Making multipayer reform work: what can be learned from medical home initiatives

Multipayer collaboratives of all types will encounter legal, logistical, and often political obstacles that multipayer medical home initiatives have already overcome. The seventeen multipayer medical home initiatives launched between 2008 and 2014 all navigated four critical decision-making points: convening stakeholders; establishing provider participation criteria; determining payment; and measuring performance. Although we observed trends toward voluntary payer participation and more flexible participation criteria for both payers and providers, initiatives continue to vary widely, each shaped largely by its insurance market and policy environment. Medical home initiatives across the United States are demonstrating that multipayer reform, although complex and difficult to implement, is feasible when committed stakeholders negotiate strategies that are responsive to the local context. Their experiences can inform, and perhaps expedite, negotiations in current and future multipayer collaborations.