THE ORGANIZATION OF PHYSICIAN PRACTICES
Important recent developments in American primary care include a shift in the organizational structure of physician practices coupled with a growing emphasis on wellness, disease management and accessibility. The move towards a more personalized model of health care delivery is taking two forms: Patient-Centered Medical Homes (PCMH) and Retainer-Based Medicine (RBM). While the PCMH model looks to improve quality of care through process restructuring, the RBM model relies on reductions in patient panels, which are financed by the introduction of membership fees. These changes to the structure of primary care practices represent major developments that remain poorly understood. The papers in this section cover all three dimensions of organization of physician practices: group practice, medical homes, and retainer-based models. The paper by Baker and Bundorf examines patient preferences for physician group practice, providing new evidence on the effects of changes in market organization. The paper by Helmchen, Cuellar, and Gimm examines the effectiveness of a PCMH intervention that provided primary care physicians with financial incentives and information about the cost and quality of specialty care for their attributed patients. The paper by David, Leive, and Weber studies the economic foundations of retainer-based medicine in health care delivery and analyze its impact on utilization, expenditures, and patient outcomes relative to traditional models of care. All studies have the potential to impact policy and inform our understanding of the market for primary care services. Furthermore, primary care will become an even more important delivery setting after implementation of the Affordable Care Act.