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.
- 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
- Industry Sectors
- 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