries. PCPs are able to join more than one ACO.