Table 1.

PCPCC payment reform for the PCMH

Performance risk	Reward	Outcome
Lowest	Least	• Maintaining fee for service (FFS)
		• Inadequate levels of payment to sustain the PCMH and counterproductive incentives that maximize volume
Modest	Modest	• Efforts to qualify as an accredited PCMH in return for a management fee to support PCMH activities needed to support practice transformation and sustained delivery of enhanced PCMH services.
Moderate	Moderate	• Adding a component of pay for performance (P4P) to FFS for achieving desired outcomes and goals in cost, quality, and patient experience.
Highest	Highest	• Global payment for operation of PCMH combined with large P4P bonus payment, which eliminates the need to maximize volume and replaces it with emphasis on value creation.