title: Multipayer patient-centered medical home implementation guided by the chronic care model.
abstract: BACKGROUND
  A unique statewide multipayer ini Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) guided by the Chronic Care Model (CCM) with diabetes as an initial target disease. This project represents the first broad-scale CCM implementation with payment reform across a diverse range of practice organizations and one of the largest PCMH multipayer initiatives.
  
  
  METHODS
  Practices implemented the CCM and PCMH through regional Breakthrough Series learning collaboratives, supported by Improving Performance in Practice (IPIP) practice coaches, with required monthly quality reporting enhanced by multipayer infrastructure payments. Some 105 practices, representing 382 primary care providers, were engaged in the four regional collaboratives. The practices from the Southeast region of Pennsylvania focused on diabetes patients (n = 10,016).
  
  
  RESULTS
  During the first intervention year (May 2008-May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients.
  
  
  CONCLUSIONS
  Transforming primary care delivery through implementation of the PCMH and CCM supported by multipayer infrastructure payments holds significant promise to improve diabetes care.
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Penn State College of Medicine, USA. rgabbay@hmc.psu.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Gabbay
authors.forename: Michael H
authors.initials: MH
authors.lastname: Bailit
authors.forename: David T
authors.initials: DT
authors.lastname: Mauger
authors.forename: Edward H
authors.initials: EH
authors.lastname: Wagner
authors.forename: Linda
authors.initials: L
authors.lastname: Siminerio
mesh_terms: D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000191:economics / Q000517:prevention & control / Q000628:therapy*; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D006284:Health Plan Implementation / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D017146:Models, Organizational; D018802:Patient-Centered Care / Q000191:economics / Q000592:standards* / Q000639:trends; D010414:Pennsylvania; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards*