Promoting the use of primary care (B)

The Congress should initiate a medical home pilot project in Medicare. Eligible medical homes must meet stringent criteria, including at least the following capabilities:
* Furnish primary care (including coordinating appropriate preventive, maintenance, and acute health services),
* Conduct care management,
* Use health information technology for active clinical decision support,
* Have a formal quality improvement program,
* Maintain 24-hour patient communication and rapid access,
* Keep up-to-date records of beneficiaries’ advance directives, and
* Maintain a written understanding with each beneficiary designating the provider as a medical home.
Medicare should provide medical homes with timely data on patient utilization. The pilot should require a physician pay-for-performance program. The pilot must have clear and explicit thresholds for determining whether it can be expanded into the full Medicare program or should be discontinued.