PCPCC PCMH Evidence Report Feb 2016

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PAGE 1 The Patient-Centered Medical Home’s Impact on Cost and Quality Annual Review of Evidence 2014-2015 Published February 2016 Authors: Marci Nielsen, PhD, MPH Lisabeth Buelt, MPH Kavita Patel, MD, MS Len M. Nichols, PhD, MS, MA Made possible with support from the Milbank Memorial Fund

Transcript of PCPCC PCMH Evidence Report Feb 2016

Page 1: PCPCC PCMH Evidence Report Feb 2016

PAGE 1

The Patient-Centered Medical Home’s Impact on Cost and Quality Annual Review of Evidence 2014-2015Published February 2016

Authors:

Marci Nielsen, PhD, MPH

Lisabeth Buelt, MPH

Kavita Patel, MD, MS

Len M. Nichols, PhD, MS, MA

Made possible with

support from the

Milbank Memorial Fund

601 13th Street NWSuite 430 N

Washington, DC 20005www.pcpcc.org

Page 2: PCPCC PCMH Evidence Report Feb 2016

ABOUT THE PATIENT-CENTERED PRIMARY CARE COLLABORATIVE (PCPCC) )RXQGHG�LQ�������WKH�3&3&&�LV�D�QRW�IRU�SUR÷�W�PHPEHUVKLS�RUJDQL]DWLRQ�GHGLFDWHG�WR�DGYDQFLQJ�DQ�

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transformation. For more information, or to become an executive member, visit www.pcpcc.org.

ABOUT THE MILBANK MEMORIAL FUND 7KH�0LOEDQN�0HPRULDO�)XQG�LV�DQ�HQGRZHG�RSHUDWLQJ�IRXQGDWLRQ�WKDW�ZRUNV�WR�LPSURYH�WKH�KHDOWK�RI�

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www.milbank.org.

AUTHORSMarci Nielsen, PhD, MPH

Chief ExecutLYH�2I÷�FHU��PCPCC

Lisabeth Buelt, MPH3ROLF\�DQG�5HVHDUFK�0DQDJHU��PCPCC

Kavita Patel, MD, MSNonresident Senior Fellow, Economic Studies, The Brookings Institution

Len M. Nichols, PhD, MS, MA 'LUHFWRU��&HQWHU�IRU�+HDOWK�3ROLF\�5HVHDUFK�DQG�(WKLFV��George Mason University

The Patient-Centered Medical Home’s Impact on Cost and QualityAnnual Review of Evidence 2014-20153DWLHQW�&HQWHUHG�3ULPDU\�&DUH�&ROODERUDWLYH

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ACKNOWLEDGMENTS7KH�3&3&&�DQG�WKH�0LOEDQN�0HPRULDO�)XQG�JUDWHIXOO\�DFNQRZOHGJH�WKH�IROORZLQJ�LQGLYLGXDOV�IRU�WKHLU�

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REVIEWERS Christine Bechtel, MA

President and CEO, Bechtel Health;

Advisor, National Partnership for Women & Families

Asaf Bitton, MD, MPH

Director, Primary Health Care Performance Initiative at Ariadne Labs;

$VVLVWDQW�3URIHVVRU�RI�0HGLFLQH�DQG�+HDOWK�&DUH�3ROLF\��Brigham and Women’s Hospital &

Harvard Medical School

Jean Malouin, MD, MPH

Medical Director, Value Partnerships, Blue Cross Blue Shield of Michigan�

Assistant Professor, Associate Medical Director, University of Michigan Medical Group

Mary Minniti, BS, CPHQ

6HQLRU�3ROLF\�DQG�3URJUDP�6SHFLDOLVW��Institute for Patient- and Family-Centered Care

Bob Phillips, MD, MPH

9LFH�3UHVLGHQW�RI�5HVHDUFK�DQG�3ROLF\� American Board of Family Medicine

Sarah Hudson Scholle, DrPH, MPH

9LFH�3UHVLGHQW�RI�5HVHDUFK�DQG�$QDO\VLV��National Committee for Quality Assurance

Lisa Dulsky Watkins, MD

Director, Milbank Memorial Fund Multi-State Collaborative

Reviewer Disclaimer: $OWKRXJK�WKH�UHYLHZHUV�OLVWHG�DERYH�SURYLGHG�PDQ\�FRQVWUXFWLYH�FRPPHQWV�DQG�

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would like to thank Christopher Koller, President of the Milbank Memorial Fund, and his staff for their

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PCPCC STAFF

Marci Nielsen, PhD, MPH

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Lisabeth Buelt, MPH

3ROLF\�DQG�5HVHDUFK�0DQDJHU

Amy Gibson, RN, MS

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Tara Hacker, MSPH

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Katy Hill, MS

Administrative Coordinator

Amanda Holt, MPH

Director of Communications &

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Fatema Salam, MPH

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PCPCC BOARD OF DIRECTORS

Douglas Henley, MD, FAAFP, Chair

([HFXWLYH�9LFH�3UHVLGHQW��&KLHI�([HFXWLYH�2I÷�FHU��

American Academy of Family Physicians

Jill Rubin Hummel, JD, Chair-Elect

3UHVLGHQW��*HQHUDO�0DQDJHU��Anthem Blue Cross and Blue Shield of Connecicut

Andrew Webber, Treasurer

&KLHI�([HFXWLYH�2I÷�FHU��Maine Health Management Coalition

Susan Edgman-Levitan, PA-C

Executive Director, John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital

Elizabeth J. Fowler, PhD, JD

9LFH�3UHVLGHQW��*OREDO�+HDOWK�3ROLF\��Johnson & Johnson

Paul Grundy, MD, MPH, FACOEM

*OREDO�'LUHFWRU��+HDOWKFDUH�7UDQVIRUPDWLRQ��IBM)RXQGLQJ�3UHVLGHQW� PCPCC

David Hebert, JD

&KLHI�([HFXWLYH�2I÷�FHU��American Association of Nurse Practitioners

Beverley H. Johnson

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Institute for Patient- and Family-Centered Care

Hal C. Lawrence III, MD

([HFXWLYH�9LFH�3UHVLGHQW��&KLHI�([HFXWLYH�2I÷�FHU��

The American College of Obstetricians and Gynecologists

David K. Nace, MD

&KLHI�0HGLFDO�2I÷�FHU��MarkLogic

Marci Nielsen, PhD, MPH

&KLHI�([HFXWLYH�2I÷�FHU� Patient-Centered Primary Care Collaborative

Karen Remley, MD, MBA, MPH, FAAP

([HFXWLYH�'LUHFWRU��&KLHI�([HFXWLYH�2I÷�FHU��

American Academy of Pediatrics

Steven E. Weinberger, MD, FACP

([HFXWLYH�9LFH�3UHVLGHQW��&KLHI�([HFXWLYH�2I÷�FHU��

American College of Physicians

Adrienne White-Faines, MPA

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American Osteopathic Association

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TABLE OF CONTENTS

EXECUTIVE SUMMARY .........................................................................................................4

SECTION ONE:A CHANGING POLICY LANDSCAPE ............................................................................. ...6

Why PCMH? The Case for Increased Investment in Primary Care ............................................... 6

'H÷�QLWLRQ�RI�0HGLFDO�+RPH��,Q�1HHG�RI�D�8QL÷�HG�9LHZ ................................................................... 7

PCMH and Primary Care Innovations: Growing in Size and Scope .............................................. 8

New Era: Delivery Reform Meets Payment Reform .......................................................................... 8

Payment Reform & PCMH: Value-based Purchasing in the Public and Private Sector ......... 9

Multi-payer Collaboratives: Opportunities for Alignment & Health System Redesign ......10

Payment Reform & Medicare .................................................................................................................11

SECTION TWO:NEW EVIDENCE FOR PCMH AND INNOVATIONS IN PRIMARY CARE ...........12

Methods ..........................................................................................................................................................12

Table 1. Peer-Reviewed Studies ..............................................................................................................14

Table 2. State Government Evaluations ...............................................................................................21

Table 3. Industry Reports ..........................................................................................................................23

Table 4. Independent Evaluations of Federal Initiatives .................................................................26

SECTION THREE: DISCUSSION OF FINDINGS AND IMPLICATIONS ................................................28

Peer-Reviewed Studies (Table 1) ............................................................................................................28

State Government Evaluations (Table 2)..............................................................................................30

Industry Reports (Non Peer-Reviewed) (Table 3) .............................................................................31

Independent Evaluations of Federal Initiatives (Table 4) ...............................................................31

Payment Model Insights and the Importance of Multi-Payer Initiatives ..................................32

Challenges in Evaluating Primary Care PCMH Interventions ......................................................33

CONCLUSION ........................................................................................................................ 33

APPENDIX 1: EDUCATIONAL INFOGRAPHIC FOR PATIENTS AND FAMILIES ........................ 35

REFERENCES .......................................................................................................................... 36

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Key points from this year’s evidence review include:

Controlling Costs by Right Sizing Care: Advanced primary care is foundational to delivery system transformation — medical home initiatives continue to reduce health care costs and unnecessary utilization of services

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30 total studies

17 peer-reviewed studies � VWDWH�JRYHUQPHQW�HYDOXDWLRQV6�LQGXVWU\�UHSRUWV

� independent evaluations of federal initiatives

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Aligning Payment and Performance: Payment reform is necessary to sustain delivery system changes, but alignment across payers is critical for health care provider buy-in

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Assessing and Promoting Value: Measurement for PCMHs must be aligned and focused on value for patients, providers, and payers

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21 of 23 studies that reported on cost measures found reductions in one or more measures

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Aggregated Outcomes from the 30 Studies

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Why PCMH? The Case for Increased Investment in Primary Care

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health care spend can be attributed to overuse, underuse, and misuse of health care resources.9 The spread

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economic welfare.10

For most Americans, primary care serves as the entry point and touchstone of the health care system,

delivering and coordinating care for patients and families, with an emphasis on promoting population

health and managing chronic illness. As such, primary care is well positioned to help repair and

optimize our broken care delivery system. :LWK�JUHDWHU�LQYHVWPHQW�LQ�DQG�VXSSRUW�IRU�FRPSUHKHQVLYH�

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55% RI�DOO�PHGLFDO�RI÷�FH�YLVLWV�DUH�IRU�SULPDU\�FDUH

55%

EXW�RQO\���to 7% of health care GROODUV�DUH�VSHQW�RQ�SULPDU\�FDUH

4%

Page 9: PCPCC PCMH Evidence Report Feb 2016

PAGE 7

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WKH�$JHQF\�IRU�+HDOWKFDUH�5HVHDUFK�DQG�4XDOLW\12 are:

• Patient-centered: 7KH�3&0+�VXSSRUWV�SDWLHQWV�LQ�OHDUQLQJ�WR�PDQDJH�DQG�RUJDQL]H�WKHLU�RZQ�FDUH�

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• Comprehensive: The PCMH offers whole-person care from a team of providers that is accountable

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and chronic care.

• Coordinated: 7KH�3&0+�HQVXUHV�WKDW�FDUH�LV�RUJDQL]HG�DFURVV�DOO�HOHPHQWV�RI�WKH�EURDGHU�KHDOWK�

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care supports.

• Accessible: 7KH�3&0+�GHOLYHUV�DFFHVVLEOH�VHUYLFHV�ZLWK�VKRUWHU�ZDLWLQJ�WLPHV��HQKDQFHG�LQ�SHUVRQ�

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• Committed to Quality and Safety: 7KH�3&0+�GHPRQVWUDWHV�FRPPLWPHQW�WR�TXDOLW\�LPSURYHPHQW�

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all.” PCMH practices differ in terms of their implementation, measurement, and performance,�� and the

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Page 10: PCPCC PCMH Evidence Report Feb 2016

PAGE 8

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PCMH and Primary Care Innovations: Growing in Size and Scope

As this report and our PCMH innovations map16�GHPRQVWUDWH��WKH�QXPEHU�RI�SUDFWLFHV�WUDQVIRUPLQJ�

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Map is a comprehensive up-to-date resource.

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State View

National View

List View

Outcomes View

Primary Care Innovations and PCMH Map

New Era: Delivery Reform Meets Payment Reform

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Page 11: PCPCC PCMH Evidence Report Feb 2016

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broader commercial marketplace.

Payment Reform & PCMH: Value-based Purchasing in the Public and Private Sector

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Payment model Description 25

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Page 12: PCPCC PCMH Evidence Report Feb 2016

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Page 13: PCPCC PCMH Evidence Report Feb 2016

PAGE 11

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Page 14: PCPCC PCMH Evidence Report Feb 2016

PAGE 12

Medicare Access and CHIP Reauthorization Act (MACRA)

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METHODSInclusion Criteria: 7KLV�SXEOLFDWLRQ�LV�OLPLWHG�WR�VWXGLHV�WKDW�DVVHVVHG�FRVW�DQG�RU�XWLOL]DWLRQ�PHDVXUHV�DVVRFLDWHG�ZLWK�WKH�3&0+�PRGHO��FRQVLVWHQW�ZLWK�SUHYLRXV�HYLGHQFH�UHSRUWV��8VLQJ�3XE0HG�DQG�RWKHU�

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Type of Study: 7KH�WDEOHV�UHø�HFW�GLIIHUHQFHV�LQ�W\SH�RI�VWXG\�RU�DXWKRUVKLS��Table 1 includes results

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SD\HUV��RU�QRW�IRU�SUR÷�W�RUJDQL]DWLRQV��DQG�Table 4 contains results from independent evaluations of three

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Page 15: PCPCC PCMH Evidence Report Feb 2016

PAGE 13

Measures of Interest: 7KH�÷�UVW�FROXPQ�SURYLGHV�WKH�QDPH�DQG�RU�GHVFULSWLRQ�RI�WKH�3&0+�LQWHUYHQWLRQ��

the publication in which outcomes were reported, and the data review period. Due to space limitations

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is included under each table. The second column provides reported Cost & Utilization outcomes for

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included in this publication reported on at least one measure of cost or utilization. However, because some of

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report were those focused on GLVHDVH�VSHFL÷�F�QRQ�SULPDU\�FDUH medical home interventions (ex. asthma,

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as a failure to achieve improvement for that outcome but rather an indication that no information on that

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honor the original language of the study authors DQG�WKHUHIRUH�PLQLPL]HG�WDNLQJ�OLEHUWLHV�LQ�VXPPDUL]LQJ�

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Page 16: PCPCC PCMH Evidence Report Feb 2016

PAGE 14

Location/Initiative

Multi-State

CHIPRA Quality Demonstration Grant Program42

Published: Academic Pediatrics, May 2015

Data Review: 2010-2012 claims data

Study evaluated utilization and access measures

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• “Medical home-ness” not associated with receipt of ZHOO�FKLOG�YLVLW�LQ�DQ\�RI�WKH�evaluated samples

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National

Medicare Fee-for-6HUYLFH�%HQH÷�FLDULHV�in NCQA-Recognized PCMHs43

Published: Annals of Emergency Medicine, March 2015

Data Review: July 2007-June 2008 (baseline group); July 2008- June 2010 (comparison groups)

Study evaluated cost and utilization measures

Compared with non-PCMH practices, PCMHs had lower rate of growth for:• ('�SD\PHQWV�SHU�EHQH÷�FLDU\�������OHVV�IRU�����������OHVV�for 2010)

• $OO�FDXVH�('�YLVLWV�����IHZHU�in 2009, 12 fewer in 2010)

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Fee-for-service

Veterans Health Administration Patient Aligned Care Teams (PACTs)44

Published: American Journal of Managed Care, March 2015

Data Review: FY 2009 (baseline); FY 2011 (comparison group)

Study evaluated cost, utilization and access measures

• 7KH�RQO\�VLJQL÷�FDQW�LQFUHDVH�LQ�FRVW�ZDV�H[SODLQHG�E\�KLJK�ULVN�FRPRUELGLW\��p<.001)

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• +LJK�VFRUHV�LQ�FDUH�coordination and transitions in care decreased mean QXPEHU�RI�('�YLVLWV�E\������visits per patient (p �������EXW�KLJK�TXDOLW\�DQG�SHUIRUPDQFH�improvement increased ED YLVLWV�E\������YLVLWV�SHU�SDWLHQW�(p ������

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Single payer

Payment Model

Description Additional OutcomesCost & Utilization

���� &KULVWHQVHQ��$�/���=LFNDIRRVH��-�6���1DW]NH��%���0F0RUURZ��6����,UH\V��+�7����������$VVRFLDWLRQV�EHWZHHQ�SUDFWLFH�UHSRUWHG�PHGLFDO�KRPHQHVV�DQG�KHDOWK�FDUH�XWLOL]DWLRQ�DPRQJ�SXEOLFO\�LQVXUHG�FKLOGUHQ��Academic Pediatrics, 15�������������GRL����������M�DFDS��������������6WXG\�DXWKRUV�FRQGXFWHG�D�ÜFURVV�VHFWLRQDO�DQDO\VLV�DVVHVVLQJ�WKH�UHODWLRQVKLS�EHWZHHQ�SUDFWLFH�UHSRUWHG�PHGLFDO�ÙKRPHQHVVÚ�DQG�KHDOWK�VHUYLFH�XVH�E\�FKLOGUHQ�HQUROOHG�LQ�0HGLFDLG�LQ����SUDFWLFHV�LQ���VWDWHV�SDUWLFLSDWLQJ�LQ�WKH�&+,35$�4XDOLW\�'HPRQVWUDWLRQ�*UDQW�3URJUDP��,OOLQRLV��,/���1RUWK�&DUROLQD��1&���DQG�6RXWK�&DUROLQD��6&��Ý�:KLOH�UHGXFWLRQV�LQ�XWLOL]DWLRQ�ZHUH�UHDOL]HG�LQ�,OOLQRLV�SUDFWLFHV��QR�DVVRFLDWLRQ�ZDV�IRXQG�LQ�1RUWK�&DUROLQD�RU�6RXWK�&DUROLQD�SUDFWLFHV��

���� 3LQHV��-�0���.H\HV��9���9DQ�+DVVHOW��0����0F&DOO��1����������(PHUJHQF\�GHSDUWPHQW�DQG�LQSDWLHQW�KRVSLWDO�XVH�E\�0HGLFDUH�EHQH÷�FLDULHV�in patient-centered medical homes. Annals of Emergency Medicine, �������������GRL����������M�DQQHPHUJPHG��������������7KH�VWXG\�DXWKRUV�XVHG�D�UHWURVSHFWLYH��ORQJLWXGLQDO��SUDFWLFH�OHYHO�DQDO\VLV�WR�HYDOXDWH�RXWFRPHV�GDWD�IURP�1&4$�UHFRJQL]HG�3&0+�SUDFWLFHV�XVLQJ�0HGLFDUH�FODLPV�GDWD�IURP�)<����������FRPSDUHG�WR�EDVHOLQH�FODLPV�GDWD�IURP�-XO\������-XQH�������

���� <RRQ��-���/LX��&�)���/R��-���6FKHFWPDQ��*���6WDUN��5���5XEHQVWHLQ��/�9����<DQR��(�0����������(DUO\�FKDQJHV�LQ�9$�PHGLFDO�KRPH�FRPSRQHQWV�DQG�XWLOL]DWLRQ��American Journal of Managed Care, 21��������������6WXG\�DXWKRUV�FRQGXFWHG�D�ORQJLWXGLQDO�VWXG\��ZKLFK�HYDOXDWHG�SDWLHQWV�WKDW�KDG�DW�OHDVW�WZR�SULPDU\�FDUH�YLVLWV�LQ�)<������DQG�XVHG�DQ\�RXWSDWLHQW�FDUH�LQ�������7KH�VWXG\�VDPSOH�LQFOXGHG�����������SDWLHQWV�IURP�����FOLQLFV��7R�VXSSRUW�3$&7�LPSOHPHQWDWLRQ��WKH�9$�KLUHG�51�FDUH�PDQDJHUV�IRU�HDFK�3$&7�FDUH�WHDP��DV�ZHOO�DV�D�IXOO�WLPH�KHDOWK�SURPRWLRQ�VSHFLDOLVW�DQG�D�KHDOWK�EHKDYLRU�FRRUGLQDWRU�DW�HYHU\�9+$�IDFLOLW\�

TABLE 1: PEER-REVIEWED STUDIES: Primary Care/PCMH Interventions That Assessed Cost or Utilization, Selected Outcomes by Location, 2014-2015

Page 17: PCPCC PCMH Evidence Report Feb 2016

PAGE 15

National (continued)

Veterans Health Administration Patient Aligned Care Teams (PACTs)45

Published: Journal of Health Care Quality, November 2014

Data Review: April 2009 – March 2010 (Pre-PACT baseline); June 2011 – May 2012 (Post-PACT comparison group)

Study evaluated utilization and access measures

For all veterans:• 8.61% reduction in

hospitalizations (p<.05)• 7.54% reduction in specialty

visits (p<.05)

Veterans under age 65:• 9.41% reduction in

hospitalizations (p<.05)• 2.56% reduction in specialty

visits(p<.05)

Veterans over age 65:• 3.49% reduction in specialty

visits (p<.05)• 18.47% reduction in urgent

care visits (p<.05)

• 10.79% increase in primary care visits for all veterans (p<.05)

• 11.23% increase in primary care visits for those under age 65 (p<.05)

• 11.86% increase in primary care visits over age 65 (p<.05)

Single payer

Location/InitiativePayment Model

Description Additional OutcomesCost & Utilization

Table 1 continued

45 Randall, I., Mohr, D.C., & Maynard, C. (2014). VHA Patient-Centered Medical Home associated with lower rate of hospitalizations and specialty care among veterans with Posttraumatic Stress Disorder. Journal of Health Care Quality. doi: 10.1111/jhq.12092 Researchers conducted a “pre–post implementation study to explore the associations between PACT implementation and utilization outcomes using clinical and administrative data from the VHA’s Corporate Data Warehouse.” This study only evaluated PACT participants with Post-Traumatic Stress Disorder.

46 Pourat, N., Davis, A., Chen, X., Vrungos, S., & Kominski, G. (2015). In California, primary care continuity was associated with reduced emergency department use and fewer hospitalizations. Health Affairs, (34)7. doi: 10.1377/hlthaff.2014.1165 The Health Care Coverage Initiative required counties to assign patients to a “medical home”. At a minimum, a medical home had to consist of a provider who was an enrollee’s usual source of primary care, maintained the enrollee’s medical records, and coordinated his or her care. This study evaluated the intervention using pre and post-intervention claims data. In the 3rd year of the intervention, the program declined to pay providers for the non-urgent claims submitted for non-assigned patients.

California

Health Care Coverage Initiative46

Published: Health Affairs, July 2015

Data Review: September 2008–August 2009 (pre period); September 2009-August 2010 (post period)

Study evaluated utilization and access to care measures

Enrollees who saw their assigned primary care providers had:• Higher probability of no

ED visits (2.1%) and no hospitalizations (1.7%)

Among this population, the percent of patients with:• 2 or more annual ED visits

decreased from 4.11% to 3.13%

• 2 or more hospitalizations decreased from 1.37% to 1.17%

After the intervention, enrollees had:• Improved continuity with one

primary care provider (69.6% vs. 31.4%)

• 41.8% higher probability of seeing the same provider

Fee-for-service withpotential provider “penalties”

Page 18: PCPCC PCMH Evidence Report Feb 2016

PAGE 16

Table 1 continued

California (continued)

UCLA Health System47

Published: American Journal of Managed Care, September 2015

Data Review: May 2012-July 2013

Study evaluated utilization measures, but reported on estimated cost and provider satisfaction

Compared with control practices, patients served by practices with coordinated care had:• ����JUHDWHU�UHGXFWLRQ�LQ�

pre-post ED visits (p<.0001)• 12% reduction in ED XWLOL]DWLRQ��p<.001)

• This led to estimated UHGXFWLRQ�RI������PLOOLRQ�LQ�total cost of care over one \HDU��FRVW�RI�VWDII�EHQH÷�WV�ZDV����������RYHU�WKH�VDPH�WLPH

An internal survey of 52 physicians at the time of the intervention found: • ����VDLG�WKH�SURJUDP�ZDV�

effective• ����VDLG�WKHLU�SDWLHQWV�ZHUH�HQWKXVLDVWLF�DERXW�DXJPHQWHG�services

Mixed payment model“Although UCLA Health has population-based capitation and risk-sharing contracts, many patients are in traditional fee-for-service plans. The CCCs evaluated in this study support patients irrespective of insurance type”

Colorado

Colorado Multi-payer PCMH pilot48

Published: Journal of General Internal Medicine, October 2015

Data Review: April 2007-March 2009 (pre-intervention baseline); April 2009-March 2012 (post-intervention)

Study evaluated cost, utilization and quality measures

• 1R�QHW�RYHUDOO�FRVW�VDYLQJV�LQ�VWXG\�SHULRG��SRVVLEO\�GXH�WR�RIIVHWWLQJ�LQFUHDVHV�LQ�RWKHU�VSHQGLQJ�FDWHJRULHV

Two years after initiation of pilot, PCMH practices (vs. baseline) had:• 5HGXFWLRQ�LQ�('�FRVWV�RI�������3030���������p< 0.001) and �������3030�IRU�SDWLHQWV�with 2 or more comorbidities ��������p<.0001)

• ~7.9 % reduction in ED use (p=0.02)

• �����UHGXFWLRQ�LQ�SULPDU\�care visits (p=.006) for patients with 2 or more comorbidities

Three years after initiation, PCMH practices showed sustained improvements with:• 5HGXFWLRQ�LQ�('�FRVWVRI�������3030���������p ��������DQG�������3030�for patients with 2 or more FRPRUELGLWLHV���������p� �����

• �����UHGXFWLRQ�LQ�('�YLVLWV�(p=0.01)

• �����UHGXFWLRQ�LQ�SULPDU\�care visits (p=.06) for patients with 2 or more comorbidities

• ������UHGXFWLRQ�LQ�$&6&�inpatient admissions (p=0.05)

PCMH pilot practices were associated with:• ,QFUHDVHG�FHUYLFDO�FDQFHU�VFUHHQLQJ�UDWHV�DIWHU���\HDUV�(12.5% increase, p<.001) DQG���\HDUV�������LQFUHDVH��p<.001)

• /RZHU�UDWHV�RI�+E$�F�WHVWLQJ�in patients with diabetes (.7% UHGXFWLRQ�DW���\HDUV��p ����

• Lower rates of colon cancer VFUHHQLQJ��������DQG�������DW���DQG���\HDUV�UHVSHFWLYHO\�p<.001)

• 'HFUHDVHG�SULPDU\�FDUH�YLVLWV�������DW���\HDUV��p=.02)

PMPM fees based on the level of NCQA accreditation that each practice attained

Pay-for-performance�SURJUDP��which awarded bonuses to SUDFWLFHV�EDVHG�RQ�PHHWLQJ�ERWK�TXDOLW\�DQG�XWLOL]DWLRQ�benchmarks

This is a multi-payer initiative

Location/InitiativePayment Model

Description Additional OutcomesCost & Utilization

���� &ODUNH��5���%KDUPDO��1���'L�&DSXD��3���7VHQJ��&���0DQJORQH��&�0���0LWWPDQ��%����6NRRWVN\��6�$����������,QQRYDWLYH�DSSURDFK�WR�SDWLHQW�FHQWHUHG�FDUH�FRRUGLQDWLRQ�LQ�SULPDU\�FDUH�SUDFWLFHV��American Journal of Managed Care, 21��������������5HWULHYHG�IURP�KWWS���ZZZ�DMPF�FRP�MRXUQDOV�LVVXH�����������YRO���Q��LQQRYDWLYH�DSSURDFK�WR�SDWLHQW�FHQWHUHG�FDUH�FRRUGLQDWLRQ�LQ�SULPDU\�FDUH�SUDFWLFHV�7KH�VWXG\�DXWKRUV�XVHG�D�PXOWLYDULDWH�UHJUHVVLRQ�PRGHO�FRQWUROOLQJ�IRU�DJH��JHQGHU��DQG�PHGLFDO�FRPSOH[LW\�WR�HYDOXDWH��������XQLTXH�SDWLHQWV�LQ����RI�WKH����HYDOXDWHG�SUDFWLFHV�RYHU�D�RQH�\HDU�SHULRG��7KH�VWXG\�DXWKRUV�QRWH�WKDW�WKH�Ü8&/$�+HDOWK�6\VWHP�GHYHORSHG�D�WUDQVIRUPDWLRQ�PRGHO�WKDW�LQFOXGHV�DVSHFWV�IURP�PDQ\�3&0+�GRPDLQV�Ý�7KLV�PRGHO�LQFOXGHV�&RPSUHKHQVLYH�&DUH�&RRUGLQDWRUV��&&&V��LQ�WKH�FDUH�WHDP��&&&V�DUH�HPEHGGHG�LQ�HDFK�SUDFWLFH�WR�VXSSRUW�SDWLHQWV�DQG�KHOS�WKHP�QDYLJDWH�WKH�KHDOWK�FDUH�V\VWHP��

���� 5RVHQWKDO��0�%���$OLGLQD��6���)ULHGEHUJ��0�:���6LQJHU��6�-���(DVWPDQ��'���/L��=����6FKQHLGHU��(�&����������$�GLIIHUHQFH�LQ�GLIIHUHQFH�DQDO\VLV�RI�FKDQJHV�LQ�TXDOLW\��XWLOL]DWLRQ�DQG�FRVW�IROORZLQJ�WKH�&RORUDGR�0XOWL�3D\HU�3DWLHQW�&HQWHUHG�0HGLFDO�+RPH�3LORW��Journal of General Internal Medicine.�GRL����������V�����������������$XWKRUV�FRQGXFWHG�GLIIHUHQFH�LQ�GLIIHUHQFH�DQDO\VHV�HYDOXDWLQJ����VPDOO�DQG�PHGLXP�VL]HG�SUDFWLFHV�SDUWLFLSDWLQJ�LQ�D�PXOWL�SD\HU�3&0+�SLORW��7KH�DXWKRUV�H[DPLQHG�WKH�SRVW�LQWHUYHQWLRQ�SHULRG�WZR�\HDUV�DQG�WKUHH�\HDUV�DIWHU�WKH�LQLWLDWLRQ�RI�WKH�SLORW��

Page 19: PCPCC PCMH Evidence Report Feb 2016

PAGE 17

Table 1 continued

Location/Initiative

Michigan

Blue Cross Blue Shield of Michigan Physician Group Incentive Program49

Published: Health Affairs, April 2015

Data Review: 2008 claims data (pre-intervention period); 2009-2011 claims data for cost analyses and 2009–2010 claims data for quality analyses (post-intervention period)

Study evaluated cost and quality measures

• PCMH practices decreased WRWDO�3030�VSHQGLQJ�E\�������PRUH�WKDQ�FRQWURO�practices (a 1.1% difference)

• However practice PMPM VSHQGLQJ�LQFUHDVHG�E\�������LQ�\HDU����3UDFWLFHV�GLG�QRW�VHH�QHW�VDYLQJV�XQWLO�VHFRQG�\HDU�

• 3&0+�SURYLGHUV�VSHQW�������PMPM less for pediatric SDWLHQWV��D�VDYLQJV�RI�����

3URJUDP�SUDFWLFHV�DFKLHYHG�same or better performance RYHU�VWXG\�SHULRG�RQ����RI����TXDOLW\�PHDVXUHV

Pay-for-Performance“Participating PCPs: • were eligible for up to 20%

increased reimbursement for RI÷�FH�YLVLW�IHHV�

• could bill for care coordination and care management services provided by ancillary providers

• had opportunity to earn an additional 5% in EM* fees for achieving high performance on quality measures”

0LFKLJDQ�%&%6�SDUWLFLSDWHV�LQ�a multi-payer demonstration (MAPCP)

Blue Cross Blue Shield of Michigan Physician Group Incentive Program49

Published: Medical Care Research and Review, August 2015

Data Review: July 2009- June 2012

Study evaluated cost and quality measures

3UDFWLFHV�EHJLQQLQJ�WKH�VWXG\�ZLWK�KLJK�LPSOHPHQWDWLRQ�VFRUHV�(“full implementation”) versus those with low implementation scores (“no implementation”) KDG��������3030�ORZHU�FRVWV�IRU�DGXOW�SDWLHQWV�DIWHU���\HDUV��������p = .02)

• 3UDFWLFHV�EHJLQQLQJ�WKH�VWXG\�ZLWK�KLJK�LPSOHPHQWDWLRQ�scores “full PCMH implementation” vs. those with low scores “no PCMH LPSOHPHQWDWLRQÝ�KDG�KLJKHU�DGXOW�TXDOLW\�FRPSRVLWH�VFRUHV��������p�������DQG�KLJKHU�adult preventive composite VFRUH��������p<.001) after ��\HDUV

• 3UDFWLFHV�WKDW�FKDQJHG�WKHLU�PCMH implementation score KDG�KLJKHU�DGXOW�TXDOLW\�FRPSRVLWH�VFRUHV��������S�������DQG�KLJKHU�DGXOW�preventive composite score �������p�������DIWHU���\HDUV

Pay-for-PerformanceÜ7KH�SURJUDP�SURYLGHV�÷�QDQFLDO�incentives to physician organiza-tions when their member practices implement PCMH capabilities” 0LFKLJDQ�%&%6�SDUWLFLSDWHV�LQ�a multi-payer demonstration (MAPCP)

New York

Hudson Valley Initiative51

Published: American Journal of Managed Care, May 2015

Data Review: 2008-2010 claims data

Study evaluated utilization measures

• Patients in a PCMH had 6% reduction in specialist visits YV��QRQ�3&0+V�DIWHU�RQH�\HDU�of implementation, without LQFUHDVLQJ�('�YLVLWV�RU�KRVSLWDO�admissions

“This study evaluates part of the Hudson Valley Initiative,a multi-payer program in which six health plans agreed to provide ÷�QDQFLDO�LQFHQWLYHV�UDQJLQJ�IURP�$2 to $10 PMPM, to practices that implemented Level III PCMHs based on 2008 NCQA standards”This is a multi-payer initiative

Payment Model

Description Additional OutcomesCost & Utilization

���� /HPDN��&+���1DKUD��7$���&RKHQ��*5���(UE��1'���3DXVWLDQ��0/���6KDUH��'����+LUWK��5$����������0LFKLJDQÚV�IHH�IRU�YDOXH�SK\VLFLDQ�LQFHQWLYH�SURJUDP�UHGXFHV�VSHQGLQJ�DQG�LPSURYHV�TXDOLW\�LQ�SULPDU\�FDUH��Health Affairs, (34)���GRL����������KOWKDII�����������6WXG\�DXWKRUV�XVHG�D�GLIIHUHQFH�LQ�GLIIHUHQFHV�GHVLJQ�WR�HYDOXDWH�PRUH�WKDQ�����PLOOLRQ�SDWLHQWV�XQGHU�DJH����VHUYHG�E\�%OXH�&URVV�%OXH�6KLHOG�RI�0LFKLJDQ�

50 $OH[DQGHU��-�$���0DUNRYLW]��$�5���3DXVWLDQ��0�/���:LVH��&�*���(O�5HGD��'�.���*UHHQ��/�$����)HWWHUV��0�'����������,PSOHPHQWDWLRQ�RI�3DWLHQW�&HQWHUHG�0HGLFDO�+RPHV�LQ�$GXOW�3ULPDU\�&DUH�3UDFWLFHV��Medical Care Research and Review, 72�������������GRL���������������������������7KLV�VWXG\�XVHV�D�ORQJLWXGLQDO�GHVLJQ�DQG�D�YDOLGDWHG�3&0+�LPSOHPHQWDWLRQ�LQVWUXPHQW�WR�DVVHVV�WKH�LPSDFW�RI�3&0+�LPSOHPHQWDWLRQ�RQ�WKUHH�SDWLHQW�UHODWHG�RXWFRPHV��XVH�RI�SUHYHQWLYH�VHUYLFHV��TXDOLW\�RI�FDUH��DQG�FRVW�RI�FDUH�

51�� .DXVKDO��5���(GZDUGV��$����.HUQ��/�0����������$VVRFLDWLRQ�EHWZHHQ�WKH�SDWLHQW�FHQWHUHG�PHGLFDO�KRPH�DQG�KHDOWKFDUH�XWLOL]DWLRQ��American Journal of Managed Care, 21�������������7KLV�VWXG\�XVHG�D�ORQJLWXGLQDO��SURVSHFWLYH�FRKRUW�VWXG\�GHVLJQ�WR�HYDOXDWH�SULPDU\�FDUH�SK\VLFLDQV�LQ�WKH�+XGVRQ�9DOOH\�UHJLRQ�RI�1HZ�<RUN�RYHU���\HDUV��������������7KH�DXWKRUV�QRWH��ÜWKLV�VWXG\�HYDOXDWHV�SDUW�RI�WKH�+XGVRQ�9DOOH\�,QLWLDWLYH��ZKLFK�VHHNV�WR�WUDQVIRUP�KHDOWKFDUH�GHOLYHU\�WKURXJK�KHDOWK�LQIRUPDWLRQ�WHFKQRORJ\��SUDFWLFH�WUDQVIRUPDWLRQ��DQG�YDOXH�EDVHG�SXUFKDVLQJ�Ý�7KLV�VWXG\�HYDOXDWHG���PHDVXUHV�RI�XWLOL]DWLRQ��EXW�RQO\�RQH�\LHOGHG�VWDWLVWLFDOO\�VLJQL÷�FDQW�UHVXOWV��DV�GHSLFWHG�LQ�WKH�table above).

Page 20: PCPCC PCMH Evidence Report Feb 2016

PAGE 18

Table 1 continued

Location/Initiative

New York (continued)

Rochester Medical Home Initiative (RMHI)52

Published: Medical Care, November 2015

Data Review: August 2007-July 2009 (comparison group); August 2009-July 2012 (intervention group)

Study evaluated cost, utilization and quality measures

• 'UXJ�VSHQGLQJ�GHFUHDVHG�E\��������3030��GHVSLWH�LQFUHDVLQJ�XWLOL]DWLRQ�RI�SUHVFULSWLRQ�GUXJV�RYHU�VWXG\�period (p=.015)

• 3LORW�SUDFWLFHV�KDG�KLJKHU�VSHQGLQJ�RQ�LQSDWLHQW�VHUYLFHV��������3030��p=0.015)

RMHI pilot associated with reductions vs. baseline in: • $&6& �('�YLVLWV��p �����• 2YHUDOO�FRXQW�RI�LPDJLQJ�WHVWV������IHZHU�SHU������PHPEHU�months p<.001)

• 50+,�SLORW�LQFUHDVHG�SULPDU\�care visits (p<.001) and ODERUDWRU\�WHVWV��p �����

• Decrease in preventable KRVSLWDOL]DWLRQV��DV�PHDVXUHG�E\�3UHYHQWLRQ�4XDOLW\�,QGLFDWRU��34,���p=.027)

• 2.6% increase in breast cancer VFUHHQLQJ��p=.005)

• �����LQFUHDVH�LQ�/'/�GLDEHWHV�tests (p �����

Blended payment model: • Model includes fee-for-

service and a pay-for-performance SURJUDP�IRFXVHG�RQ�TXDOLW\�DQG�FRVW�

• 3D\PHQW�OHYHOV�ZHUH�VHW�VR�as to support practice costs related to the intervention, LQFOXGLQJ�VXSSRUW�RI�D�1XUVH�&DUH�0DQDJHU

Pennsylvania

Geisinger Health System patient-centered medical home (ProvenHealth Navigator)53

Published: Health Affairs, April 2015

Data Review: January 2006-June 2013

Study evaluated cost measures

• $YJ��RI������WRWDO�FRVW�VDYLQJV�DFURVV����PRQWK�VWXG\�SHULRG��DQ�DYJ��RI�����VDYLQJV�LQ�PMPM total cost of care per site)

• ����3030�VDYLQJV�IRU�DFXWH�LQSDWLHQW�FDUH������VDYLQJV�PMPM)

• $FXWH�LQSDWLHQW�FRVW�VDYLQJV�DFFRXQW�IRU�a����RI�WKH�WRWDO�HVWLPDWHG�VDYLQJV�

• /RQJHU�LPSOHPHQWDWLRQ�WLPH�DVVRFLDWHG�ZLWK�JUHDWHU�FRVW�VDYLQJV

Fee-for-servicePay-for-performance based on TXDOLW\�RXWFRPHV�

Shared savings model based on performance

Pennsylvania Chronic Care Initiative54

Published: JAMA Internal Medicine, June 2015

Data Review: October 2007–September 2012 (2 years prior to and 3 years after the pilot inception date)

Study evaluated utilization, access and quality measures

By year 3, pilot participation was associated with lower rates (per 1000 patients per month) for:• $OO�FDXVH�KRVSLWDOL]DWLRQ�������• $OO�FDXVH�('�YLVLWV�������• $PEXODWRU\�FDUH�VHQVLWLYH�('�YLVLWV�������

• $PEXODWRU\�YLVLWV�IRU�VSHFLDOLVWV��������

• +LJKHU�SHUIRUPDQFH�LQ�DOO���H[DPLQHG�PHDVXUHV�RI�GLDEHWHV�FDUH�TXDOLW\��+E$�F�WHVWLQJ��/'/�&�WHVWLQJ��QHSKURSDWK\�PRQLWRULQJ��H\H�examinations) and breast FDQFHU�VFUHHQLQJ�

• %\�\HDU����SLORW�ZDV�DVVRFLDWHG�ZLWK�KLJKHU�UDWHV�RI�DPEXODWRU\�SULPDU\�FDUH�YLVLWV�(+77.5) per 1000 patients per month

Participating practices received:• $1.50 PMPM in care PDQDJHPHQW�SD\PHQWV

• $1.50 PPPM in “practice VXSSRUW�SD\PHQWVÝ

• Shared savings bonuses FRQWLQJHQW�RQ�PHHWLQJ�TXDOLW\�EHQFKPDUNV��ERQXV�SD\PHQWV�FRXOG�UDQJH�IURP�����WR�����RI�FDOFXODWHG�VDYLQJV�LQ�HDFK�\HDU

This is a multi-payer initiative

Payment Model

Description Additional OutcomesCost & Utilization

52 5RVHQWKDO��0�%���6LQDLNR��$�'���(DVWPDQ��'���&KDSPDQ��%����3DUWULGJH��*����������,PSDFW�RI�WKH�5RFKHVWHU�0HGLFDO�+RPH�,QLWLDWLYH�RQ�SULPDU\�FDUH�SUDFWLFHV��TXDOLW\��XWLOL]DWLRQ��DQG�FRVWV��Medical Care, 53��������������GRL����������0/5������������������6WXG\�DXWKRUV�FRQGXFWHG�D�GLIIHUHQFH�LQ�GLIIHUHQFH�DQDO\VLV�ZLWK�D�PDWFKHG�FRPSDULVRQ�JURXS�XVLQJ�FODLPV�GDWD�IURP�([FHOOXV�%OXH�&URVV�%OXH�6KLHOG�DQG�093�+HDOWK�&DUH��,Q�DGGLWLRQ�WR�WKH�UHVXOWV�LQFOXGHG�DERYH��WKH�DXWKRUV�QRWH�ÜHVWLPDWHV�RQ�RWKHU�XWLOL]DWLRQ�DQG�VSHQGLQJ�PHDVXUHV��LQFOXGLQJ�WRWDO�VSHQGLQJ�SHU�SDWLHQW�SHU�PRQWK�ZHUH�QRW�VWDWLVWLFDOO\�VLJQL÷�FDQW��ZKLFK�PHDQV�ZH�FDQQRW�GHWHUPLQH�ZKHWKHU�WKH�HIIHFW�RI�WUDQVIRUPLQJ�LQWR�D�3&0+�KDV�D�SRVLWLYH�RU�QHJDWLYH�HIIHFW�RQ�WKHVH�RXWFRPHV�Ý

���� 0DHQJ��'�'���.KDQ��1���7RPFDYDJH��-���*UDI��7�5���'DYLV��'�(����6WHHOH��*�'����������5HGXFHG�DFXWH�LQSDWLHQW�FDUH�ZDV�ODUJHVW�VDYLQJV�FRPSRQHQW�RI�*HLVLQJHU�KHDOWK�V\VWHPÚV�SDWLHQW�FHQWHUHG�PHGLFDO�KRPH� Health Affairs, (34)������������GRL����������KOWKDII�����������7KLV�VWXG\�IRFXVHG�RQ�WKH�LPSDFW�RI�WKH�3URYHQ+HDOWK�1DYLJDWRU�RQ�WKH�HOGHUO\�0HGLFDUH�$GYDQWDJH�SDWLHQW�SRSXODWLRQ��5HVHDUFKHUV�XVHG�D�VHW�RI�PXOWLYDULDWH�UHJUHVVLRQ�PRGHOV�WR�H[DPLQH�WKH�SURJUDP�DQG�EUHDN�GRZQ�WKH�WRWDO�FRVW�VDYLQJV�DVVRFLDWHG�LQWR�LWV�PDMRU�FRPSRQHQWV��RXWSDWLHQW��LQSDWLHQW��SURIHVVLRQDO��DQG�SUHVFULSWLRQ�GUXJV��DQG�HVWDEOLVK�WKH�DVVRFLDWLRQV�VHSDUDWHO\�EHWZHHQ�D�FOLQLFÚV�H[SRVXUH�WR�WKH�1DYLJDWRU�DQG�HDFK�RI�WKH�FRVW�FRPSRQHQWV��

��� �)ULHGEHUJ��0�:���5RVHQWKDO��0�%���:HUQHU��5�0���9ROSS��.�*����6FKQHLGHU��(�&����������(IIHFWV�RI�D�PHGLFDO�KRPH�DQG�VKDUHG�VDYLQJV�LQWHUYHQWLRQ�RQ�TXDOLW\�DQG�XWLOL]DWLRQ�RI�FDUH��JAMA Internal Medicine, 175����������������GRL���������MDPDLQWHUQPHG������������7KH�DXWKRUV�XVHG�D�ÜGLIIHUHQFH�LQ�GLIIHUHQFHV�GHVLJQ�WR�FRPSDUH�FKDQJHV�GXULQJ�D���\HDU�SHULRG�LQ�WKH�TXDOLW\�DQG�XWLOL]DWLRQ�RI�FDUH�IRU�SDWLHQWV�DWWULEXWHG�WR�SUDFWLFHV�WKDW�SDUWLFLSDWHG�LQ�WKH�QRUWKHDVW�3$&&,�DQG�FRPSDULVRQ�SUDFWLFHV�WKDW�GLG�QRW�SDUWLFLSDWH�LQ�WKLV�PHGLFDO�KRPH�LQWHUYHQWLRQ�Ý�,Q�WKH�1RUWKHDVW�5HJLRQ��SDUWLFLSDWLQJ�SUDFWLFHV�ZHUH�UHTXLUHG�WR�DFKLHYH�1&4$�UHFRJQLWLRQ�ZLWKLQ����PRQWKV�RI�LPSOHPHQWDWLRQ�

Page 21: PCPCC PCMH Evidence Report Feb 2016

PAGE 19

Table 1 continued

Location/Initiative

Pennsylvania

Pennsylvania Chronic Care Initiative55

Published: American Journal of Managed Care, January 2015

Data Review: 2008 (baseline); 2009-2011 (comparison group)

Study evaluated cost and utilization measures

• Lower total costs in PCMH SUDFWLFHV�LQ�DOO���IROORZ�XS�\HDUV��p������GULYHQ�E\�VLJQL÷�FDQWO\�ORZHU�LQSDWLHQW�(p<.01) and specialist (p<.0001) costs

• 5HODWLYH�WR�EDVHOLQH��RYHUDOO�PMPM costs were:

• �������ORZHU�LQ�����• �������ORZHU�LQ�����• �������ORZHU�LQ������• ,Q�������DGMXVWHG�FRVWV�IRU�

PCMH were 17.5% lower than those in non-PCMH practices.

• PCMH practices maintained ORZHU�XWLOL]DWLRQ�IRU�KRVSLWDO�admissions (p<.0001) and specialist visits (p<.01) each IROORZ�XS�\HDU

“To facilitate transition to the PCMH model, practices received VXSSOHPHQWDO�÷�QDQFLDO�LQFHQWLYHVÝ� This is a multi-payer initiative

Texas

Texas Children’s Health Plan56

Published: Journal of Health Care for the Poor and Underserved, May 2015

Data Review: August 2011–August 2012

Study evaluated utilization measures

• +DYLQJ�D�XVXDO�VRXUFH�RI�care per parent-report was associated with lower rate of documented ED visits and KRVSLWDOL]DWLRQV

• +LJKHU�PHDQ�VFRUH�IRU�RUJDQL]DWLRQDO�FDSDFLW\�ZDV�VLJQL÷�FDQWO\�DVVRFLDWHG�ZLWK�both lower rates of ED visits DQG�KRVSLWDOL]DWLRQV

• +LJKHU�GDWD�PDQDJHPHQW�PHDQ�VFRUH�ZDV�VLJQL÷�FDQWO\�associated with lower rates of ED visits

1RQH�VSHFL÷�HG�ZLWKLQ�WKLV�publication

Payment Model

Description Additional OutcomesCost & Utilization

55 1HDO��-���&KDZOD��5���&RORPER��&���6Q\GHU��5����1LJDP��6����������0HGLFDO�KRPHV��FRVW�HIIHFWV�RI�XWLOL]DWLRQ�E\�FKURQLFDOO\�LOO�SDWLHQWV��American Journal of Managed Care, 21(1), e51-61. 6WXG\�DXWKRUV�XVHG�D�ORQJLWXGLQDO�REVHUYDWLRQDO�GHVLJQ�DQG�DQDO\]HG�WKH�LPSDFW�RI�WKH�3&0+�PRGHO�RQ�3030�FRVWV�XVLQJ�D�JHQHUDOL]HG�OLQHDU�UHJUHVVLRQ�PRGHO��7KLV�VWXG\�HYDOXDWHG�D�ÜFRKRUW�RI�FKURQLFDOO\�LOO�PHPEHUVØGH÷�QHG�DV�SDWLHQWV�KDYLQJ�DVWKPD��FRURQDU\�DUWHU\�GLVHDVH��FRQJHVWLYH�KHDUW�IDLOXUH��FKURQLF�REVWUXFWLYH�SXOPRQDU\�GLVHDVH��GLDEHWHV��DQG�RU�K\SHUWHQVLRQØZKLFK�ZDV�FUHDWHG�IURP�DGPLQLVWUDWLYH�PHGLFDO�FODLPV�LQ�WKH�EDVHOLQH�\HDU�������Ý�

56 5DSKDHO��-�/���&RROH\��:�&���9HJD��$���.RZDONRZVNL��0�$���7UDQ��;���7UHDGZHOO��-���*LDUGLQR��$�3����*LRUGDQR��7�3����������2XWFRPHV�IRU�children with chronic conditions associated with parent-and provider-reported measures of the medical home. Journal of Health Care for the Poor and Underserved, 26�������������GRL����������KSX�����������6WXG\�DXWKRUV�FRQGXFWHG�D�FURVV�VHFWLRQDO��UHWURVSHFWLYH�DQDO\VLV�RI�DGPLQLVWUDWLYH�FODLPV�GDWD�IURP�7H[DV�&KLOGUHQÚV�+HDOWK�3ODQ��D�PDQDJHG�FDUH�RUJDQL]DWLRQ��7KH�VWXG\�HYDOXDWHG�����FKLOGUHQ�ZLWK�FKURQLF�GLVHDVHV�IURP�����SUDFWLFHV��7KH�DXWKRUV�GH÷�QH�RUJDQL]DWLRQDO�FDSDFLW\�DV�ÜWKH�SUDFWLFHÚV�FRPPLWPHQW�WR�SDWLHQW�FHQWHUHG�FDUH�DV�GHPRQVWUDWHG�E\�VROLFLWDWLRQ�RI�SDWLHQW�IHHGEDFN��PXOWLSOH�PHFKDQLVPV�IRU�FRPPXQLFDWLRQ�ZLWK�IDPLOLHV��SDWLHQW�DFFHVV�WR�PHGLFDO�UHFRUGV��DQG�FRQWLQXDO�VWDII�HGXFDWLRQ�DQG�WUDLQLQJ�Ý

(continued)

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PAGE 20

Table 1 continued

Location/Initiative

Utah

University of Utah Care By Design57

Published: Journal for Healthcare Quality, January 2015

Data Review: June 2010- May 2011 (baseline); June 2011 – September 2013 (intervention period)

Study evaluated utilization measures

• $OO�FDXVH����GD\�KRVSLWDO�readmission rate decreased IURP�������WR�������p<.05)

• Mean time to hospital UHDGPLVVLRQ�ZLWKLQ�����GD\V�ZDV�GHOD\HG�IURP����WR�����GD\V��p<.05)

1RQH�VSHFL÷�HG�ZLWKLQ�WKLV�publication

Vermont

Vermont Blueprint for Health58

Published: Population Health Management, September 2015

Data Review: Review of annual outcomes from 2008-2013

Study evaluated cost, utilization, access and quality of care measures

• Participant expenditures were UHGXFHG�E\�î�����303< �(p<.001)

• 5HGXFWLRQ�LQ�LQSDWLHQW��î�����303< ��p<.001) and outpatient hospital H[SHQGLWXUHV��î�����303< ��p<.001)

• ,QFUHDVH�LQ�H[SHQGLWXUHV�IRU�GHQWDO��VRFLDO��DQG�FRPPXQLW\�EDVHG�VXSSRUW�VHUYLFHV������303< ��p<.001)

• Total annual reduction in H[SHQGLWXUHV�ZDV��������million

• Medical expenditures GHFUHDVHG�E\�DSSUR[LPDWHO\������PLOOLRQ�IRU�HYHU\����million spent on the Blueprint initiative

• 5HGXFWLRQ�LQ�LQSDWLHQW�GLVFKDUJHV�UHGXFHG�E\�����SHU�1000 members (p<.001)

• 5HGXFWLRQ�LQ�LQSDWLHQW�GD\V�UHGXFHG�E\������SHU������members (p<.001)

• 6LJQL÷�FDQW�UHGXFWLRQ�LQ�VWDQGDUG�LPDJLQJ��DGYDQFHG�LPDJLQJ��HFKRJUDSK\

• +LJKHU�UDWHV�RQ���RI����effective and preventive care measures

• +LJKHU�VFUHHQLQJ�UDWHV�for breast cancer and cervical cancer (p<.001) DQG�DSSURSULDWH�WHVWLQJ�IRU�SKDU\QJLWLV��p<.001)

• Participants with diabetes had KLJKHU�UDWHV�RI�H\H�WHVWLQJ�DQG�/'/�&�WHVWLQJ��p<.001)

• 3DUWLFLSDQWV�KDG�VLJQL÷�FDQWO\�KLJKHU�UDWHV�RI�DGROHVFHQW�well-care visits (p<.001)

Fee-for-service + capitated payments“Two payment reforms were implemented to support PCMH and CHT* operations: • a capitated payment that went

directly to the practice based on its NCQA PCMH score

• a capitated payment that went to the administrative entity in each service area to operate the CHT*”

Vermont Blueprint for Health is a multi-payer initiative that participates in the MAPCP demonstration

Payment Model

Description Additional OutcomesCost & Utilization

57 )DUUHOO��7�:���7RPRDLD�&RWLVHO��$���6FDPPRQ��'�/���%UXQLVKRO]��.���.LP��-���'D\��-���â�0DJLOO��0�.����������,PSDFW�RI�DQ�LQWHJUDWHG�WUDQVLWLRQ�PDQDJHPHQW�SURJUDP�LQ�SULPDU\�FDUH�RQ�KRVSLWDO�UHDGPLVVLRQV��Journal for Healthcare Quality, 37������������GRL�������������-+4����������������������6WXG\�DXWKRUV�QRWH�WKDW�WKH�Ü8QLYHUVLW\�RI�8WDK�&RPPXQLW\�&OLQLFV��88&&V��GHYHORSHG�DQG�LPSOHPHQWHG�WKH�Ü&DUH�%\�'HVLJQÝ��&%'��PRGHO��ZKLFK�LV�Ù88&&VÚ�YHUVLRQ�RI�WKH�3&0+Úâ�WKH�WKUHH�RUJDQL]LQJ�SULQFLSOHV�RI�&%'�Ø�$SSURSULDWH�Access (AA), Care Teams (CTs), and Planned Care (PC) — correspond to core PCMH principles.”

���� -RQHV��&���)LQLVRQ��.���0F*UDYHV�/OR\G��.���7UHPEOD\��7���0RKOPDQ��0�.���7DQ]PDQ��%���â�6DPXHOVRQ��-����������9HUPRQWÚV�FRPPXQLW\�RULHQWHG�DOO�SD\HU�PHGLFDO�KRPH�PRGHO�UHGXFHV�H[SHQGLWXUHV�DQG�XWLOL]DWLRQ�ZKLOH�GHOLYHULQJ�KLJK�TXDOLW\�FDUH��Population Health Management. GRL���������SRS�����������7KLV�VWXG\�XVHG�D�VHTXHQWLDO�FURVV�VHFWLRQDO�GHVLJQ�WR�UHYLHZ�DQQXDO�RXWFRPHV�IURP������WKURXJK������IRU�SDUWLFLSDQWV�YHUVXV�D�FRPSDULVRQ�SRSXODWLRQ�DW�HDFK�VWDJH�RI�SURJUDP�LPSOHPHQWDWLRQ�DQG�PDWXUDWLRQ��

Page 23: PCPCC PCMH Evidence Report Feb 2016

PAGE 21

TABLE 2: STATE GOVERNMENT EVALUATIONS: Primary Care/PCMH Interventions That Assessed Cost or Utilization, Selected Outcomes by Location, 2014-2015

Location/Initiative

Arkansas

Arkansas PCMH program59

Published: Arkansas Department of Human Services, October 2015

Data Review: 2014 claims data

• ,Q�������WKH�VWDWH�DYRLGHG�����PLOOLRQ�LQ�0HGLFDLG�FRVWV�LQ������

• 19 providers received shared VDYLQJV�SD\PHQWV�IRU�D�WRWDO�RI�RYHU����PLOOLRQ

Fee-for-service + PMPM SD\PHQWV�IRU�FDUH�FRRUGLQDWLRQ�and enhanced access

2SSRUWXQLW\�WR�TXDOLI\�IRU�shared savings7KH�$UNDQVDV�3&0+�SURJUDP�is a multi-payer SURJUDP�WKDW�participates in the CPC initiative

Payment Model

Description Additional OutcomesCost & Utilization

59 Arkansas Department of Human Services. (2015). Arkansas Medicaid Rewarding Primary Care Providers for Prevention, Disease Management. 5HWULHYHG�IURP�KWWS���KXPDQVHUYLFHV�DUNDQVDV�JRY�SUHVVURRP�3UHVV5RRP'RFV�'06SDWLHQWFHQWHUPKDZDUGV15RFW���SGI�To determine FRVW�DYRLGDQFH��WKH�VWDWH�÷�UVW�HYDOXDWHG�EDVHOLQH�FRVWV�IRU�������������DQG�������,W�JDYH�HDFK�\HDU�D�ZHLJKW������IRU�����������IRU������DQG�����IRU������DQG�XVHG�WKLV�IRUPXOD�WR�GHWHUPLQH�����ÚV�SURMHFWHG�FRVW��

60 &RORUDGR�'HSDUWPHQW�RI�+HDOWK�&DUH�3ROLF\�DQG�)LQDQFLQJ����������Creating a Culture of Change: Accountable Care Collaborative 2014 Annual Report. 5HWULHYHG�IURP��KWWSV���ZZZ�FRORUDGR�JRY�SDFL÷�F�VLWHV�GHIDXOW�÷�OHV�$FFRXQWDEOH���&DUH���&ROODERUDWLYH����������$QQXDO���5HSRUW�SGI�3ULPDU\�FDUH�SURYLGHUV�FRQWUDFWHG�ZLWK�D�5&&2�WR�VHUYH�DV�PHGLFDO�KRPHV�IRU�$&&�PHPEHUV�

Colorado

Colorado Accountable Care Collaborative (ACC)60

Published: Colorado Department of Health Care Policy and Financing, November 2014

Data Review: FY 2013-2014

• ���������PLOOLRQ�LQ�JURVV�SURJUDP�VDYLQJV����������PLOOLRQ�LQ�QHW�VDYLQJV��

• a����PLOOLRQ�UHLQYHVWHG�LQWR�SURYLGHUV�E\�SURJUDP��LQFOXGLQJ�LQFHQWLYH�SD\PHQWV�

• ���IHZHU�(5�VHUYLFHV�IRU�DGXOW�$&&�HQUROOHHV�LQ�SURJUDP�more than 6 months vs. non-enrolled

• 6OLJKWO\�KLJKHU�XVH�RI�(5�services for ACC enrollees with disabilities vs. non-enrolled

• Fewer readmissions for children and adult ACC members without disabilities vs. non-enrolled

Fewer high cost imaging services for ACC enrollees vs. non-enrolled: • ���IHZHU�IRU�$&&�PHPEHUV�

with disabilities • 16% fewer for adult ACC

members• 12% fewer for children ACC

members

Fee-for-service base + additional incentives$&&�XVHV�K\EULG�RI�VHYHUDO�SD\PHQW�VWUDWHJLHV�ZLWK�D�EDVH�of fee-for-service:

• 5&&2V �DQG�3&03V �UHFHLYH�LQFHQWLYH�SD\PHQWV�IRU�UHDFKLQJ�NH\�SHUIRUPDQFH�LQGLFDWRU��.3,��WDUJHWV�(pay for performance)

• 3&03V�JHW�3030�SD\PHQWV�IRU�DFKLHYLQJ���RI���VWDQGDUGV�of enhanced PCMH

In FY 2014-2015:• 5&&2V�DQG�3&03V�ZLOO�UHFHLYH�D�VKDUH�RI�WKH�VDYLQJV�when the ACC saves on medical expenditures

• $&&�LV�WHVWLQJ�IXOO�ULVN�capitation�LQ�RQH�UHJLRQ�DQG�LQFUHDVLQJ�3&03 �3030�SD\PHQWV

Page 24: PCPCC PCMH Evidence Report Feb 2016

PAGE 22

Table 2 continued

Location/Initiative

Oregon

Oregon Coordinated Care Organizations61

Published: Oregon Health Authority, June 2015

Data Review: 2011 (comparison group); 2014 (PCMH group)

• 2UHJRQ�LV�PHHWLQJ�LWV�&06�FRPPLWPHQW�WR�UHGXFH�JURZWK�LQ�VSHQGLQJ�E\���SHUFHQWDJH�SRLQWV��303<�

• PMPM costs for inpatient hospital services have GHFUHDVHG�E\�������VLQFH�2011

• ���RXW�RI����&&2V�HDUQHG������RI�WKHLU�TXDOLW\�SRRO�SD\PHQWV

• 5HGXFWLRQ�LQ�DOO�FDXVH����GD\�UHDGPLVVLRQV��IURP�������LQ������WR�������LQ������

• 5HGXFWLRQ�LQ�('�YLVLWV�������per 1000 member months in �����YV�������LQ����������LQ�2011)

• 5HGXFWLRQ�LQ�DYRLGDEOH�('�visits

Since 2011 baseline:• 22% reduction in ED visits • 26.9% reduction in admissions

for patients with diabetes and short-term complications

• 60% reduction in admissions for patients with COPD or asthma

• Almost 50% reduction in avoidable ED visits

• ,QFUHDVHG�6%,57 �LQWHUYHQWLRQ�������WR������

• 3HUFHQWDJH�RI�LQGLYLGXDOV�DEOH�WR�DFFHVV�FDUH�TXLFNO\�ZKHQ�QHHGHG�UHPDLQHG�VWHDG\

• Childhood and adolescent DFFHVV�WR�SULPDU\�FDUH�providers declined

Since 2011 baseline:• ,QFUHDVHG�DSSURSULDWH�WHVWLQJ�IRU�FKLOGUHQ�ZLWK�SKDU\QJLWLV

• ,QFUHDVHG�ZHOO�FDUH�YLVLWV• PCPCH enrollment increased

56%• ,QFUHDVHG�VDWLVIDFWLRQ�ZLWK�

care

Fee-for-service + Pay-for-performance To earn full incentive payment, CCOs must:• Meet benchmarks or LPSURYHPHQW�WDUJHWV�RQ�at least 12 of 17 incentive PHDVXUHV�

• Meet benchmark or LPSURYHPHQW�WDUJHW�IRU�(+5�DGRSWLRQ��$1'

• Have at least 60% of members enrolled in a PCPCH

CCOs earn “challenge pool funds” for meeting benchmark of improvement target on:• $OFRKRO�DQG�GUXJ�PLVXVH��6%,57���

• 'LDEHWHV�+E$�F�SRRU�FRQWURO��• 'HSUHVVLRQ�VFUHHQLQJ�DQG�IROORZ�XS�SODQ��

• PCPCH enrollment

North Carolina

Community Care of North Carolina (CCNC)62

Published: State Auditor Report, August 2015

Data Review: July 2003-December 2012

• 6DYLQJV�RI�a����SHU�TXDUWHU�SHU�EHQH÷�FLDU\��a�����D�\HDU��a���VDYLQJV�

• 'HFUHDVHG�VSHQGLQJ�LQ�DOPRVW�DOO�FDWHJRULHV��ZLWK�ODUJHVW�reduction in inpatient services

• CCNC saved the state 0HGLFDLG�SURJUDP�DERXW������million

• 5HGXFWLRQ�LQ�UHDGPLVVLRQV��inpatient admissions for GLDEHWHV��DOWKRXJK�QRW�VWDWLVWLFDOO\�VLJQL÷�FDQW���DQG�ED visits for asthma

• ~25% reduction in inpatient admissions

• $SSUR[LPDWHO\�D�����LQFUHDVH�LQ�SK\VLFLDQ�VHUYLFHV

• $SSUR[LPDWHO\�D�������GHFOLQH�LQ�SUHVFULSWLRQ�GUXJ�XVH

Fee-for-service + Care coordination fee0HGLFDLG�SDLG�DQ�DGMXVWHG�DGPLQLVWUDWLYH�IHH�UDQJLQJ�IURP�������WR��������IURP������WKURXJK�����

&&1&�IRUPHUO\�SDUWLFLSDWHG�in the multi-payer MAPCP demonstration

Payment Model

Description Additional OutcomesCost & Utilization

61 2UHJRQ�+HDOWK�$XWKRULW\����������Oregon’s Health System Transformation: 2014 Final Report.�5HWULHYHG�IURP��KWWS���ZZZ�RUHJRQ�JRY�RKD�0HWULFV�'RFXPHQWV��������)LQDO���5HSRUW�������-XQH��������SGI�7KLV�÷�QDO�UHSRUW�RXWOLQHV�WKH�SURJUHVV�RI�2UHJRQ�&&2V�LQ����������SHUFHQW�RI�&&2�PHPEHUV�DUH�HQUROOHG�LQ�D�UHFRJQL]HG�SDWLHQW�FHQWHUHG�SULPDU\�FDUH�KRPH��3&3&&�GLG�QRW�LQFOXGH�DOO�HYDOXDWHG�PHDVXUHV�LQ�WKH�WDEOH�DERYH��)ROORZ�WKH�OLQN�IRU�FRPSUHKHQVLYH�SURJUDP�UHVXOWV�

62 �2I÷�FH�RI�WKH�6WDWH�$XGLWRU����������Community Care of North Carolina.�5HWULHYHG�IURP��KWWS���ZZZ�QFDXGLWRU�QHW�(36:HE�5HSRUWV�)LVFDO&RQWURO�)&$�����������SGI�7KH�VWXG\�SRSXODWLRQ�LV�OLPLWHG�WR�QRQ�HOGHUO\��QRQ�GXDO�0HGLFDLG�EHQH÷�FLDULHV��$OO�FRVW�÷�QGLQJV�DUH�HVWLPDWHG�LQ������LQø�DWLRQ�DGMXVWHG�GROODUV�

Page 25: PCPCC PCMH Evidence Report Feb 2016

PAGE 23

TABLE 3: INDUSTRY REPORTS: Primary care/PCMH interventions that assessed cost or utilization, selected outcomes by location, 2014-2015

Location/Initiative

Multi-state

Anthem Enhanced Personal Health Care (EPHC)63

Published: Anthem industry report, 2015

Data Review: Results from program year 1 (vs. matched control group)

• �����PLOOLRQ�LQ�VDYLQJV�RYHU�12 month period

• *URVV�PHGLFDO�VDYLQJV�RI�������3HU�$WWULEXWHG�0HPEHU�3HU�0RQWK��3D030� ��QHW�VDYLQJV�RI�������3D030

• 2YHUDOO�SKDUPDF\�VDYLQJV�RI������3D030

• �����ORZHU�(5�FRVWV• �����UHGXFWLRQ�LQ�LQSDWLHQW�FRVWV��GULYHQ�E\�D������reduction in acute inpatient admissions

• �����GHFUHDVH�LQ�DOORZHG�(5�FRVWV��GULYHQ�E\������UHGXFWLRQ�LQ�(5�XWLOL]DWLRQ

• �����UHGXFWLRQ�LQ�RI÷�FH�YLVLW�costs

• �����LQFUHDVH�LQ�SULPDU\�FDUH�YLVLW�FRVWV�IRU�KLJK�ULVN�population

• �����UHGXFWLRQ�LQ�UHIHUUDOV�WR�HOHFWLYH�SURFHGXUHV�DQG�KLJK�FRVW�UDGLRORJ\

Compared with non-EPHC peers, EPHC providers performed:• 9.6% better in pediatric

prevention • �����EHWWHU�LQ�DQQXDO�PRQLWRULQJ�RI�SHUVLVWHQW�medications

• �����EHWWHU�LQ�GLDEHWHV�FDUH�• �����EHWWHU�LQ�FHUYLFDO�DQG�EUHDVW�FDQFHU�VFUHHQLQJ�

• �����EHWWHU�LQ�RWKHU�DFXWH�DQG�chronic care measures

Fee-for-service + PMPM Clinical Coordination 5HLPEXUVHPHQW (care coordination payment)$GGLWLRQDO�RSSRUWXQLW\�IRU�shared savings�WKURXJK�LWV�LQFHQWLYH�SURJUDP

Anthem participates in multi-payer efforts (CPC and MAPCP)

Louisiana

Blue Cross Blue Shield of Louisiana Quality Blue Primary Care (QBPC) Program64, 65

Published: Blue Cross Blue Shield of Louisiana Press Release, “Quality Blue Primary Care Collaborative” presentation slide deck, October 2015

Data Review: 2013- 2014 claims data

QBPC program vs. comparison practices: • 5HGXFHG�WRWDO�FRVWV�E\�a����

PMPM• 5HGXFHG�RYHUDOO�FRVW�RI�RI÷�FH�EDVHG�YLVLWV��ODUJHO\�GXH�WR�UHGXFWLRQ�LQ�VSHFLDOW\�YLVLWV

• 5HGXFHG�LQSDWLHQW�DGPLVVLRQV�RYHUDOO�DQG�DPRQJ�SDWLHQWV�with heart disease, K\SHUWHQVLRQ��GLDEHWHV��DQG�FKURQLF�NLGQH\�GLVHDVH

• ,QFUHDVHG�RYHUDOO�DQG�$&6&�ED visits

• ,QFUHDVHG�RI÷�FH�EDVHG�SULPDU\�FDUH�YLVLWV

From January 2015 to September 2015, the program showed:• 25% improvement in diabetes TXDOLW\�PHDVXUHV

• ����LPSURYHPHQW�LQ�K\SHUWHQVLRQ�TXDOLW\�PHDVXUHV

• ����LPSURYHPHQW�LQ�YDVFXODU�GLVHDVH�TXDOLW\�PHDVXUHV

• 69% improvement on chronic NLGQH\�GLVHDVH�PHDVXUHV

Fee-for-service + Care Management Fee (CMF) “Twice a year, Blue Cross evaluates CMFs for adjustment, based on how each QBPC-enrolled practice performed on the program’s core measures”

Payment Model

Description Additional OutcomesCost & Utilization

���� $QWKHP��,QF����������Innovation with proven results: Enhanced Personal Health Care. 5HWULHYHG�IURP�KWWSV���ZZZ�SFSFF�RUJ�VLWHV�GHIDXOW�÷�OHV�(3+&B:KLWH3DSHUB$QWKHP�SGI�$FFRUGLQJ�WR�WKH�SURJUDP�GHVFULSWLRQ�PRGL÷�HG�����������WKH�$QWKHP�(3+&�3URJUDP�EXLOGV�XSRQ�WKH�VXFFHVV�RI�3&0+�SURJUDPV�DQG�IRVWHUV�D�FROODERUDWLYH�UHODWLRQVKLS�EHWZHHQ�$QWKHP�DQG�LWV�FRQWUDFWHG�SURYLGHUV��7KH�UHVXOWV�LQ�WKLV�VWXG\�UHø�HFW�FDUH�IRU�$QWKHP�PHPEHUV�LQ�LWV�DI÷�OLDWHG�SODQV�LQ�&DOLIRUQLD��&RORUDGR��2KLR��1HZ�<RUN��DQG�9LUJLQLD�

��� Blue Cross Blue Shield of Louisiana. (2015). Blue Cross getting better results for customers.�5HWULHYHG�IURP��KWWS���ZZZ�EFEVOD�FRP�$ERXW%OXH�PHGLDFHQWHU�QHZV�3DJHV�%OXH&URVV*HWWLQJ%HWWHU+HDOWK5HVXOWVIRU&XVWRPHUV�DVS[�5HVXOWV�SXEOLVKHG�LQ�WKLV�SUHVV�UHOHDVH�ZHUH�YDOLGDWHG�E\�7XODQH�8QLYHUVLW\ÚV�6FKRRO�RI�3XEOLF�+HDOWK��

65�� 6KL��/����������4%3&�3URJUDP�(YDOXDWLRQ��3UHVHQWDWLRQ�DW�WKH�4XDOLW\�%OXH�3ULPDU\�&DUH�&ROODERUDWLYH��7KH�VWXG\�XVHG�D�GLIIHUHQFH�LQ�GLIIHUHQFH�DSSURDFK�WR�HYDOXDWH�RXWFRPHV�DVVRFLDWHG�ZLWK�WKH�4%3&�SURJUDP�

Page 26: PCPCC PCMH Evidence Report Feb 2016

PAGE 24

66 CareFirst BlueCross BlueShield. (2015). Quality Remains Strong as Cost Increases Slow Dramatically for Members in Patient-Centered Medical Home Program. 5HWULHYHG�IURP��KWWSV���PHPEHU�FDUH÷�UVW�FRP�LQGLYLGXDOV�QHZV�PHGLD�QHZV������TXDOLW\�UHPDLQV�VWURQJ�DV�FRVW�LQFUHDVHV�IRU�PHPEHUV�LQ�SDWLHQW�FHQWHUHG�PHGLFDO�KRPH�SURJUDP�VORZ�GUDPDWLFDOO\�SDJH

67�� %OXH�&URVV�%OXH�6KLHOG�RI�0LFKLJDQ����������Michigan continues to lead nation in patient-centered health care, thanks to Blue Cross Blue Shield of Michigan Patient-Centered Medical Home program. 5HWULHYHG�IURP��KWWS���ZZZ�EFEVP�FRP�EOXH�FURVV�EOXH�VKLHOG�RI�PLFKLJDQ�QHZV�QHZV�UHOHDVHV������MXO\������EOXH�FURVV�SDWLHQW�FHQWHUHG�PHGLFDO�KRPH�SURJUDP�KWPO

Maryland

CareFirst Blue Cross Blue Shield PCMH Program66

Published: CareFirst Blue Cross Blue Shield Press Release, July 2015

Data Review: 2014 claims data

• Costs for members in a PCMH ZHUH������PLOOLRQ�OHVV�WKDQ�SURMHFWHG�LQ������DQG������million less than expected since 2011

• a����RI�SURYLGHU�SDQHOV�HDUQHG�2XWFRPH�,QFHQWLYH�$ZDUGV��2,$��DYHUDJLQJ�����������������

Since 2011, PCMH members have had*:• 19% fewer hospital admissions ������IHZHU�LQ������

• ����IHZHU�GD\V�LQ�WKH�KRVSLWDO��������IHZHU�LQ������

• 20% fewer hospital readmissions for all causes ������IHZHU�LQ������

• 5% fewer outpatient health IDFLOLW\�YLVLWV��������IHZHU�LQ�������

Fee-for-service +

All PCMH providers earned a 12 SHUFHQWDJH�SRLQW�SDUWLFLSDWLRQ�fee (risk-adjusted PMPM)

3ULPDU\�FDUH�SDQHOV�FDQ�HDUQ�2XWFRPH�,QFHQWLYH�$ZDUGV��2,$V��EDVHG�RQ�ERWK�WKH�OHYHO�RI�TXDOLW\�DQG�GHJUHH�RI�VDYLQJV�WKH\�DFWXDOO\�DFKLHYHG�DJDLQVW�SURMHFWLRQV��SDLG�SURVSHFWLYHO\

Michigan

Blue Cross Blue Shield of Michigan Physician Incentive Program67

Published: Blue Cross Blue Shield of Michigan Press Release, July 2015

Data Review: 2015 claims data

• (VWLPDWHG������PLOOLRQ�LQ�VDYLQJV�RYHU���\HDUV

• 3&0+�SUDFWLFHV�KDG�DQ������ORZHU�UDWH�RI�DGXOW�KLJK�WHFK�UDGLRORJ\�XVH

Patients that visited PCMH practices:• 26% lower rate of hospital

admissions for common conditions

• ������ORZHU�UDWH�RI�DGXOW�(5�visits

• ������ORZHU�UDWH�RI�SHGLDWULF�(5�YLVLWV

• ������ORZHU�UDWH�RI�SHGLDWULF�(5�YLVLWV�IRU�FRPPRQ�FKURQLF�and acute conditions (i.e. asthma)

1RQH�VSHFL÷�HG�ZLWKLQ�WKLV�publication

%&%6�0LFKLJDQ�SDUWLFLSDWHV�LQ�multi-payer efforts (MAPCP)

Location/InitiativePayment Model

Description Additional OutcomesCost & Utilization

Table 3 continued

Page 27: PCPCC PCMH Evidence Report Feb 2016

PAGE 25

Table 3 continued

New Jersey

Horizon Blue Cross Blue Shield New Jersey Patient-Centered Programs68

Published: Horizon Blue Cross Blue Shield Press Release, August 2015

Data Review: 2014 claims data

Compared with members served by traditional primary care practices: • 9% lower total cost of care• ���ORZHU�UDWH�RI�KRVSLWDO�

admission • 5% lower rate of ED visits

Compared with members served by traditional primary care practices:• ���KLJKHU�UDWH�LQ�LPSURYHG�

diabetes control• ����KLJKHU�UDWH�LQ�FKROHVWHURO�PDQDJHPHQW�IRU�GLDEHWLF�patients

• ���KLJKHU�UDWH�LQ�FRORUHFWDO�FDQFHU�VFUHHQLQJV

• ���KLJKHU�UDWH�LQ�EUHDVW�FDQFHU�VFUHHQLQJ

Fee-for-service +PCMH practices have an RSSRUWXQLW\�WR�UHFHLYH�outcome-based or shared-savings payments, provided WKH\�PHHW�VSHFL÷�HG�JRDOV�IRU�DFKLHYLQJ�EHWWHU�KHDOWK�RXWFRPHV��LPSURYLQJ�WKH�SDWLHQW�H[SHULHQFH�DQG�ORZHULQJ�WKH�cost of care.

+RUL]RQ�%&%6�SDUWLFLSDWHV�LQ�multi-payer efforts (CPC)

Rhode Island

Blue Cross Blue Shield of Rhode Island PCMH program69

Published: Blue Cross Blue Shield of Rhode Island Press Release, November 2015

Data Review: 2009-2014 claims data

• PCMH practices were 5% OHVV�FRVWO\�DQG�VDYHG����0�YV��VWDQGDUG�SULPDU\�FDUH�providers

• 250% return on investment

Patients with complex medical conditions were:• ����OHVV�OLNHO\�WR�EH�KRVSLWDOL]HG�RU�QHHG�DQ�('�visit

• ����ORZHU�UHDGPLVVLRQV�WR�hospitals

“BCBSRI and partners have shared ÷�QDQFLDO�LQFHQWLYHV�WR�LPSURYH�access to care, coordination among clinicians”

%&%6�5KRGH�,VODQG�SDUWLFLSDWHV�in multi-payer efforts (MAPCP)

Location/InitiativePayment Model

Description Additional OutcomesCost & Utilization

���� +RUL]RQ�%OXH�&URVV�%OXH�6KLHOG�RI�1HZ�-HUVH\����������Patient-centered care continues to deliver on promise of better quality care at a lower cost. 5HWULHYHG�IURP��KWWS���ZZZ�KRUL]RQEOXH�FRP�DERXW�XV�QHZV�RYHUYLHZ�FRPSDQ\�QHZV�KRUL]RQ�EFEVQM�SDWLHQW�FHQWHUHG�FDUH�RQ�SURPLVH�RI�EHWWHU�TXDOLW\

69 %OXH�&URVV�%OXH�6KLHOG�RI�5KRGH�,VODQG����������New Study Shows Patient Centered Medical Homes Improve Health, Lower Costs. 5HWULHYHG�IURP��KWWSV���ZZZ�EFEVUL�FRP�DERXW�XV�QHZV�HYHQWV�QHZV�QHZ�VWXG\�VKRZV�SDWLHQW�FHQWHUHG�PHGLFDO�KRPHV�LPSURYH�KHDOWK�ORZHU�costs 7KH�UHSRUW�WUDFNHG�PRUH�WKDQ��������FRPPHUFLDO�DQG��������0HGLFDUH�$GYDQWDJH�PHPEHUV�ZLWKLQ�%&%65,ÚV�3&0+�RYHU�WKH������×������WLPH�SHULRG�

Page 28: PCPCC PCMH Evidence Report Feb 2016

PAGE 26

TABLE 4: INDEPENDENT EVALUATIONS OF FEDERAL INITIATIVES: Primary care/PCMH interventions that assessed cost or utilization, selected outcomes by location, 2014-2015

Location/Initiative

Multi-state (7 regions)

Comprehensive Primary Care (CPC) Initiative37

Published: Mathematica Independent Evaluation, January 2015

Data Review: Performance Year 2013

Participating practices located in Arkansas, Oklahoma (Greater Tulsa region), Oregon, Colorado, Ohio (Cincinnati-Dayton region and Northern Kentucky region), New Jersey, and New York (Capitol District-Hudson Valley region)

Report evaluated cost, utilization, quality, access, and patient satisfaction measures

Cost and utilization outcomes for the CPC program varied across regions; overall program results include: • $FURVV�WKH���UHJLRQV��&3&�

reduced Medicare Part A and Part B expenditures E\�����3%30 ��ZLWK�FDUH�PDQDJHPHQW�IHHV�H[FOXGHG��PHGLDQ�RI���������SHU�clinician)

• 2% reduction in hospital DGPLVVLRQV�DQG����UHGXFWLRQ�in ED visits

• ���&3&�ZLGH�GHFOLQH�LQ�XQSODQQHG����GD\�UHDGPLVVLRQV��QRW�VWDWLVWLFDOO\�VLJQL÷�FDQW�

• 0DMRULW\�RI�VDYLQJV�JHQHUDWHG�E\�SDWLHQWV�LQ�WKH�KLJKHVW�ULVN�TXDUWLOH��EXW�IDYRUDEOH�results were also seen in other patients

Quality outcomes for the CPC program varied across regions

Medicare payments:• Fee-for-service + care

management fee. ,Q�WKH�÷�UVW�WZR�\HDUV�RI�&3&��WKH�0HGLFDUH�ULVN�DGMXVWHG�3030�SD\PHQW�UDWHV�DUH���������������DQG������GHSHQGLQJ�RQ�D�SDWLHQWÚV�+&& �VFRUH��DYHUDJH�UDWH�LV�����3%30 �

• 2SSRUWXQLW\�IRU�shared savings LQ��QG���UG��DQG��WK�\HDU�LI�QHW�VDYLQJV�LQ�0HGLFDUH�Part A and B health care FRVWV�LV�DFKLHYHG���TXDOLW\�performance

Other participating payers:• 3URYLGH�HQKDQFHG�SD\PHQWV�

for each of their members attributed to a practice �DOPRVW�DOZD\V�D�3030�FDUH�PDQDJHPHQW�SD\PHQW��

This is a multi-payer initiative

Multi-state (8 regions)

Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration70

Published: RTI International Independent Evaluation, January 2015

Data Review: Performance Year 2013

8 states began MAPCP in 2011: Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island and Vermont (5 continuing to participate through 2016: ME, MI, NY, RI, VT)

Cost and utilization outcomes for the MAPCP program varied by state, overall the program:• *HQHUDWHG�DQ�HVWLPDWHG������PLOOLRQ�LQ�VDYLQJV�LQ�LWV�÷�UVW�\HDU�WKURXJK�WKH�XVH�RI�DGYDQFHG�SULPDU\�FDUH�initiatives

Fee-for-service +• Each state has its own SD\PHQW�OHYHOV�DQG�established its own PHWKRGRORJLHV

• &06�PDNHV�PRQWKO\�0$3&3�SD\PHQWV�WR�3&0+V�IRU�DVVLJQHG�GHPRQVWUDWLRQ�EHQH÷�FLDULHV

• 6WDWHV�LQVWUXFWHG�WKDW�WKH�DYJ��0HGLFDUH�3030�SD\PHQW�VKRXOG�QRW�H[FHHG�����DQG�WKDW�SD\PHQW�PHWKRGV�VKRXOG�EH�DSSOLHG�FRQVLVWHQWO\�E\�DOO�SDUWLFLSDWLQJ�SD\HUVØEXW�QRW�QHFHVVDULO\�DW�WKH�VDPH�GROODU�level

This is a multi-payer demonstration

Payment Model

Description Additional OutcomesCost & Utilization

���� 7D\ORU��(�)���'DOH��6���3HLNHV��'���%URZQ��5���*KRVK��$���&URVVRQ��-��â6KDSLUR��5����������(YDOXDWLRQ�RI�WKH�&RPSUHKHQVLYH�3ULPDU\�&DUH�,QLWLDWLYH��)LUVW�$QQXDO�5HSRUW��Mathematica Policy Research. 5HWULHYHG�IURP��KWWS���LQQRYDWLRQ�FPV�JRY�)LOHV�UHSRUWV�&3&,�(YDO5SW��pdf 0DWKHPDWLFD�3ROLF\�5HVHDUFK�FRQGXFWHG�DQ�LQGHSHQGHQW�HYDOXDWLRQ�RI�WKH�÷�UVW�SHUIRUPDQFH�\HDU�RI�WKH�&3&�LQLWLDWLYH��WKURXJK�6HSWHPEHU��������7KH�&3&�LQLWLDWLYH�LV�D�PXOWL�SD\HU�SDUWQHUVKLS�EHWZHHQ�0HGLFDUH��0HGLFDLG�SULYDWH�KHDOWK�FDUH�SD\HUV��DQG�SULPDU\�FDUH�SUDFWLFHV�LQ�IRXU�VWDWHV��$UNDQVDV��&RORUDGR��1HZ�-HUVH\�DQG�2UHJRQ��DQG�WKUHH�UHJLRQV��1HZ�<RUNÚV�&DSLWDO�'LVWULFW�DQG�+XGVRQ�9DOOH\��2KLR�DQG�.HQWXFN\ÚV�&LQFLQQDWL�'D\WRQ�UHJLRQ��DQG�2NODKRPDÚV�*UHDWHU�7XOVD�UHJLRQ��

70�� 57,�,QWHUQDWLRQDO����������Evaluation of the Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration: First Annual Report. 5HWULHYHG�IURP��KWWSV���GRZQORDGV�FPV�JRY�÷�OHV�FPPL�0$3&3�)LUVW(YDOXDWLRQ5HSRUWB�B��B���SGI�57,�,QWHUQDWLRQDO�FRQGXFWHG�DQ�LQGHSHQGHQW�HYDOXDWLRQ�RI�WKH�HLJKW�SDUWLFLSDWLQJ�0$3&3�VWDWHV�LQ�WKH�÷�UVW�SHUIRUPDQFH�\HDU��7KH�HYDOXDWLRQ�XVHV�D�PL[�RI�TXDOLWDWLYH�DQG�TXDQWLWDWLYH�PHWKRGV�WR�FDSWXUH�HDFK�RI�WKH�VWDWHVÚ�XQLTXH�IHDWXUHV�DQG�WR�GHYHORS�DQ�LQ�GHSWK�XQGHUVWDQGLQJ�RI�WKH�WUDQVIRUPDWLYH�SURFHVVHV�WKDW�RFFXU�ZLWKLQ�DQG�DFURVV�WKH�VWDWHVÚ�KHDOWK�FDUH�V\VWHPV�DQG�SDUWLFLSDWLQJ�3&0+�SUDFWLFHV��7KH�HYDOXDWLRQ�XVHG�D�PL[HG�PHWKRG�GHVLJQ��ZLWK�ERWK�TXDQWLWDWLYH�DQG�TXDOLWDWLYH�PHWKRGV�DQG�GDWD��&KDSWHU���LQFOXGHV�D�VXPPDU\�RI�FURVV�VWDWH�÷�QGLQJV��SDJH�����

Page 29: PCPCC PCMH Evidence Report Feb 2016

PAGE 27

Table 4 continued

48 States

)HGHUDOO\�4XDOL÷�HG�Health Center Advanced Primary Care Practice Demonstration FQHC 71

Published: Rand Corporation, July 2015

Data Review: November 2011- October 2014

Report evaluated cost, utilization, access and quality measures

Relative to 4 baseline quarters, claims-based analyses across ��TXDUWHUV�VKRZ�VLJQL÷�FDQWO\�more utilization and costs for demonstration FQHCs vs. comparison FQHCs.Demonstration FQHC users KDG�VLJQL÷�FDQWO\�PRUH��• 7RWDO�0HGLFDUH�SD\PHQWV����TXDUWHUV��

• Hospital admissions (2 TXDUWHUV���

• 5HDGPLVVLRQV����TXDUWHU��• ('�YLVLWV����TXDUWHUV�

• The demonstration )4+&�JURXS�VLJQL÷�FDQWO\�outperformed comparison JURXS�IRU�DW�OHDVW���TXDUWHUV�IRU�+E$�&�WHVWV��UHWLQDO�H\H�H[DPV��DQG�QHSKURSDWK\�WHVWLQJ

• ,Q�\HDU����GHPRQVWUDWLRQ�FQHCs associated with a ~1% GHFUHDVH�LQ�FRQWLQXLW\�ZKHQ�ORRNLQJ�DFURVV�DOO�SULPDU\�care provider visits and when ORRNLQJ�DW�SULPDU\�FDUH�DQG�VSHFLDOLVW�FDUH�WRJHWKHU

Fee-for-service +&06�SURYLGHV�SDUWLFLSDWLQJ�)4+&V�ZLWK�D�TXDUWHUO\�care management payment of ����IRU�HDFK�HOLJLEOH�0HGLFDUH�EHQH÷�FLDU\

Location/InitiativePayment Model

Description Additional OutcomesCost & Utilization

71 .DKQ��.�/���7LPELH��-�:���)ULHGEHUJ��0�:���/DYHOOH��7�$���0HQGHO��3���$VKZRRG��-�6������6HWRGML��&�0����������Evaluation of CMS FQHC APCP Demonstration: Second Annual Report. 5DQG�&RUSRUDWLRQ��5HWULHYHG�IURP��KWWSV���LQQRYDWLRQ�FPV�JRY�)LOHV�UHSRUWV�ITKF�VFQGHYDOUSW�SGI�5$1'�&RUSRUDWLRQ�FRQGXFWHG�DQ�LQGHSHQGHQW�HYDOXDWLRQ�RI�WKH�)4+&�$GYDQFHG�3ULPDU\�&DUH�3UDFWLFH��$3&3��GHPRQVWUDWLRQ�DQG�DVVHVVHG�WKH�HIIHFWV�RI�WKH�$3&3�PRGHO�RQ�DFFHVV��TXDOLW\��DQG�FRVW�RI�FDUH�SURYLGHG�WR�0HGLFDUH�DQG�0HGLFDLG�EHQH÷�FLDULHV�FXUUHQWO\�VHUYHG�E\�)4+&V��)RU�WKLV�GHPRQVWUDWLRQ��&06�UHFRJQL]HV�DGYDQFHG�SULPDU\�FDUH�DV�WKH�W\SH�RI�FDUH�WKDW�LV�RIIHUHG�E\�)4+&V�WKDW�KDYH�DFKLHYHG�/HYHO���1&4$�UHFRJQLWLRQ�DV�D�3&0+�

SNAPSHOT OF THE EVIDENCE

21 of 23 studies that reported on cost measures found reductions in one or more measures

studies that reported on XWLOL]DWLRQ�PHDVXUHV

found reductions in one or more measures

23 of 25

Aggregated Outcomes from the 30 Studies

Page 30: PCPCC PCMH Evidence Report Feb 2016

PAGE 28

SECTION THREE: DISCUSSION OF FINDINGS AND IMPLICATIONS7KH�UHSRUW�FRQFOXGHV�ZLWK�DQ�DQDO\VLV�DQG�GLVFXVVLRQ�RI�WKH�HYLGHQFH�DQG�LWV�LPSOLFDWLRQV�LQ�OLJKW�RI�SD\PHQW�

UHIRUP��$OWKRXJK�WKH�SULPDU\�FDUH�3&0+�LQWHUYHQWLRQV�LQFOXGHG�LQ�WKLV�UHSRUW�YDULHG�VXEVWDQWLDOO\�LQ�VL]H��

VFRSH��JHRJUDSKLF�ORFDWLRQ��3&0+�LPSOHPHQWDWLRQ�VWUDWHJ\��DQG�SD\PHQW�PRGHO��WUHQGV�LQ�WKH�UHSRUWHG�

UHVXOWV�DUH�FOHDU�DQG�HQFRXUDJLQJ��$FURVV�WKH�YDULRXV�VWXGLHV��WKH�3&0+�PRGHO�ZDV�DVVRFLDWHG�ZLWK�ODUJHO\�

SRVLWLYH�DQG�FRQVLVWHQW�WUHQGV�RQ�FRVW�DQG�XWLOL]DWLRQ�PHDVXUHV��WKH�PDMRU�IRFXV�RI�WKLV�DQQXDO�HYLGHQFH�

report.

Peer-Reviewed Studies (Table 1)

2YHUDOO��WKH�UHVXOWV�IURP����SHHU�UHYLHZHG�VWXGLHV�DVVRFLDWH�3&0+�LPSOHPHQWDWLRQ�ZLWK�JHQHUDO�

LPSURYHPHQWV�LQ�FRVW�DQG�XWLOL]DWLRQ�PHDVXUHV��2I�WKH����VWXGLHV�WKDW�GHVLJQDWHG�FRVW�DV�DQ�RXWFRPH�

YDULDEOH��QLQH�VKRZHG�DQ�LPSURYHPHQW�LQ�RQH�RU�PRUH�FRVW�PHDVXUHV��VXFK�DV�HPHUJHQF\�GHSDUWPHQW��('��

FRVWV�RU�LQSDWLHQW�VSHQGLQJ��7KH�9HUPRQW�%OXHSULQW�IRU�+HDOWK�IRXQG�LPSUHVVLYH�UHGXFWLRQV�LQ�LQSDWLHQW�

������p�������DQG�RXWSDWLHQW�KRVSLWDO�H[SHQGLWXUHV�������p�������ZKLOH�VLPXOWDQHRXVO\�LQFUHDVLQJ�

VSHQGLQJ�IRU�GHQWDO��VRFLDO��DQG�FRPPXQLW\�EDVHG�VXSSRUW�VHUYLFHV�������p<.001), which resulted in total

FRVW�VDYLQJV�IRU�WKH�VWDWH�DQG�D�UHWXUQ�RQ�LQYHVWPHQW�RI�QHDUO\���WR����DQQXDOL]HG�FRVW�JDLQ�UDWLR���� Both

SHHU�UHYLHZHG�VWXGLHV�IURP�%OXH�&URVV�%OXH�6KLHOG�0LFKLJDQ�LGHQWL÷�HG�WRWDO�FRVW�RI�FDUH�VDYLQJV��ZLWK�RQH�

VWXG\�UHSRUWLQJ�D�����SHUFHQW�ORZHU�FRVW�DPRQJ�DGXOWV�50�ZKLOH�WKH�*HLVLQJHU�VWXG\�LGHQWL÷�HG�DQ�LPSUHVVLYH�

����SHUFHQW�WRWDO�FRVW�VDYLQJV�DFURVV�D����PRQWK�VWXG\�SHULRG��� One of the two peer-reviewed studies

GHVFULELQJ�WKH�3HQQV\OYDQLD�&KURQLF�&DUH�LQLWLDWLYH�IRXQG�VWDWLVWLFDOO\�VLJQL÷�FDQW�FRVW�VDYLQJV�DVVRFLDWHG�

ZLWK�3&0+�SUDFWLFHV�VHUYLQJ�WKRVH�ZLWK�FKURQLF�LOOQHVV�LQ�DOO�WKUHH�IROORZ�XS�\HDUV��p������GULYHQ�E\�

VLJQL÷�FDQWO\�ORZHU�LQSDWLHQW��p<.01) and specialist (p<.0001) costs.55

1RW�DOO�QLQH�VWXGLHV��KRZHYHU��UHSRUWHG�RQ�WRWDO�FRVW�RI�FDUH��7KH�&RORUDGR�0XOWL�SD\HU�3&0+�SLORW�VWXG\��

ZKLFK�UHSRUWHG�ORZHU�('�FRVWV�HVSHFLDOO\�IRU�WKRVH�ZLWK�FKURQLF�LOOQHVV��PHDVXUHG�EXW�GLG�QRW�÷�QG�QHW�

RYHUDOO�FRVW�VDYLQJV��� Most studies did not assess the total cost of care, but the trend across these 17 peer-

UHYLHZHG�VWXGLHV�VXJJHVWV�WKDW�WKH�ORQJHU�WKH�3&0+�SURJUDP�KDG�EHHQ�LPSOHPHQWHG�DQG�VXEVHTXHQWO\�

HYDOXDWHG��LPSURYHPHQWV�LQ�FRVW�RU�XWLOL]DWLRQ�ZHUH�GHPRQVWUDWHG��7KLV�ZDV�VSHFL÷�FDOO\�VXJJHVWHG�E\�WKH�

%OXH�&URVV�6KLHOG�0LFKLJDQ�VWXGLHV��WKH�*HLVLQJHU�3URYHQKHDOWK�1DYLJDWRU�SURJUDP��WKH�3HQQV\OYDQLD�

&KURQLF�&DUH�LQLWLDWLYH��DQG�WKH�0HGLFDUH�)HH�)RU�6HUYLFH�1&4$�VWXG\��

“7KH�WUHQG�DFURVV�WKHVH����SHHU�UHYLHZHG�VWXGLHV�VXJJHVWV�

WKDW�WKH�ORQJHU�WKH�3&0+�SURJUDP�KDG�EHHQ�LPSOHPHQWHG�DQG�

VXEVHTXHQWO\�HYDOXDWHG��LPSURYHPHQWV�LQ�FRVW�RU�XWLOL]DWLRQ�

were demonstrated.”

Page 31: PCPCC PCMH Evidence Report Feb 2016

PAGE 29

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PRUH�PHDVXUHV��0HDVXUHV�RI�ÜXSVWUHDPÝ�XWLOL]DWLRQ�Ø�VXFK�DV�LPSURYHPHQWV�LQ�ÜXVXDO�VRXUFH�RI�FDUHÝ�

IRXQG�LQ�WKH�7H[DV�&KLOGUHQÚV�+HDOWK�&DUH�VWXG\�RU�LQFUHDVHG�XVH�RI�SULPDU\�FDUH�LQ�RQH�RI�WKH�WZR�9$�

3$&7�VWXGLHV�Ø�UHVXOWHG�LQ�ÜGRZQVWUHDPÝ�XWLOL]DWLRQ�FKDQJHV��DV�GHPRQVWUDWHG�E\�ORZHU�('�YLVLWV�DQG�

KRVSLWDOL]DWLRQV��VXFK�DV�WKDW�UHSRUWHG�E\�WKH�&+,35$�4XDOLW\�GHPRQVWUDWLRQ��7KHVH�XWLOL]DWLRQ�PHDVXUH�

FKDQJHV��('�XVH��KRVSLWDOL]DWLRQ��VSHFLDOLVW�YLVLWV��ZHUH�VLPLODU�DFURVV�WKH�PDMRULW\�RI�WKH�SHHU�UHYLHZHG�

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DQG�PHDQLQJIXO�YLVLWV�DQG�SRVVLEO\�UHGXFH�WKH�QHHG�IRU�UHWXUQ�YLVLWV����$QRWKHU�PHDVXUH�RI�XWLOL]DWLRQ�—

FRQWLQXLW\�RI�FDUH��ZDV�GHPRQVWUDWHG�LQ�WKH�&DOLIRUQLD�+HDOWK�&DUH�&RYHUDJH�,QLWLDWLYH��� which evaluated

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PHGLFDO�KRPH��7R�LQFHQWLYL]H�SURYLGHUV�WR�SURPRWH�DQG�HPEUDFH�WKLV�PRGHO��WKH�SURJUDP�GHFOLQHG�WR�SD\�

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'HVSLWH�DSSURSULDWH�FDXWLRQ�DERXW�WKH�XQLQWHQGHG�FRQVHTXHQFHV�RI�SROLFLHV�RU�SURJUDPV�WKDW�OLPLW�DFFHVV�

WR�FDUH��WKLV�LQQRYDWLYH�DSSURDFK�UHVXOWHG�LQ�FKDQJLQJ�ERWK�SURYLGHU�DQG�SDWLHQW�EHKDYLRU�DQG�D�VXEVHTXHQW�

UHGXFWLRQ�LQ�LQDSSURSULDWH�DQG�FRVWO\�XWLOL]DWLRQ�RI�KHDOWK�FDUH�VHUYLFHV��

“‘NatureÚ�UHIHUV�WR�WKH�KHDOWK�FDUH�HFRORJ\�RI�WKH�UHJLRQ�

LQFOXGLQJ�SUDFWLFH�VL]H��SUDFWLFH�FXOWXUH��DQG�SDWLHQW�SRSXODWLRQ��

whereas ‘nurtureÚ�UHIHUV�WR�WKH�LQWHUYHQWLRQ�GHVLJQ�DQG�

LWV�FRPSRQHQWV��LQFOXGLQJ�WHFKQLFDO�DVVLVWDQFH��SURYLGHU�

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incentives, etc.).”$QRWKHU�H[DPSOH�RI�D�PXOWL�SD\HU�FROODERUDWLYH�WKDW�UHVXOWHG�LQ�ERWK�VLJQL÷�FDQW�FRVW�VDYLQJV�DQG�XWLOL]DWLRQ�

LPSURYHPHQWV�FDPH�IURP�3HQQV\OYDQLD��7KH�3HQQV\OYDQLD�&KURQLF�&DUH�,QLWLDWLYH��3D�&&,��GHPRQVWUDWHG�

SRVLWLYH�UHVXOWV��FRQWUDVWLQJ�ZLWK�ODVW�\HDUÚV�ZLGHO\�FLWHG�-$0$�VWXG\72 that reported no association

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XWLOL]DWLRQ��DV�ZHOO�DV�QRWDEOH�LPSURYHPHQWV�LQ�TXDOLW\�RI�FDUH��,Q�D������Health Affairs article, authors

)ULHGEHUJ��6L[WD�DQG�%DLOLW���UHIHU�WR�WKH�ÜQDWXUHÝ�DQG�ÜQXUWXUHÝ�FKDUDFWHULVWLFV�RI�WKH�3HQQV\OYDQLD�PHGLFDO�

KRPH�LQLWLDWLYH��ZKLFK�ZDV�UROOHG�RXW�GLIIHUHQWO\�LQ�YDULRXV�UHJLRQV�RI�WKH�VWDWH��Ü1DWXUHÝ�UHIHUUHG�WR�WKH�

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FRPSDUHV�WKH�UHJLRQDO�GLIIHUHQFHV�DQG�WKH�VXEVHTXHQW�FRQWUDVWLQJ�UHVXOWV��ZKLFK�PD\�SURYLGH�LPSRUWDQW�

OHVVRQV�QRW�RQO\�IRU�SD\PHQW�UHIRUP��EXW�DOVR�IRU�3&0+�LQWHUYHQWLRQ�GHVLJQ�

Page 32: PCPCC PCMH Evidence Report Feb 2016

PAGE 30

State Government Evaluations (Table 2)

$OO�IRXU�VWDWH�JRYHUQPHQW�HYDOXDWLRQV�SURYLGH�YDOXDEOH�LQVLJKW�RQ�VWDWH�VSRQVRUHG�SULPDU\�FDUH�3&0+�

initiatives, and each reported improvement in one or more cost metric. The Colorado Accountable Care

&ROODERUDWLYH�UHSRUWHG�DQ�RYHUDOO�QHW�VDYLQJV�WR�WKH�VWDWH�RI���������PLOOLRQ�RYHU�D�WZR�\HDU�WLPHIUDPH�60

,Q�1RUWK�&DUROLQD��DQ�LQGHSHQGHQW�VWDWH�DXGLWRU�UHSRUW�HYDOXDWLQJ�WKH�&RPPXQLW\�&DUH�RI�1RUWK�&DUROLQD�

SURJUDP�IRXQG�WKDW�UHGXFWLRQV�LQ�('�YLVLWV��LQSDWLHQW�DGPLVVLRQV��DQG�UHDGPLVVLRQV�VDYHG�WKH�VWDWH�

0HGLFDLG�SURJUDP�DSSUR[LPDWHO\������PLOOLRQ�62�2I�QRWH��WKH�DXGLWRU�HYDOXDWHG�WKH�SURJUDP�RYHU�QLQH�

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UHVXOWV��,Q�DGGLWLRQ��DOO�RI�WKH�VWDWH�JRYHUQPHQW�HYDOXDWLRQV�WKDW�UHSRUWHG�RQ�XWLOL]DWLRQ�PHDVXUHV�IRXQG�

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UHPDUNDEOH�UHGXFWLRQV�LQ�LQDSSURSULDWH�DQG�DYRLGDEOH�('�XVH��7KH�HYDOXDWLRQ�ODUJHO\�DWWULEXWHG�XWLOL]DWLRQ�

LPSURYHPHQWV�WR�ÜHPHUJHQF\�GHSDUWPHQW�QDYLJDWRUVÝ�ZKR�UHIHU�SDWLHQWV�SUHVHQWLQJ�ZLWK�QRQ�XUJHQW�

FRQGLWLRQV�WR�PRUH�DSSURSULDWH�FDUH�VHWWLQJV��LQFOXGLQJ�3DWLHQW�&HQWHUHG�3ULPDU\�&DUH�+RPHV�61

Southeast Region Northeast Region

Nature Practices • 0RVWO\�VPDOO��LQGHSHQGHQW�SUDFWLFHV�• $�IHZ�YHU\�ODUJH�DFDGHPLF�PHGLFDO�

centers and FQHCs

• 6HYHUDO�ÜULJKW�VL]HÝ��PHGLXP�VL]HG��practices

• 6ROR�SUDFWLFHV�RIWHQ�EHORQJHG�WR�ODUJHU�PHGLFDO�JURXS

• 6WURQJ�UHODWLRQVKLS�ZLWK�KRVSLWDOV

Patient population

• 0DQ\�KDG�VLJQL÷�FDQW�HFRQRPLF�hardship

• Less diverse, fewer with economic FKDOOHQJHV

Nurture Quality improvement focus

• 4,�IRFXVHG�DOPRVW�H[FOXVLYHO\�RQ�diabetes care

• Focused on multiple chronic conditions

Implementation • )DLUO\�UXVKHG�LPSOHPHQWDWLRQ���VW�UHJLRQ�LQ�WKH�LQLWLDWLYH�WR�ODXQFK

• 2QO\�����RI�SUDFWLFHV�KDG�(+5V�DW�WKH�EHJLQQLQJ�RI�LPSOHPHQWDWLRQ

• +DG�RSSRUWXQLW\�WR�OHDUQ�IURP�RWKHU�UHJLRQV

• $OO�SUDFWLFHV�KDG�(+5V�DW�EHJLQQLQJ�RI�implementation

Payment model • Practices received PMPM after HDUQLQJ�1&4$�UHFRJQLWLRQ

• 3D\PHQWV�QRW�FRQWLQJHQW�XSRQ�KLULQJ�FDUH�PDQDJHU

• 3UDFWLFHV�ZHUH�QRW�UHTXLUHG�WR�KDYH�1&4$�UHFRJQLWLRQ�XQWLO����PRQWKV�into implementation

2 streams of payment: • ��IRU�FDUH�PDQDJHPHQW�DQG• 1 for practice transformation

1R�RSSRUWXQLW\�IRU�VKDUHG�VDYLQJV�XQWLO�\HDU����DIWHU�LQLWLDO�-$0$�VWXG\72 was published)

2SSRUWXQLW\�IRU�VKDUHG�VDYLQJV�WLHG�WR�TXDOLW\�LPSURYHPHQW

Payer support ,Q�PDQ\�SUDFWLFHV��QR�GDWD�DQG�QR�technical support provided

Provided practices with ED and inpatient QRWL÷�FDWLRQ�DQG�UHSRUWV�IURP�WKH�EHJLQQLQJ�RI�LPSOHPHQWDWLRQ

Findings Evaluation )RFXVHG�RQ�÷�UVW���\HDUV�RI�LPSOHPHQWDWLRQ��EXW�\HDUV���DQG���KDG�JUHDWHU�VXFFHVV

(YDOXDWHG�GDWD�IURP���\HDUV�SULRU�WR�DQG���\HDUV�DIWHU�WKH�SLORW�LQFHSWLRQ�GDWH

Results • Limited improvement on diabetes care

• 1R�UHGXFWLRQV�LQ�XWLOL]DWLRQ• 1R�FRVW�VDYLQJV

• 5HGXFWLRQV�LQ�XQQHFHVVDU\�LQDSSURSULDWH�XWLOL]DWLRQ

• ,PSURYHPHQWV�LQ�FDUH�TXDOLW\�PHDVXUHV��VFUHHQLQJV

NATURE VS. NURTURE: Factors Driving PCMH Outcomes in Two Regions of Pennsylvania73

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Page 33: PCPCC PCMH Evidence Report Feb 2016

PAGE 31

Industry Reports (Non Peer-Reviewed) (Table 3)

5HVXOWV�IURP�YDULRXV�LQGXVWU\�UHSRUWV�DUH�XQLIRUPO\�SRVLWLYH�DQG�VSHDN�WR�WKH�VL]DEOH�LQYHVWPHQW�SULYDWH�

SD\HUV�DUH�PDNLQJ�LQ�HQKDQFHG�SULPDU\�FDUH�DQG�WKH�3&0+��$OO�VL[�LQGXVWU\�SXEOLFDWLRQV�UHSRUW�UHGXFWLRQV�

LQ�ERWK�FRVW�DQG�XWLOL]DWLRQ��DQG�WKUHH�GHWDLO�LPSRUWDQW�LPSURYHPHQWV�LQ�TXDOLW\�RI�FDUH�PHDVXUHV��7KH�

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Ø�UHSRUWHG�QHW�FRVW�VDYLQJV�RI�������SHU�DWWULEXWHG�PHPEHU�SHU�PRQWK��3D030��LQ�LWV�DI÷�OLDWHG�SODQV�

LQ�&DOLIRUQLD��&RORUDGR��2KLR��1HZ�<RUN�DQG�9LUJLQLD����%OXH�&URVV�%OXH�6KLHOG�RI�0LFKLJDQ��RQH�RI�WKH�

ODUJHVW�DQG�ORQJHVW�UXQQLQJ�3&0+�SURJUDPV�LQ�WKH�FRXQWU\��HVWLPDWHV������PLOOLRQ�LQ�VDYLQJV�RYHU�VL[�

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&DUH)LUVWÚV�XQLTXH�3&0+�SURJUDP�WKDW�YLUWXDOO\�FRQQHFWV�QRQ�DI÷�OLDWHG�SURYLGHUV�WKURXJK�QXUVH�FDUH�

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LWV�H[SHFWHG�VSHQG�VLQFH�������ZLWK����SHUFHQW�RI�LWV�SURYLGHU�SDQHOV�HDUQLQJ�2XWFRPH�,QFHQWLYH�$ZDUGV�

�2,$��66�+RUL]RQ�%OXH�&URVV�%OXH�6KLHOG�LQ�1HZ�-HUVH\�ZDV�DEOH�WR�UHGXFH�WRWDO�FRVW�RI�FDUH�E\���SHUFHQW��

UHGXFH�WKH�UDWH�RI�KRVSLWDO�DGPLVVLRQ�E\���SHUFHQW��DQG�UHGXFH�WKH�UDWH�RI�('�YLVLWV�E\���SHUFHQW��ZKLOH�DW�

WKH�VDPH�WLPH�LPSURYLQJ�RQ�D�QXPEHU�RI�TXDOLW\�PHDVXUHV�UHODWHG�WR�GLDEHWHV��FKROHVWHURO��DQG�FDQFHU���

7KHVH�IDYRUDEOH�UHVXOWV�DUH�LQø�XHQWLDO�LQ�QRW�RQO\�DGYDQFLQJ�IXUWKHU�H[SDQVLRQ�RI�H[LVWLQJ�FRPPHUFLDO�SD\HU�

SURJUDPV��EXW�DOVR�LQ�SURPRWLQJ�SULYDWH�VHFWRU�HQJDJHPHQW�LQ�PXOWL�SD\HU�FROODERUDWLYHV��

Independent Evaluations of Federal Initiatives (Table 4)

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VWDWH�VSHFL÷�F�RXWFRPHV��ZKHQ�UHSRUWHG��DUH�DYDLODEOH�RQ�HDFK�SURJUDPÚV�UHVSHFWLYH�SDJH�DQG�RQ�WKH�RQOLQH�

3&3&&�3ULPDU\�&DUH�,QQRYDWLRQV�DQG�3&0+�0DS��)XUWKHU��ZH�VXPPDUL]HG�VWDWH�VSHFL÷�F�WUHQGV�EHORZ�

7KH�0XOWL�3D\HU�$GYDQFHG�3ULPDU\�&DUH�3UDFWLFH��0$3&3��'HPRQVWUDWLRQ��DV�GHVFULEHG�LQ�7DEOH����

FRPELQHV�HLJKW�XQLTXH�VWDWH�VSRQVRUHG�LQLWLDWLYHV�WRJHWKHU�ZLWK�0HGLFDUH�WR�SURPRWH�WKH�DGRSWLRQ�RI�WKH�

3&0+��DOORZLQJ�IRU�VXEVWDQWLDO�ø�H[LELOLW\�LQ�3&0+�LPSOHPHQWDWLRQ�DQG�SD\PHQW��7KH�HYDOXDWLRQ�IRFXVHG�

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FRRUGLQDWLRQ�RI�FDUH��VSHFLDO�SRSXODWLRQV��EHQH÷�FLDU\�H[SHULHQFH�ZLWK�FDUH��SDWWHUQV�RI�XWLOL]DWLRQ��0HGLFDUH�

DQG�0HGLFDLG�H[SHQGLWXUHV�DQG�EXGJHW�QHXWUDOLW\��,W�UHSRUWHG�DQ�RYHUDOO�HVWLPDWHG������PLOOLRQ�LQ�0HGLFDUH�

FRVW�VDYLQJV�70�$�GHHSHU�GLYH�LQWR�WKH�HYDOXDWLRQ�KLJKOLJKWV�WKH�OLPLWDWLRQV�RI�HDUO\�GDWD�UHYLHZV�DQG�WKH�

YDULDELOLW\�DFURVV�VWDWHV��ZLWK�RQO\�WZR�RI�WKH�HLJKW�0$3&3�VWDWHV��9HUPRQW�DQG�0LFKLJDQ��DFKLHYLQJ�QHW�

FRVW�VDYLQJV��GULYHQ�E\�UHGXFHG�JURZWK�LQ�H[SHQGLWXUHV�IRU�VKRUW�VWD\��DFXWH�FDUH�KRVSLWDOL]DWLRQV��%RWK�

VWDWHV��DV�GHVFULEHG�LQ�WKH�SHHU�UHYLHZHG�VWXGLHV�DERYH��KDYH�KDG�PDWXUH�3&0+�SURJUDPV�IRU�VHYHUDO�

\HDUV��7KH�HYDOXDWLRQ�IRXQG�HYHQ�IHZHU�XWLOL]DWLRQ�PHDVXUH�FKDQJHV��ZLWK�RQO\�0LQQHVRWD�GHPRQVWUDWLQJ�

UHGXFWLRQV�LQ�('�YLVLW�UDWHV��$V�VXJJHVWHG�E\�WKH�LQGHSHQGHQW�HYDOXDWRUV��KHDOWK�V\VWHP�WUDQVIRUPDWLRQ�

WDNHV�WLPH�DQG�WKH�OLPLWHG�÷�QGLQJV�KHUH�DUH�OLNHO\�D�UHVXOW�RI�WKLV�HDUO\�UHYLHZ�70�7KH�GHFLVLRQ�E\�&06�WR�

H[WHQG�WKH�SURJUDP��IURP���WR���\HDUV��LQ�÷�YH�RI�WKH�HLJKW�VWDWHV�DSSHDUV�WR�XQGHUVFRUH�WKLV�XQGHUVWDQGLQJ�

$OVR�GHVFULEHG�LQ�7DEOH����WKH�&RPSUHKHQVLYH�3ULPDU\�&DUH�,QLWLDWLYH�LV�D�PXOWL�SD\HU�SURJUDP�WKDW�XQLWHV�

SXEOLF�VHFWRU��ERWK�IHGHUDO�DQG�VWDWH��DV�ZHOO�DV�SULYDWH�VHFWRU�SD\HUV��KHDOWK�SODQV��HPSOR\HUV��DQG�XQLRQV��

WR�VXSSRUW�SULPDU\�FDUH�SUDFWLFHV�LQ�WUDQVIRUPLQJ�FDUH�GHOLYHU\��,W�LV�XQLTXH�LQ�LWV�HIIRUW�WR�GULYH�D�PRUH�

VWDQGDUGL]HG�GHOLYHU\�DQG�SD\PHQW�UHIRUP�HIIRUW�LQ�IRXU�VWDWHV��$5��&2��1-��DQG�25��DQG�WKUHH�UHJLRQV�

�1HZ�<RUNÚV�&DSLWDO�'LVWULFW�DQG�+XGVRQ�9DOOH\��2KLR�DQG�QRUWKHUQ�.HQWXFN\ÚV�&LQFLQQDWL�'D\WRQ�UHJLRQ��

DQG�2NODKRPDÚV�*UHDWHU�7XOVD�UHJLRQ�����3DUWLFLSDWLQJ�SULPDU\�FDUH�SUDFWLFHV�UHFHLYH�WHFKQLFDO�DVVLVWDQFH�

IRU�TXDOLW\�LPSURYHPHQW��FDUH�PDQDJHPHQW�IHHV�WR�VXSSRUW�WKH�FRVWV�RI�QRQ�YLVLW�EDVHG�VHUYLFHV��DQG�DQ�

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Page 34: PCPCC PCMH Evidence Report Feb 2016

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Page 35: PCPCC PCMH Evidence Report Feb 2016

PAGE 33

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Page 36: PCPCC PCMH Evidence Report Feb 2016

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Page 37: PCPCC PCMH Evidence Report Feb 2016

PAGE 35

To learn more about the PCMH, visit www.pcpcc.org

Creates stronger relationships with your providers

Saves you time

Provides better support and communication

A Patient-Centered Medical Home is the right care at the right time. It offers:

Medication review to help you understand and monitor the prescriptions you’re taking.

Connection to support and encouragement from peers in your community who share similar health issues and experiences.

Coaching and advice to help you follow your care plan and meet your goals.

Personalized care plans you help design that address your health concerns.

As you pursue your health care journey, you may make stops at different places:

Studies show that PCMH:

Wherever your journey takes you, your primary care team will help guide the way and coordinate your care.

Primary Care

Patient and Family

Specialists Community Supports

Pharmacy

Behavioral & Mental Health

Hospital

What Is a Patient-Centered Medical Home (PCMH)?

Technology makes it easy to get health care when and how you need it. You can reach your doctor through email, video chat, or after-hour phone calls. Mobile apps and electronic resources help you stay on top of your health and medical history.

It’s not a place… It’s a partnership with your primary care provider.

PCMH puts you at the center of your care, working with your health care team to create a personalized plan for reaching your goals.

Your primary care team is focused on getting to know you and earning your trust. They care about you while caring for you.

APPENDIX 1: EDUCATIONAL INFOGRAPHIC FOR PATIENTS AND FAMILIES

Page 38: PCPCC PCMH Evidence Report Feb 2016

PAGE 36

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11 6LQVN\��&�$���:LOODUG�*UDFH��5���6FKXW]EDQN��$�0���6LQVN\��7�$���0DUJROLV��'����%RGHQKHLPHU��7����������,Q�VHDUFK�RI�MR\�LQ�SUDFWLFH��D�UHSRUW�RI����KLJK�IXQFWLRQLQJ�SULPDU\�FDUH�SUDFWLFHV��Annals of Family Medicine, 11�������������

12 8�6��'HSDUWPHQW�RI�+HDOWK�DQG�+XPDQ�6HUYLFHV��$JHQF\�IRU�+HDOWKFDUH�5HVHDUFK�DQG�4XDOLW\��$+54���Patient-centered PHGLFDO�KRPH�UHVRXUFH�FHQWHU��GH÷�QLQJ�WKH�3&0+��5HWULHYHG�IURP�KWWS���SFPK�DKUT�JRY�SDJH�GH÷�QLQJ�SFPK

��� *DQV��'�1����������A Comparison of the national patient-centered medical home accreditation and recognition programs. 0HGLFDO�*URXS�0DQDJHPHQW�$VVRFLDWLRQ��5HWULHYHG�IURP�KWWS���ZZZ�PHGLFDOKRPHVXPPLW�FRP�UHDGLQJV�$�&RPSDULVRQ�RI�WKH�1DWLRQDO�3DWLHQW�&HQWHUHG�0HGLFDO�+RPH�$FFUHGLWDWLRQ�DQG�5HFRJQLWLRQ�3URJUDPV�SGI

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15 7LURGNDU�0�$���0RUWRQ�6���:KLWLQJ�7���0RQDKDQ�3���0F%HH�(���6DXQGHUV�5����6FKROOH�6�+����������7KHUHÚV�PRUH�WKDQ�RQH�ZD\�WR�EXLOG�D�PHGLFDO�KRPH��The American Journal of Managed Care, 20(12).

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17 7DNDFK��0����������$ERXW�KDOI�RI�WKH�VWDWHV�DUH�LPSOHPHQWLQJ�SDWLHQW�FHQWHUHG�PHGLFDO�KRPHV�IRU�WKHLU�0HGLFDLG�populations. Health Affairs, 31�����������������GRL����������KOWKDII����������

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��� &RQZD\��3�+����������7KH�&RUH�4XDOLW\�0HDVXUHV�&ROODERUDWLYH��D�UDWLRQDOH�DQG�IUDPHZRUN�IRU�SXEOLF�SULYDWH�PHDVXUH�DOLJQPHQW��Health Affairs Blog. 5HWULHYHG�IURP�KWWS���KHDOWKDIIDLUV�RUJ�EORJ������������WKH�FRUH�TXDOLW\�PHDVXUHV�FROODERUDWLYH�D�UDWLRQDOH�DQG�IUDPHZRUN�IRU�SXEOLF�SULYDWH�TXDOLW\�PHDVXUH�DOLJQPHQW�

��� 7DNDFK��0���7RZQOH\��&���<DORZLFK��5����.LQVOHU��6����������0DNLQJ�PXOWLSD\HU�UHIRUP�ZRUN��ZKDW�FDQ�EH�OHDUQHG�IURP�medical home initiatives. Health Affairs, 34������GRL����������KOWKDII����������

��� 7D\ORU��(�)���'DOH��6���3HLNHV��'���%URZQ��5���*KRVK��$���&URVVRQ��-��â6KDSLUR��5�����������Evaluation of the Comprehensive Primary Care Initiative: First Annual Report. 0DWKHPDWLFD�3ROLF\�5HVHDUFK��5HWULHYHG�IURP�KWWS���LQQRYDWLRQ�FPV�JRY�)LOHV�UHSRUWV�&3&,�(YDO5SW��SGI

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��� $30�)UDPHZRUN�DQG�3URJUHVV�7UDFNLQJ�:RUN�*URXS��������� Health Care Payment Learning and Action Network. 5HWULHYHG�IURP��KWWSV���SXEOLVK�PLWUH�RUJ�KFSODQ�ZRUN�JURXSV�DSP�IUDPHZRUN�DQG�SURJUHVV�WUDFNLQJ�ZRUN�JURXS�

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52 5RVHQWKDO��0�%���6LQDLNR��$�'���(DVWPDQ��'���&KDSPDQ��%����3DUWULGJH��*����������,PSDFW�RI�WKH�5RFKHVWHU�0HGLFDO�+RPH�,QLWLDWLYH�RQ�3ULPDU\�&DUH�3UDFWLFHV��4XDOLW\��8WLOL]DWLRQ��DQG�&RVWV��Medical Care, 53��������������GRL����������0/5������������������

��� 0DHQJ��'�'���.KDQ��1���7RPFDYDJH��-���*UDI��7�5���'DYLV��'�(����6WHHOH��*�'����������5HGXFHG�DFXWH�LQSDWLHQW�FDUH�ZDV�ODUJHVW�VDYLQJV�FRPSRQHQW�RI�*HLVLQJHU�KHDOWK�V\VWHPÚV�SDWLHQW�FHQWHUHG�PHGLFDO�KRPH��Health Affairs, (34)������������GRL����������KOWKDII����������

��� )ULHGEHUJ��0�:���5RVHQWKDO��0�%���:HUQHU��5�0���9ROSS��.�*����6FKQHLGHU��(�&����������(IIHFWV�RI�D�PHGLFDO�KRPH�DQG�VKDUHG�VDYLQJV�LQWHUYHQWLRQ�RQ�TXDOLW\�DQG�XWLOL]DWLRQ�RI�FDUH��JAMA Internal Medicine, 175����������������GRL���������MDPDLQWHUQPHG�����������

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56 5DSKDHO��-�/���&RROH\��:�&���9HJD��$���.RZDONRZVNL��0�$���7UDQ��;���7UHDGZHOO��-��â*LRUGDQR��7�3����������2XWFRPHV�IRU�children with chronic conditions associated with parent- and provider-reported measures of the medical home. Journal of Health Care for the Poor and Underserved, 26�������������GRL����������KSX����������

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��� -RQHV��&���)LQLVRQ��.���0F*UDYHV�/OR\G��.���7UHPEOD\��7���0RKOPDQ��0�.���7DQ]PDQ��%��â6DPXHOVRQ��-����������9HUPRQWÚV�FRPPXQLW\�RULHQWHG�DOO�SD\HU�PHGLFDO�KRPH�PRGHO�UHGXFHV�H[SHQGLWXUHV�DQG�XWLOL]DWLRQ�ZKLOH�GHOLYHULQJ�KLJK�TXDOLW\�care. Population Health Management.�GRL���������SRS����������

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61 2UHJRQ�+HDOWK�$XWKRULW\����������Oregon’s Health System Transformation: 2014 Final Report.�5HWULHYHG�IURP��KWWS���ZZZ�RUHJRQ�JRY�RKD�0HWULFV�'RFXPHQWV��������)LQDO���5HSRUW�������-XQH��������SGI

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65 6KL��/����������4%3&�3URJUDP�(YDOXDWLRQ��3UHVHQWDWLRQ�DW�WKH�4XDOLW\�%OXH�3ULPDU\�&DUH�&ROODERUDWLYH�

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Page 43: PCPCC PCMH Evidence Report Feb 2016
Page 44: PCPCC PCMH Evidence Report Feb 2016

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