No Place Like Home — Testing a New Model of Care Delivery

John J. Inglehart in the New England Journal of Medicine Seeking ways to slow the growth of Medicare spending and to better coordinate the health care it finances, the federal government is preparing to test the concept of the "medical home" in the Medicare program. In response to a mandate in the Tax Relief and Health Care Act of 2006, the staff at the Centers for Medicare and Medicaid Services (CMS) is developing a demonstration program that will operate for 3 years in rural, urban, and underserved areas in up to eight states. Congress has directed the agency to use the program to "redesign the health care delivery system to provide targeted, accessible, continuous and coordinated, family-centered care to high-need populations." Reluctant to constrain the freedom of beneficiaries currently covered under the traditional fee-for-service model, however, Congress placed no limits on patients' freedom to seek treatment, without a referral, from physicians not affiliated with their medical home and made virtually all practices eligible to participate in the demonstration program.