Table 2. Characteristics of Medicare Demonstration Projects That Focus on Care Coordination

	Medicare Coordinated Care Demonstration	Care Management for High-Cost Beneficiaries Demonstration	Multi-Payer Advanced Primary Care Practice Demonstration	Comprehensive Primary Care Initiative
Start year	2002	2005	2011	2012
Duration (years)	4	3	3	4
Patients involved (n)	∼16,000	∼28,000	∼900,000	∼313,000
Programs/states involved	15 Programs	6 Programs	8 States	7 Markets in 8 states
Payer(s) involved	Medicare	Medicare	Medicare, Medicaid, private health plans	Medicare, Medicaid, private health plans
Program goal(s)	Determine whether case management and disease management programs can lower costs and improve patient outcomes	Determine whether pay-for-performance and new strategies for complex, high-cost patients, reduce costs, improve quality, and improve beneficiary and provider satisfaction	Assess the effect of advanced primary care practice (ie, the patient-centered medical home) on health care effectiveness, quality, patient engagement, and cost	Test whether comprehensive primary care, coupled with payment reform, use of data to guide improvement, and meaningful use of health information technology, can achieve the 3-part aim of better care, improved health, and reduced costs
Who designed the intervention?	Programs	Programs	States	Centers for Medicare and Medicaid Services
Evaluation
Design	Patients were randomized and controlled	Patients were randomized and controlled	Evaluation is ongoing	Evaluation is ongoing
Expenses	Three (Health Quality Partners, Georgetown, and Mercy) cost less than controls Two (Health Quality Partners and Georgetown) had savings enough to offset fees.⁴⁹	One (Massachusetts General Hospital) achieved cost savings¹³	Evaluation is ongoing
Hospitalizations/mortality	One (Mercy) had fewer hospitalizations than controls	Three (Health Buddy Consortium, Massachusetts General Hospital, and CareLevel Management) had lower all-cause hospitalization rates^13–15 Two (Massachusetts General Hospital and the Health Buddy Consortium) achieved mortality reductions.^13,14
Payment structure on top of fee-for-service	Per-enrollee, per-month payments only	Monthly payments were held at risk based on performance. There was also a shared savings provision.	Per-beneficiary, per-month payment (dependent on patient complexity and the medical home level achieved by the practice) Community health teams also receive payments.	Shared savings (in years 3 and 4) in addition to per-beneficiary, per-month payments
Shared savings component	No	Yes	Yes (1 of the 8 states)	Yes
Community health teams	No	No	Yes (5 of the 8 states)	No
Per-enrollee, per-month range ($)	50–437	117–295	0.60–58.50 (for care management fees) 1.16–6.50 (for community health teams)	8–40