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

References

1. 1.↵
   1. Bodenheimer T,
   2. Lo B,
   3. Casalino L

   . Primary care physicians should be coordinators, not gatekeepers. JAMA 2009;281:2045–9.

   OpenUrl
2. 2.↵
   1. Hempstead K,
   2. Delia D,
   3. Cantor JC,
   4. Nguyen T,
   5. Brenner J

   . The fragmentation of hospital use among a cohort of high utilizers: implications for emerging care coordination strategies for patients with multiple chronic conditions. Med Care 2014;52:S67–74.

   OpenUrlPubMed
3. 3.↵
   Centers for Medicare and Medicaid Services. Chronic conditions among Medicare beneficiaries. Baltimore (MD): Centers for Medicare and Medicaid Services; 2012. Available from: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/Downloads/2012Chartbook.pdf. Accessed April 24, 2015.
4. 4.↵
   Centers for Medicare and Medicaid Services. Solicitation for proposals for the Medicare Coordinated Care Demonstration. Baltimore (MD): Centers for Medicare and Medicaid Services; 2000. Available from: http://www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/downloads/CC_Solicitation_p.pdf. Accessed April 24, 2015.
5. 5.↵
   National Center for Chronic Disease Prevention and Health Promotion. At a glance: 2015: National Center for Chronic Disease Prevention and Health Promotion; 2015. Available from: http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2015/nccdphp-aag.pdf. Accessed July 28, 2015.
6. 6.↵
   1. Pham HH,
   2. O'Malley AS,
   3. Bach PB,
   4. Saiontz-Martinez C,
   5. Schrag D

   . Primary care physicians' links to other physicians through Medicare patients: The scope of care coordination. Ann Intern Med 2009;150:236–42.

   OpenUrlCrossRefPubMedWeb of Science
7. 7.↵
   1. McDonald KM,
   2. Sundaram V,
   3. Bravata DM,
   4. et al

   . Closing the quality gap: a critical analysis of quality improvement strategies (Vol. 7: care coordination). Rockville (MD): Agency for Healthcare Research and Quality; 2007. Available from http://www.ncbi.nlm.nih.gov/books/NBK44015/pdf/TOC.pdf. Accessed April 24, 2015.
8. 8.↵
   1. Berwick DM,
   2. Nolan TW,
   3. Whittington J

   . The triple aim: care, health, and cost. Health Aff (Millwood) 2008;27:759–69.

   OpenUrlAbstract/FREE Full Text
9. 9.↵
   H.R.2 – Medicare Access and CHIP Reauthorization Act of 2015. 2015. Available from: https://www.congress.gov/bill/114th-congress/house-bill/2/text. Accessed April 25, 2015.
10. 10.↵
    Centers for Medicare & Medicaid Services. Details for title: CMS-1612-P. Baltimore (MD): Centers for Medicare & Medicaid Services; 2014. Available from http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1612-P.html?DLPage=1&DLSort=2&DLSortDir=descending. Accessed April 24, 2015.
11. 11.↵
    1. Brown R,
    2. Peikes D,
    3. Chen A,
    4. Schore J

    . 15-site randomized trial of coordinated care in Medicare FFS. Health Care Financ Rev 2008;30:5–25.

    OpenUrlPubMedWeb of Science
12. 12.↵
    1. Brown R,
    2. Peikes D,
    3. Chen A,
    4. Ng J,
    5. Schore J,
    6. Soh C

    . The evaluation of the Medicare Coordinated Care Demonstration: findings for the first two years. Princeton (NJ): Mathematica Policy Research; 2007. Available from: http://innovation.cms.gov/Files/x/Evaluation-of-Medicare-Coordinated-Care.pdf. Accessed April 24, 2015.
13. 13.↵
    1. McCall N,
    2. Cromwell J,
    3. Urato C

    . Evaluation of Medicare Care Management for High Cost Beneficiaries (CMHCB) Demonstration: Massachusetts General Hospital and Massachusetts General Physicians Organization (MGH). Final report. Research Triangle Park (NC): RTI International; 2010. Available from: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/mccall_mgh_cmhcb_final_2010.pdf. Accessed April 24, 2015.
14. 14.↵
    1. McCall N,
    2. Cromwell J,
    3. Smith K,
    4. Urato C

    . Evaluation of Medicare Care Management for High Cost Beneficiaries (CMHCB) Demonstration: The Health Buddy Consortium (HBC). Revised final report. Research Triangle Park (NC): RTI International; 2011. Available from: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/McCall_Eval_of_CMHCB_Demo_April_2011.pdf. Accessed April 24, 2015.
15. 15.↵
    1. McCall N,
    2. Cromwell J,
    3. Urato C,
    4. Eng T

    . Evaluation of Medicare Care Management for High Cost Beneficiaries (CMHCB) Demonstration: Care Level Management (CLM). Final report. Research Triangle Park (NC): RTI International; 2010. Available from: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/CMHCB_CLM_McCall_2010.pdf. Accessed April 24, 2015.
16. 16.↵
    1. McCall N,
    2. Cromwell J,
    3. Urato C

    . Evaluation of Medicare Care Management for High Cost Beneficiaries (CMHCB) Demonstration: VillageHealth's Key to Better Health (KTBH). Final report. Research Triangle Park (NC): RTI International; 2010. Available from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/McCall_KTBH_Final_2010.pdf. Accessed April 24, 2015.
17. 17.↵
    1. McCall N,
    2. Cromwell J,
    3. Urato C

    . Evaluation of Medicare Care Management for High Cost Beneficiaries (CMHCB) Demonstration: Montefiore Medical Center's Care Guidance Program (CGP). Revised final report. Research Triangle Park (NC): RTI International; 2011. Available from: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/McCall_MontefioreFinalReport_May_2011.pdf. Accessed April 24, 2015.
18. 18.↵
    1. McCall N,
    2. Cromwell J,
    3. Urato C,
    4. Eng T

    . Evaluation of Medicare Care Management for High Cost Beneficiaries (CMHCB) Demonstration: Texas Senior Trails (TST). Final report. Research Triangle Park (NC): RTI International; 2010. Available from: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/CMHCB_TST_McCall_2010.pdf. Accessed April 24, 2015.
19. 19.↵
    Patient-Centered Primary Care Collaborative. Defining the medical home. Washington (DC): Patient-Centered Primary Care Collaborative; 2013. Available from: http://www.pcpcc.org/about/medical-home. Accessed April 24, 2015.
20. 20.↵
    Patient Protection and Affordable Care Act of 2010, PL 111–148, sec. 3021.
21. 21.↵
    1. Barr MS,
    2. Foote SM,
    3. Krakauer R,
    4. Mattingly PH

    . Lessons for the new CMS Innovation Center from the Medicare Health Support Program. Health Aff (Millwood) 2010;29:1305–9.

    OpenUrlAbstract/FREE Full Text
22. 22.↵
    1. Buxbaum J,
    2. Takach M

    . State multi-payer medical home initiatives and Medicare's Advanced Primary Care Demonstration. Washington (DC): National Academy for State Health Policy; 2010. Available from http://www.nashp.org/sites/default/files/MedHomesWebinar.pdf. Accessed April 24, 2015.
23. 23.↵
    Centers for Medicare and Medicaid Services. Multi-payer Advanced Primary Care Practice Demonstration. Questions & answers—updated April 12, 2011. Baltimore (MD): Centers for Medicare and Medicaid Services; 2011. Available from: http://www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/downloads/mapcpdemo_QA.pdf. Accessed April 24, 2015.
24. 24.↵
    1. Friedberg MW,
    2. Schneider EC,
    3. Rosenthal MB,
    4. Volpp KG,
    5. Werner RW

    . Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care. JAMA 2014;311:815–25.

    OpenUrlCrossRefPubMedWeb of Science
25. 25.↵
    Center for Medicare and Medicaid Intervention. Comprehensive Primary Care (CPC) Initiative: primary care practice solicitation. Baltimore (MD): Centers for Medicare and Medicaid Services; 2011. Available from: http://innovation.cms.gov/Files/x/CPC_PracticeSolicitation.pdf. Accessed April 24, 2015.
26. 26.↵
    Centers for Medicare and Medicaid Services. FAQ: the CPC initiative and participation in other CMS initiatives. Baltimore (MD): Centers for Medicare and Medicaid Services; 2012. Available from: http://innovation.cms.gov/Files/x/Comprehensive-Primary-Care-Initiative-Frequently-Asked-Questions.pdf. Accessed April 24, 2015.
27. 27.↵
    1. Sautter K,
    2. Schore J,
    3. Brown R,
    4. Aliotta S,
    5. Peikes D,
    6. Orzol S

    . The CorSolutions Medicare Coordinated Care Demonstration Program after one year. Final report. Princeton (NJ): Mathematica Policy Research; 2005. Available from: http://www.mathematica-mpr.com/∼/media/publications/pdfs/corsolutionsoneyear.pdf. Accessed April 24, 2015.
28. 28.↵
    1. Archibald N,
    2. Schore J,
    3. Brown R,
    4. Peikes D,
    5. Orzol S

    . The University of Maryland Medicare Coordinated Care Demonstration Program after one year. Princeton (NJ): Mathematica Policy Research; 2005. Available from: http://www.mathematica-mpr.com/publications/PDFs/universityofMD.pdf. Accessed April 24, 2015.
29. 29.
    1. Sautter K,
    2. Schore J,
    3. Brown R,
    4. Chen A,
    5. Peikes D,
    6. Orzol S

    . The Georgetown Medicare Coordinated Care Demonstration Program after one year. Final report. Princeton (NJ): Mathematica Policy Research; 2004. Available from: http://www.mathematica-mpr.com/∼/media/publications/PDFs/georgetownoneyear.pdf. Accessed April 24, 2015.
30. 30.
    1. Archibald N,
    2. Schore J,
    3. Brown R,
    4. Peikes D,
    5. Orzol S

    . The Jewish Home and Hospital Lifecare System Medicare Coordinated Care Demonstration Program after one year. Final report. Princeton (NJ): Mathematica Policy Research; 2005. Available from: http://www.mathematica-mpr.com/∼/media/publications/PDFs/jewishhomeoneyear.pdf. Accessed April 24, 2015.
31. 31.
    1. Sautter K,
    2. Schore J,
    3. Brown R,
    4. Aliotta S,
    5. Peikes D,
    6. Orzol S

    . The Avera Medicare Coordinated Care Demonstration Program after one year. Princeton (NJ): Mathematica Policy Research; 2005. Available from: http://www.mathematica-mpr.com/publications/PDFs/averaoneyear.pdf. Accessed April 24, 2015.
32. 32.
    1. Chen A,
    2. Sautter K,
    3. Schore J,
    4. Brown R,
    5. Peikes D,
    6. Orzol S

    . The Medical Care Development Medicare Coordinated Care Demonstration Program after one year. Final report. Princeton (NJ): Mathematica Policy Research; 2005. Available from: http://www.mathematica-mpr.com/∼/media/publications/pdfs/medicalcare.pdf. Accessed April 24, 2015.
33. 33.↵
    1. Sautter K,
    2. Schore J,
    3. Brown R,
    4. Aliotta S,
    5. Peikes D,
    6. Orzol S

    . The Mercy Medicare Coordinated Care Demonstration Program after one year. Final report. Princeton (NJ): Mathematica Policy Research; 2004. Available from: http://www.mathematica-mpr.com/publications/PDFs/mercyoneyear.pdf. Accessed April 24, 2015.
34. 34.
    1. Archibald N,
    2. Schore J,
    3. Brown R,
    4. Peikes D,
    5. Orzol S

    . The Charlestown Retirement Community Medicare Coordinated Care Demonstration Program after one year. Final report. Princeton (NJ): Mathematica Policy Research; 2005. Available from: http://www.mathematica-mpr.com/∼/media/publications/pdfs/charlestown.pdf. Accessed April 24, 2015.
35. 35.
    1. Archibald N,
    2. Schore J,
    3. Brown R,
    4. Peikes D,
    5. Orzol S

    . The Hospice of the Valley's Medicare Coordinated Care Demonstration Program after one year. Final report. Princeton (NJ): Mathematica Policy Research; 2005. Available from: http://www.mathematica-mpr.com/∼/media/publications/PDFs/hospiceoneyear.pdf. Accessed April 24, 2015.
36. 36.
    1. Archibald N,
    2. Schore J,
    3. Brown R,
    4. Peikes D,
    5. Orzol S

    . The Washington University Medicare Coordinated Care Demonstration Program after one year. Final report. Princeton (NJ): Mathematica Policy Research; 2005. Available from: http://www.mathematica-mpr.com/∼/media/publications/PDFs/washingtonunivoneyear.pdf. Accessed April 24, 2015.
37. 37.
    1. Schore J,
    2. Brown R,
    3. Peikes D,
    4. Orzol S

    . The Carle Medicare Coordinated Care Demonstration Program after one year. Princeton (NJ): Mathematica Policy Research; 2005. Available from: https://cire.mathematica-mpr.com/∼/media/publications/pdfs/carle.pdf. Accessed April 24, 2015.
38. 38.
    1. Chen A,
    2. Schore J,
    3. Brown R,
    4. Peikes D,
    5. Orzol S,
    6. Soh C,
    7. Sautter K

    . The Quality Oncology Medicare Coordinated Care Demonstration Program after one year. Final report. Princeton (NJ): Mathematica Policy Research; 2005. Available from: http://www.mathematica-mpr.com/∼/media/publications/pdfs/qualityoncology.pdf. Accessed April 24, 2015.
39. 39.
    1. Archibald N,
    2. Schore J,
    3. Brown R,
    4. Peikes D,
    5. Orzol S

    . The Health Quality Partners Medicare Coordinated Care Demonstration Program after one year. Final report. Princeton (NJ): Mathematica Policy Research; 2005. Available from: http://www.mathematica-mpr.com/∼/media/publications/PDFs/healthqualitypartners.pdf. Accessed April 24, 2015.
40. 40.
    1. Sautter K,
    2. Schore J,
    3. Brown R,
    4. Aliotta S,
    5. Peikes D,
    6. Orzol S

    . The Qmed Medicare Coordinated Care Demonstration Program after one year. Final report. Princeton (NJ): Mathematica Policy Research; 2005. Available from: http://www.mathematica-mpr.com/∼/media/publications/pdfs/qmedoneyear.pdf. Accessed April 24, 2015.
41. 41.
    1. Archibald N,
    2. Schore J,
    3. Brown R,
    4. Peikes D,
    5. Orzol S

    . The CenVaNet Medicare Coordinated Care Demonstration Program after one year. Final report. Princeton (NJ): Mathematica Policy Research; 2005. Available from: http://www.mathematica-mpr.com/∼/media/publications/pdfs/cenvanet.pdf. Accessed April 24, 2015.
42. 42.
    Multi-payer Advanced Primary Care Practice Demonstration Application. Minneapolis: Minnesota Department of Health, Minnesota Department of Human Services; 2010. Available from: http://www.health.state.mn.us/healthreform/homes/medicare/MN_MAPCPApplication.pdf. Accessed April 24, 2015.
43. 43.
    1. Cosway R,
    2. Girod C,
    3. Abbott B

    . Analysis of Community Care of North Carolina cost savings. San Diego (CA): Milliman, Inc.; 2011. Available from: http://www.ncqa.org/Portals/0/Public%20Policy/NC_milliman-executive-summary_8.30.12.pdf. Accessed April 24, 2015.
44. 44.
    Maine patient centered medical home pilot memorandum of agreement for participation. Maine PCMH pilot expansion & MAPCP demonstration. Addendum. Available from: http://www.mainequalitycounts.org/image_upload/PCMH%20Pilot%20Practice%20Memorandum%20of%20Agreement%20Addendum%202012.pdf. Accessed April 24, 2015.
45. 45.
    Michigan primary care transformation project. Michigan Department of Community Health: 2011. Available from http://the-carebridge.com/sites/default/files/pdfs/MiPCT-Summary.pdf. Accessed July 29, 2015.
46. 46.
    Vermont Blueprint for Health implementation manual. Williston (VT): Department of Vermont Health Access; 2010. Available from http://blueprintforhealth.vermont.gov/sites/blueprint/files/BlueprintPDF/printforhealthimplementationmanual2010-11-17.pdf. Accessed April 24, 2015.
47. 47.
    1. Gabbay RA,
    2. Bailit MH,
    3. Mauger DT,
    4. Wagner EH,
    5. Siminerio L

    . Multipayer patient-centered medical home implementation guided by the chronic care model. Jt Comm J Qual Patient Saf 2011;37:265–73.

    OpenUrlPubMed
48. 48.
    CSI-RI: strategic planning. Final plan. PCMH Rhode Island. 2013. Available from http://www.pcmhri.org/files/uploads/CSI_Strategic_Plan_Summary%20March%202013.pdf. Accessed April 24, 2015.
49. 49.
    1. Peikes D,
    2. Chen A,
    3. Schore J,
    4. Brown R

    . Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries. JAMA. 2009;301:603–18.

    OpenUrlCrossRefPubMedWeb of Science
50. 50.↵
    Implementation support and payment processing for the Multi-payer Advanced Primary Care Practice Demonstration. Baltimore (MD): Centers for Medicare and Medicaid Services; 2011. Available from: http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R81DEMO.pdf. Accessed April 25, 2015.
51. 51.↵
    1. Baker LC,
    2. Macaulay DS,
    3. Sorg RA,
    4. Diener MD,
    5. Johnson SJ,
    6. Birnbaum

    . Effects of care management and telehealth: a longitudinal analysis using Medicare data. J Am Geriatr Soc 2013;61:1560–7.

    OpenUrlPubMed
52. 52.↵
    1. Bielaszka-DuVernay C

    . Vermont's Blueprint for medical homes, community health teams, and better health at lower cost. Health Aff (Millwood) 2011;30:383–6.

    OpenUrlFREE Full Text
53. 53.↵
    1. Brown RS,
    2. Peikes D,
    3. Peterson G,
    4. Schore J,
    5. Razafindrakoto CM

    . Six features of Medicare Coordinated Care Demonstration Programs that cut hospital admissions of high-risk patients. Health Aff (Millwood) 2012;31:1156–66.

    OpenUrlAbstract/FREE Full Text
54. 54.↵
    1. Tai-Seale M,
    2. McGuire TG,
    3. Zhang W

    . Time allocation in primary care office visits. Health Serv Res 2007;42:1871–94.

    OpenUrlCrossRefPubMedWeb of Science
55. 55.↵
    1. Peikes D,
    2. Peterson G,
    3. Brown RS,
    4. Graff S,
    5. Lynch JP

    . How changes in Washington University's Medicare Coordinated Care Demonstration pilot ultimately achieved savings. Health Aff (Millwood) 2012;31:1216–26.

    OpenUrlAbstract/FREE Full Text
56. 56.↵
    1. Starfield B,
    2. Shi L,
    3. Macinko J

    . Contributions of primary care to health systems and health. Milbank Q 2005;83:457–502.

    OpenUrlCrossRefPubMedWeb of Science
57. 57.↵
    Institute of Medicine. Integrating primary care and public health. Washington (DC): National Academies Press; 2012.