title: Case study of a primary care-based accountable care system approach to medical home transformation.
abstract: We report a case study of a mature primary care-based accountable care organization that is both a health plan and a network of medical homes. Over 20 years, WellMed Inc (San Antonio, Texas) implemented many patient-centered services, experimenting to find which belong within clinics and which operate best as system functions. The adjusted mortality rate is half that of the state for people older than 65 years. Hospitalization and readmission rates and emergency department visits have not changed over time, but preventive services have improved. Phased implementation across the network makes it difficult to link improvements to specific processes but they seem to have improved outcomes collectively.
authors.affiliation: The Robert Graham Center, Washington, District of Columbia 20036, USA. bphillips@aafp.org
authors.forename: Robert L
authors.initials: RL
authors.lastname: Phillips
authors.forename: Svetlana
authors.initials: S
authors.lastname: Bronnikov
authors.forename: Stephen
authors.initials: S
authors.lastname: Petterson
authors.forename: Maribel
authors.initials: M
authors.lastname: Cifuentes
authors.forename: Bridget
authors.initials: B
authors.lastname: Teevan
authors.forename: Martey
authors.initials: M
authors.lastname: Dodoo
authors.forename: Wilson D
authors.initials: WD
authors.lastname: Pace
authors.forename: David R
authors.initials: DR
authors.lastname: West
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D017146:Models, Organizational; D019982:Organizational Case Studies; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D013781:Texas