[MUSIC] Medical homes have also gained popularity in recent years. Particularly, among advocates who believe that better primary care results in better health outcomes with lower cost. With the introduction of RBRVS, or resource-based relative value scale, fee schedules. Payments for primary care services have not kept pace with payments for specialty care. And many argue that in order for primary care physicians to make enough money in a fee for service world, they need to see many patients during the course of the day and refer care to specialist rather than caring for the patients themselves. Medical home models attempt to keep appropriate care in the primary setting and to pay primary care physicians adequately for doing that. They provide incentives to primary care practices to utilize health technology, data analytics and a team of care professionals including nurse practitioner and physician assistant as well as behavioral health professionals. To allow the entire primary care team to practice at the top of their medical license while caring for patients. Characteristics of medical homes include the use of care teams to treat patients so that nurse practitioners, registered nurses, behavioral health professionals, nutritionist and others. Are supporting the primary care physician and allowing all medical professionals to practice at the top of their license. These practices use electronic medical records and data analysis to identify gaps in care and patients that require additional attention to enhance care coordination and avoid catastrophic events. They are available to patients with more expanded hours, so that patients are not diverted to emergency rooms or other high-cost settings. They work with the patient to help them better manage their health. The payment models continue to utilize the fee-for-service foundation, but they also include per patient care management fees that are intended to build out the necessary IT and care management infrastructure. They also tend to have incentive models, one-sided models, that allow physicians to earn additional money if they meet or beat quality or cost efficiency targets. So who is doing this sort of stuff? Medicare has introduced several medical home models targeted to both the general population as well as specific populations who suffer from chronic illness and are at high risk for bouncing in and out of a hospital through re-admissions. Private payers also have used these payment models, sometimes on a standalone basis, and other times in conjunction with an ACO model. Results are mixed for the medical homes, with researchers showing reduced special referrals, admissions, re-admissions and emergency room care. However, at times the savings do not offset the cost of the care management fees. The medical home model provides a solution to a gap within our current health care delivery system. They focus on the need to keep care in the primary care setting rather than referring care to specialists or hospital based settings. Medical homes do not need to be considered an isolation home, and can be quite complimentary to ACO and bundle payments models. Here is a link to an awesome resource on various payment modules that was developed by Kaiser Family Foundation, that you can refer to for additional information. [MUSIC]