Abstract

The article by Wasson alludes to, but does not resolve, the challenge that the current fee-for-service payment system generates for practices trying to reform their troubled assets in accordance with the 3 elements described. It fails to acknowledge the critical role that insurers and employers currently play in supporting or thwarting changes in care delivery. The emerging evidence regarding which medical home initiatives succeed, and which do not, seems to highlight the critical supporting role that payment reform plays in facilitating demonstrable practice changes. To promote care reform, without also changing the way practices are paid, is not only incomplete but also ineffective. Beyond payment reforms, the fact that the predominant insurance products offered neither mandate nor incent patients choosing (or using) a primary care clinician as a “first or frequent stop” for comprehensive care has served to build a highway circumventing the medical home neighborhood entirely.