A nationwide survey of patient centered medical home demonstration projects.
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.


METHODS
Cross-sectional key-informant interviews.


METHODS
Leaders from existing PCMH demonstration projects with external payment reform.


METHODS
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.


CONCLUSIONS
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.
Bitton
Asaf
A
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115-5899, USA.
Martin
Carina
C
Landon
Bruce E
BE
D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006801:Humans; D018802:Patient-Centered Care / Q000458:organization & administration*; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D014481:United States
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