Do interventions promoting medical homes in FQHCs improve continuity of care for Medicare beneficiaries?

  • Christine ButtorffEmail author
  • Justin W. Timbie
  • Tara A. Lavelle
  • Rosalie Malsberger
  • Amii M. Kress
  • Claude M. Setodji
  • Katherine L. Kahn
Original Article



We examine whether primary care continuity of care (PCCOC) improved for Medicare beneficiaries under a 3-year demonstration to help federally qualified health centers (FQHCs) become patient-centered medical homes (PCMH).

Subjects and methods

We used a difference-in-differences analysis to compare changes over time in PCCOC for beneficiaries in 503 demonstration sites to those in 827 comparison sites. We measured PCCOC using the claims-based usual provider of care (UPC) index (range 0–1) indicating the proportion of visits to the most commonly seen provider or practice over a 1-year period.


Average baseline UPC index values were 0.77 at the provider level and 0.88 at the practice level, with similar values for demonstration and comparison sites. UPC decreased more over time in demonstration clinics than comparison clinics, but the magnitude of these changes were small.


FQHCs already have high levels of PCCOC. These levels did not increase in association with the 3-year PCMH demonstration. Continuity for practices is higher than for providers, suggesting that Medicare beneficiaries may see multiple providers within one FQHC.


Federally qualified health center Medicare Medicare beneficiaries Patient-centered medical home Medical home Continuity of care Dual-eligible 



Funding support: funding was provided by Centers for Medicare & Medicaid Services, (Contract: HHSM-500-2005-00028I, Task # T0008). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

This research involved secondary data, and the RAND IRB determined this study exempt. As such, informed consent was not necessary.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.RAND CorporationArlingtonUSA
  2. 2.Tufts Medical CenterBostonUSA
  3. 3.Mathematica Policy ResearchPrincetonUSA
  4. 4.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  5. 5.David Geffen School of Medicine at UCLALos AngelesUSA

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