A Nationwide Survey of Patient Centered Medical Home Demonstration Projects
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The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country.
Cross-sectional key-informant interviews.
Leaders from existing PCMH demonstration projects with external payment reform.
We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design.
A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified—consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans.
Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows.
- Bodenheimer T, Grumbach K, Berenson RA. A lifeline for primary care. N Engl J Med. 2009;360(26):2693–6. CrossRef
- Hauer KE, et al. Factors associated with medical students’ career choices regarding internal medicine. Jama. 2008;300(10):1154–64. CrossRef
- Lipner RS, et al. Who is maintaining certification in internal medicine–and why? A national survey 10 years after initial certification. Ann Intern Med. 2006;144(1):29–36.
- McGlynn EA, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45. CrossRef
- Ginsburg JA, et al. Achieving a high-performance health care system with universal access: what the United States can learn from other countries. Ann Intern Med. 2008;148(1):55–75.
- Rittenhouse DR, Shortell SM. The patient-centered medical home: will it stand the test of health reform? Jama. 2009;301(19):2038–40. CrossRef
- Fisher ES. Building a medical neighborhood for the medical home. N Engl J Med. 2008;359(12):1202–05. CrossRef
- Berenson RA, et al. A house is not a home: keeping patients at the center of practice redesign. Health Aff (Millwood). 2008;27(5):1219–30. CrossRef
- American Academy of Family Physicians (AAFP) et al. Joint principles of the patient-centered medical home. 2007 [cited November 20th, 2009]; Available from: http://www.acponline.org/running_practice/pcmh/demonstrations/jointprinc_05_17.pdf.
- Rosenthal TC. The medical home: growing evidence to support a new approach to primary care. J Am Board Fam Med. 2008;21(5):427–40. CrossRef
- Paulus RA, Davis K, Steele GD. Continuous innovation in health care: implications of the Geisinger experience. Health Aff (Millwood). 2008;27(5):1235–45. CrossRef
- Nutting PA, et al. Initial lessons from the first national demonstration project on practice transformation to a patient-centered medical home. Ann Fam Med. 2009;7(3):254–60. CrossRef
- Steiner BD, et al. Community care of North Carolina: improving care through community health networks. Ann Fam Med. 2008;6(4):361–7. CrossRef
- Reid R, et al. Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation. Am J Manag Care. 2009;15(9):e71–89.
- PCPCC. Patient centered medical home: building evidence and momentum. 2009 [cited June 5, 2009]; Available from: http://www.pcpcc.net/content/pcpcc_pilot_report.pdf.
- ACP. Patient centered medical home. 2009 [cited June 5, 2009]; Available from: http://www.acponline.org/running_practice/pcmh/.
- Chin MH, et al. Improving and sustaining diabetes care in community health centers with the health disparities collaboratives. Med Care. 2007;45(12):1135–43. CrossRef
- Coleman K, et al. Evidence on the chronic care model in the new millennium. Health Aff (Millwood). 2009;28(1):75–85. CrossRef
- Homer CJ, et al. Impact of a quality improvement program on care and outcomes for children with asthma. Arch Pediatr Adolesc Med. 2005;159(5):464–9. CrossRef
- Landon BE, et al. Improving the management of chronic disease at community health centers. N Engl J Med. 2007;356(9):921–934. CrossRef
- Mangione-Smith R, et al. Measuring the effectiveness of a collaborative for quality improvement in pediatric asthma care: does implementing the chronic care model improve processes and outcomes of care? Ambul Pediatr. 2005;5(2):75–82. CrossRef
- Vargas RB, et al. Can a chronic care model collaborative reduce heart disease risk in patients with diabetes? J Gen Intern Med. 2007;22(2):215–22. CrossRef
- Hroscikoski MC, et al. Challenges of change: a qualitative study of chronic care model implementation. Ann Fam Med. 2006;4(4):317–26. CrossRef
- Solberg LI, et al. Transforming medical care: case study of an exemplary, small medical group. Ann Fam Med. 2006;4(2):109–16. CrossRef
- Kuzel AJ, Skoch EM. Achieving a patient-centered medical home as determined by the NCQA–at what cost, and to what purpose? Ann Fam Med. 2009;7(1):85–6. CrossRef
- A Nationwide Survey of Patient Centered Medical Home Demonstration Projects
Journal of General Internal Medicine
Volume 25, Issue 6 , pp 584-592
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- primary care
- physician payment
- health reform
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- Author Affiliations
- 1. Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115-5899, USA
- 2. Division of General Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- 3. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA