TY - JOUR
KW - Medicare
KW - Health Care Costs
KW - primary care redesign
KW - Program Evaluation
KW - Qualitative Research
AU - Rachel A. Burton
AU - Nicole M. Lallemand
AU - Rebecca A. Peters
AU - Stephen Zuckerman
AU - MAPCP Demonstration Evaluation Team
A1 - 
AB - BACKGROUND: Through the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare, Medicaid, and private payers offered supplemental payments to 849 primary care practices that became patient-centered medical homes (PCMHs) in eight states; practices also received technical assistance and data reports. Average Medicare payments were capped at $10 per beneficiary per month in each state. OBJECTIVE: Since there was variation in the eight participating states' demonstration designs, experiences, and outcomes, we conducted a qualitative multi-case analysis to identify the key factors that differentiated states that were estimated to have generated net savings for Medicare from states that did not. PARTICIPANTS: States' MAPCP Demonstration initiatives were comprehensively profiled in case studies based on secondary document review, three rounds of annual interviews with state staff, payers, practices, and other stakeholders, and other data sources. APPROACH: Case study findings were summarized in a case-ordered predictor-outcome matrix, which identified the presence or absence of key demonstration design features and experiences and arrayed states based on the amount of net savings or losses they generated for Medicare. We then used this matrix to identify initiative features that were present in at least three of the four states that generated net savings and absent from at least three of the four states that did not generate savings. RESULTS: A majority of the states that generated net savings: required practices to be recognized PCMHs to enter the demonstration, did not allow late entrants into the demonstration, used a consistent demonstration payment model across participating payers, and offered practices opportunities to earn performance bonuses. Practices in states that generated net savings also tended to report receiving the demonstration payments and bonuses they expected to receive, without any issues. CONCLUSIONS: Designers of future PCMH initiatives may increase their likelihood of generating net savings by incorporating the demonstration features we identified.
AD - The Urban Institute, Washington, DC, USA. rburton@urban.org.; The Urban Institute, Washington, DC, USA.; The Urban Institute, Washington, DC, USA.; The Urban Institute, Washington, DC, USA.
BT - Journal of general internal medicine
C5 - Financing & Sustainability; Medical Home
CP - 7
CY - United States
DO - 10.1007/s11606-018-4309-x
IS - 7
JF - Journal of general internal medicine
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Through the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare, Medicaid, and private payers offered supplemental payments to 849 primary care practices that became patient-centered medical homes (PCMHs) in eight states; practices also received technical assistance and data reports. Average Medicare payments were capped at $10 per beneficiary per month in each state. OBJECTIVE: Since there was variation in the eight participating states' demonstration designs, experiences, and outcomes, we conducted a qualitative multi-case analysis to identify the key factors that differentiated states that were estimated to have generated net savings for Medicare from states that did not. PARTICIPANTS: States' MAPCP Demonstration initiatives were comprehensively profiled in case studies based on secondary document review, three rounds of annual interviews with state staff, payers, practices, and other stakeholders, and other data sources. APPROACH: Case study findings were summarized in a case-ordered predictor-outcome matrix, which identified the presence or absence of key demonstration design features and experiences and arrayed states based on the amount of net savings or losses they generated for Medicare. We then used this matrix to identify initiative features that were present in at least three of the four states that generated net savings and absent from at least three of the four states that did not generate savings. RESULTS: A majority of the states that generated net savings: required practices to be recognized PCMHs to enter the demonstration, did not allow late entrants into the demonstration, used a consistent demonstration payment model across participating payers, and offered practices opportunities to earn performance bonuses. Practices in states that generated net savings also tended to report receiving the demonstration payments and bonuses they expected to receive, without any issues. CONCLUSIONS: Designers of future PCMH initiatives may increase their likelihood of generating net savings by incorporating the demonstration features we identified.
PP - United States
PY - 2018
SN - 1525-1497; 0884-8734
SP - 1028
EP - 1034
EP - 
T1 - Characteristics of Patient-Centered Medical Home Initiatives that Generated Savings for Medicare: a Qualitative Multi-Case Analysis
T2 - Journal of general internal medicine
TI - Characteristics of Patient-Centered Medical Home Initiatives that Generated Savings for Medicare: a Qualitative Multi-Case Analysis
U1 - Financing & Sustainability; Medical Home
U2 - 29404947
U3 - 10.1007/s11606-018-4309-x
VL - 33
VO - 1525-1497; 0884-8734
Y1 - 2018
Y2 - Jul
ER -