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J Gen Intern Med. 2010 Jun;25(6):584-92. doi: 10.1007/s11606-010-1262-8.

A nationwide survey of patient centered medical home demonstration projects.

Author information

  • 1Department of Health Care Policy, Harvard Medical School, Boston, MA 02115-5899, USA.

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.

PMID:
20467907
[PubMed - indexed for MEDLINE]
PMCID:
PMC2869409
Free PMC Article
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