Lessons for Primary Care from the First Ten Years of Medicare Coordinated Care Demonstration Projects

Average monthly per-member payments for Medicare demonstration programs. 1. We averaged the monthly care management fees per host organization. The fees were obtained from Brown et al.¹² 2. We averaged the monthly care management fee for each organization across the demonstration's 3 years and then averaged the fees across the 6 organizations. We obtained the fee amounts from RTI International's evaluation of each organization. 3. The monthly care management fee schedule varied by state, with some states adjusting for the practice's medical home status and patient complexity. Five states allocated additional payments for community health teams. For this calculation, we averaged the maximum and minimum possible payments per state, added this amount to the community health team fee (when available), and then averaged the fees across the states. We obtained the monthly fees from Centers Medicare and Medicaid Services (CMS) data.⁵⁰ 4. The CMS paid an average of $20 per beneficiary per month (PBPM) for the first 2 years and then $15 PBPM for the last 2 years. We averaged these 2 amounts across the 4 years.²⁶ 5. Only patients with program-defined, high-cost diagnoses were eligible to participate. 6. All Medicare beneficiaries within practices were eligible to participate.