Table 2. Characteristics of Medicare Demonstration Projects That Focus on Care Coordination
Medicare Coordinated Care DemonstrationCare Management for High-Cost Beneficiaries DemonstrationMulti-Payer Advanced Primary Care Practice DemonstrationComprehensive Primary Care Initiative
Start year2002200520112012
Duration (years)4334
Patients involved (n)∼16,000∼28,000∼900,000∼313,000
Programs/states involved15 Programs6 Programs8 States7 Markets in 8 states
Payer(s) involvedMedicareMedicareMedicare, Medicaid, private health plansMedicare, Medicaid, private health plans
Program goal(s)Determine whether case management and disease management programs can lower costs and improve patient outcomesDetermine whether pay-for-performance and new strategies for complex, high-cost patients, reduce costs, improve quality, and improve beneficiary and provider satisfactionAssess the effect of advanced primary care practice (ie, the patient-centered medical home) on health care effectiveness, quality, patient engagement, and costTest 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?ProgramsProgramsStatesCenters for Medicare and Medicaid Services
    DesignPatients were randomized and controlledPatients were randomized and controlledEvaluation is ongoingEvaluation is ongoing
    ExpensesThree (Health Quality Partners, Georgetown, and Mercy) cost less than controls Two (Health Quality Partners and Georgetown) had savings enough to offset fees.49One (Massachusetts General Hospital) achieved cost savings13Evaluation is ongoing
    Hospitalizations/mortalityOne (Mercy) had fewer hospitalizations than controlsThree (Health Buddy Consortium, Massachusetts General Hospital, and CareLevel Management) had lower all-cause hospitalization rates1315 Two (Massachusetts General Hospital and the Health Buddy Consortium) achieved mortality reductions.13,14
Payment structure on top of fee-for-servicePer-enrollee, per-month payments onlyMonthly 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 componentNoYesYes (1 of the 8 states)Yes
Community health teamsNoNoYes (5 of the 8 states)No
Per-enrollee, per-month range ($)50–437117–2950.60–58.50 (for care management fees) 1.16–6.50 (for community health teams)8–40