Abstract
Background
The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country.
Design
Cross-sectional key-informant interviews.
Participants
Leaders from existing PCMH demonstration projects with external payment reform.
Measurements
We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design.
Results
A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified—consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans.
Conclusion
Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows.
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Acknowledgements
The authors would like to thank all of the survey respondents for their willingness to participate in the study. This study was funded in part by grants from the Agency for Health Care Research and Quality, the Commonwealth Fund, and The American Board of Internal Medicine Foundation. Dr. Bitton is supported by grant number T32HP10251 from the Health Resources and Services Administration of the Department of Health and Human Services to support the Harvard Medical School Fellowship in General Medicine and Primary Care. The study contents are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Services.
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Appendix 1
Excluded Demonstration Projects (DOC 105 kb)
Appendix 2
Transformation Part I (DOC 89 kb)
Appendix 3
Transformation Part II (DOC 88 kb)
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Bitton, A., Martin, C. & Landon, B.E. A Nationwide Survey of Patient Centered Medical Home Demonstration Projects. J GEN INTERN MED 25, 584–592 (2010). https://doi.org/10.1007/s11606-010-1262-8
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DOI: https://doi.org/10.1007/s11606-010-1262-8