Program Start Date Sector Payors

1998

2005 Public CMS

2006 Private BCBS of MI

2009

Palmetto Health 2010 Private Palmetto Health

2011 5 years Both

Jan-10 private

Jan-10 Private

Jun-10 Private Premier Inc.

Jul-10 Public Medicaid

private

Baylor Health System private

Pilot/Demo Length

Convening Organization

Name

Community Care of North Carolina

Physician Group Practice Demonstration

Pathways to Health, Battle Creek, MI

BCBS of Michigan & Integrated Health Partners

University of Minnesota at Fairview and Medica

Medica and University of Minnesota Medical Center at Fairview

NH Citizens Health Initiative Accountable Care Organization Pilot Program

all major insurance carriers participating

New Hampshire Citizens Initiative

Robert Wood Johnson Medical School

Robert Wood Johnson Foundation Medical School

Blue Shield of California-Hill Physicians-Catholic Healthcare West

Blue Shield of CA

Blue Shield of California, Catholic Healthcare West (CHW) and Hill Premier - ACO

Readiness Collaborative

Accountable Care Collaborative (Colorado)

Colorado Department of Health Care Policy and Financing Brookings-Dartmouth

ACO Learning Network Each Network is a 12-month period.

Brookings Institution & The Dartmouth Institute for Health Care Baylor Health System

Private Premier Inc.

Jan-09 Private

1-Jun-10 Public

Premier - ACO Implementation Collaborative

Blue Cross Blue Shield of Massachusetts Alternative QUALITY Contract

BCBS of MA

Blue Cross Blue Shield of Massachusetts

Minnesota - General Assistance Medical Care

General Asssitance Medical Care

Minnesota Department of Health

Hospitals Involved Geographic Location Payment Model Quality Measures

North Carolina

32 quality measures

Battle Creek, MI TBD

Minneapolis, MN Capitation

South Carolina

New Hampshire TBD TBD

6 hospitals TBD

Sacramento, CA

nationwide

Colorado $20 PMPM N/A

nationwide TBA TBA

Baylor Health System - 13 hospitals North Texas

10 provider organizations and physician networks

Providers are incentivized to coordinate care delivered to Medicare patients.

University of Minnesota Medical Center at Fairview

Littleton Regional Hospital, Cottage Hospital, Speare Memorial Hospital, Cheshire Medical Center, Dartmouth-Hitchcock Keene, Southern New Hampshire Health System, Southern

Adventist Health – Roseville, CA Albert Einstein Healthcare Network - Philadelphia, PA Appalachian Regional Healthcare System – Boone, NC Ardent Health Services – Nashville, TN; Hillcrest

Metrics in: Population Health (QUEST outcomes, Select HEDIS metrics, health

Alegent Health Clinic (Nebraska)Arizona Integrated Physicians (Arizona)Aultman Hospital & AultCare Health Plans (Ohio)Baycare Health Partners (Massachusetts) Will use bundled

payments

nationwide

Massachusetts

Minnesota

Aria Health – Philadelphia, PA; AtlantiCare – Atlantic City, NJ; Baystate Health – Springfield, MA; Billings Clinic – Billings, MT; Bon Secours Health System, Inc. – Marriottsville, MD; Richmond, VA

The ACO Implementation Collaborative consists of members who can pursue

Metrics in: Population Health (QUEST outcomes, Select HEDIS metrics, health Mount Auburn Hospital, Tufts Medical

Center, Lowell General Hospital, South Shore Hospital

Global payment for care across the continuum; Annual inflation tied to CPI; Incentive to

Hospital Quality & Safety Quality Measures: Clinical process measures - Acute MI, Heart Failure care,Hospitals paid set

amount to treat unknown number of patients.

Population Served

Medicaid

Medicare

chronic disease

Medicaid

Additional Notes

Published Results (if program complete)

Publication Name

Through year three of the program, all ten participating sites achieved success on most quality Pathways to

Health features key ACO concepts

BCBSM reports that hospitalizations for conditions that can be prevented via better ambulatory GAMC patients

(high needs, often homeless and hard to reach)

issue brief, outline available

NH_CHI_ACOPilot_issuebrief_Feb2010.pdf; NH_CHI_NHPaymentReformPill

California Public Employees’ Retirement System (CalPERS) members (40,000

Blue Shield has another five potential California ACO pilots in The ACO Readiness Collaborative will develop the Part of a state Medicaid reform effort. Brookings-Dartmouth is set to release a new guide in 2010 that Plans to convert to ACO by 2015

HMO Members

GAMC patients (high needs, often homeless and hard to reach)

Per new state law, GAMC is being redesigned

Website

https://palmettohealth.org/body-NoRightMenu.cfm?id=3118&action=detail&ref=509

http://citizenshealthinitiative.org/

http://www.hcjnc.com/index.php/healthcare-quality/51-healthcare-quality/493-blue-shield-chw-and-hill-physicians-succeeding-with-aco.html

http://www.premierinc.com/quality-safety/tools-services/ACO/index.jsp

http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1233759745246

https://xteam.brookings.edu/bdacoln/Pages/home.aspx

http://www.premierinc.com/quality-safety/tools-services/ACO/index.jsp

http://www.qualityaffordability.com/solutions/alternative-quality-contract.html

Program Start Date Pilot/Demo Length In a Collaborative

2004 5 years HRSA-MCHB

2004 2 years (2004-2005)

2009 3 years PCPCC

2009 2 years TransforMED site

2010 5 years No

2010 No

2012

Guided Care June 1, 2006 3 years PCPCC

Jun-06 No

September 1, 2007 3+ years PCPCC

September 1, 2007 2 years PCPCC

Minnesota Medical Home Learning Collaborative

National Institute for Children’s Healthcare Quality

has convened 2 collaboratives with funding from HRSA-MCHB

MediQhome Quality Project: Patient-Centered Advanced Medical Home Quality Improvement Taconic Independent Practice Association

Adirondack Region Medical Home Pilot

Maryland Health Care Commission PCMH

Program to sunset December 31, 2015

Community Care of North Carolina

TransforMED National Demonstration Project

2 years (ended June 2008)

Louisiana Health Care Quality Forum Medical Home Initiative

Patient-Centered Medical Home—Diabetes Management

September 21, 2007 3+ years PCPCC

Oct-07 PCPCC

January 1, 2008 3+ years PCPCC

January 1, 2008 2 years PCPCC

April 1, 2008 ongoing PCPCC

May 13, 2008 3+ years PCPCC

May 22, 2008 3+ years

June 1, 2008 2-3 years PCPCC

July 1, 2008 2-3 years PCPCC;

September 30, 2008 3+ years PCPCC

October 1, 2008 2-3 years PCPCC

November 1, 2008 1.5-2 years PCPCC

Greater New Orleans Primary Care Access and Stabilization Grant

Blue Cross Blue Shield Association

Blue Cross Blue Shield of Michigan: Patient Centered Medical Home Program

EmblemHealth Medical Home High Value Network Project

National Naval Medical Center Medical Home Program

Pennsylvania Chronic Care Initiative

CDPHP Patient-Centered Medical Home Pilot

PCPCC, TransforMED site

CIGNA and Dartmouth-Hitchcock Patient-Centered Medical Home Pilot

Vermont Blueprint Integrated Pilot Program

OU School of Community Medicine—Patient-Centered Medical Home Project

Rhode Island Chronic Care Sustainability Initiative

Metcare of Florida/Humana Patient-Centered Medical Home

November 1, 2008 2-3 years

December 1, 2008 3+ years PCPCC

December 1, 2008 1.5-2 years PCPCC

January 1, 2009 2 years

January 1, 2009 3+ years PCPCC

Jan-09 2-3 years PCPCC

Jan-09

February 1, 2009 1 year PCPCC

March 26, 2009 PCPCC

April 1, 2009 2 years PCPCC

Apr-09 5 years No

April 1, 2009 2-3 years PCPCC

Priority Health PCMH Grant Program

PCPCC, TransforMED site

Colorado Family Medicine Residency PCMH Project

Queen City Physicians/Humana Patient-Centered Medical Home

CareFirst BlueCross BlueShield Patient-Centered Medical Home Demonstration Program

PCPCC, TransforMED site

Hudson Valley P4P-Medical Home Project

New Hampshire Citizens Health Initiative Medical Home Pilot Project

Oklahoma - SoonerCare Choice

Quality Quest Medical Home

NJ Academy of Family Physicians/Horizon Blue Cross Blue Shield of NJ

18 months (through September 2010)

I3 PCMH Academic Collaborative

Safety Net Medical Home Initiative (SNMHI)

UnitedHealth Group PCMH Demonstration Program

May 1, 2009 2-3 years PCPCC

May 1, 2009 1.5-2 years PCPCC

July 1, 2009 2 years PCPCC

September 1, 2009 2-3 years PCPCC

September 12, 2009 2-3 years PCPCC; RWJ-AF4Q

November 1, 2009 3 years PCPCC; RWJ-AF4Q

November 1, 2009 1.5-2 years PCPCC

November 12, 2009 2 years TransforMED site

January 1, 2010 undetermined PCPCC

January 1, 2010 2-3 years PCPCC

February 16, 2010 3 years PCPCC

Dfcic PCMH pilot May 31, 2010 PCPCC

The Colorado Multi-Payer, Multi-State Patient-Centered Medical Home Pilot

TriHealth Physician Practices/Humana Patient-Centered Medical Home

Washington Patient-Centered Medical Home Collaborative

Alabama Health Improvement Initiative–Medical Home Pilot

Health Improvement Collaborative of Greater Cincinnati-Greater Cincinnati Aligning Forces for Maine Quality Counts PCMH Pilot

West Virginia Medical Home Pilot

Blue Cross Blue Shield of Kansas City PCMH Pilot

CIGNA/Eastern Maine Health Systems

Texas Medical Home Initiative

NJ FQHC Medical Home Pilot

June 1, 2010 PCPCC

July 1, 2010 1 year No

January 1, 2011

January 1, 2011 No

1 year PCPCC

Massachusetts PCMH

No

4 years SNMHI

CIGNA/Piedmont Physician Group Collaborative Accountable Patient Centered Medical Blue Cross-Palmetto-USC Medicine

Nebraska Medicaid Medical Home Pilot Program

2 years - terminates June 30, 2014

NASHP - 2nd Collaborative

Wright State University

Memphis Multi-Payer Patient-Centered Medical Home

not defined (as of 2008), possibly 2009 - haven't been able to find anything on net

selecting practices in 2010

Goal for all PCPs to become PCMHs by 2015

safety net piece is part of SNMHI

Blue Cross Blue Shield of North Carolina Patient Centered Medical Home

Blue Cross Blue Shield of Tennessee Patient Centered Medical Home

CMS Medicare Medical Home Demonstration

CMS Multi-payer Advanced Primary Care Initiative

Geisinger Health System Care Model Redesign

Oregon Primary Care Association & CareOregon

RWJ-AF4Q

No

1.5-2 years PCPCC

P2 Collaborative of Western New York

University of Alabama at Birmingham Health System & PrimeCare - Kirklin Medical Home

WellStar Health System/Humana Patient-Centered Medical Home

University of Nebraska Medical Center - Turner Park Clinic

University of Kansas School of Medicine-Wichita Family Medicine Residency Program at Smoky Hill

Sector Payors

public 36

30

private Commerical 100 800

private Commercial 13

both 40 120-150

Both 50 (target) 200 (target)

private 8 49

private 36

public 45 500

private Commercial 4 21

Number of Practice Involved

Number of Physicians Involved

public - contracted to HRSA Maternal and Child Health Bureau

Medicaid, private managed care organizations

public:Medicaid; private: Blue Shield of Northeastern NY, CDPHP, Empire Blue Cross, Excellus, Fidelis All majorprivatepayers(Aetna,CareFirst,

Medicare fee-for-service, Tricare (also known as U.S. Family Health Plan, which covers retired military

Medicaid Managed Care

91 324

private BCBS of MI 2,477 8,147

private 38 159

Tricare 1 25

both 170 780

private 3 18

private commercial 5 253

both 14 44

public 4

both 5 28

private Medicare Advantage 9 17

public (PCASG is federally funded)

Federal grant program

Commercial, Medicare Advantage, Medicaid Managed Care

public (Military Health System)

Commercial, Medicare Advantage, Medicaid Managed Care

Commercial, Medicare Advantage, Medicaid Managed Care

Commercial, Medicare Advantage, Medicaid Managed Care

Medicaid Managed Care

Commercial, Medicare Advantage, Medicaid Managed Care ,Other: Medicaid PCCM

private Commercial 16 108

private none 10 320

private 4 18

private Commercial 11 84

private Commercial 50 500

both 11 63

3 TBD

private 33 165

25 753

Medicaid

private 7 25

Commercial, Medicare Advantage

HarvardPilgrimHealthCare,MVP,

Commercial, HMOs, State Health Benefits, Medicare Advantage

both (academic institutions)

Both (all expected to participate in Medicaid)

5 RCCs, with 12-15 clinics in each RCC

Commercial, Medicare Advantage, Medicaid Managed Care

private 16 51

private 1 8

both 33 755

private 14 70

private 11 35

both 26 221

private 25 50

private Commercial 13

private commercial 7 75

private Commercial 3 30

public both 3 17

private commercial 1 1

Commercial, Medicare Advantage, Medicaid Managed Care, Other: Safety Net Insurer Commercial, Medicare Advantage

Commercial and Public

Commercial, Medicare Advantage

private: UnitedHealthCare, Anthem (Wellpoint), Humana, HealthBridgeAnthemBCBS ofMaine;Aetna;CIGNA;Commercial, Medicaid Managed Care

private commercial 4 93

Public

44

private TBD TBD

pubic TBD TBD

private Commercial 39 140

private Commercial 2 7

private Commercial 25 110

15 95

Commercial, Medicare Advantage

large commercial, Medicaid

private

5

private Commercial 2 12

State Region within State Project Category

7,000 MN

multi-stakeholder

650,000 ND insurer-based

NY Hudson Valley multi-stakeholder

150,000 NY multi-stakeholder

200,000 (target) MD statewide multi-stakeholder

NC

1,212 MD multi-stakeholder

National

1,200,000 LA multi-stakeholder

1,100 ND insurer-based

Number of Covered Lives

DC, IL, ME, MD, MN, PA, TX, VT, WV

Will include BCBSND participating providers in the contiguous counties of MN, SD, and MT.

Clinton, Essex, Franklin, Warren, and Hamilton counties

8 community-based primary care practices in the Baltimore-Washington, DC region

Greater New Orleans, Baton Rouge, Lake Charles, Shreveport

Fargo (initial effort), rolling out statewide

160,000 LA multi-stakeholder

1,800,000 MI statewide insurer-based

12,000 NY insurer-based

35,390 MD Bethesda

1,093,246 PA statewide multi-stakeholder

13,500 NY Albany insurer-based

16,600 NH insurer-based

60,000 VT statewide multi-stakeholder

30,000 OK

28,000 RI statewide multi-stakeholder

8,527 FL insurer-based

Orleans, Jefferson, St. Bernard and Plaquemines parishes

New York City and surrounding counties

Tulsa—North Eastern Oklahoma

Central and South Florida

36,300 MI insurer-based

CO statewide multi-stakeholder

5,200 OH Cincinnati insurer-based

40,000 MD insurer-based

NY Hudson Valley multi-stakeholder

39,000 NH statewide multi-stakeholder

OK

TBD IL multi-stakeholder

5,600 NJ insurer-based

880,000 NC, SC, VA

multi-stakeholder

14,000 AZ Phoenix, Tuscon insurer-based

Greater Grand Rapids and Holland

Maryland, District of Columbia and northern Virginia

Peoria and surrounding counties

CO, MA, ID, OR, PA (Pittsburgh)

100,000 CO Front Range multi-stakeholder

1,100 OH Cincinnati insurer-based

700,000 WA statewide multi-stakeholder

AL statewide insurer-based

30,000-100,000 OH Cincinnati multi-stakeholder

75,000 ME statewide multi-stakeholder

20,000 WV statewide multi-stakeholder

MO insurer-based

4,000 ME insurer-based

30,000 TX multi-stakeholder

20,000 NJ Hudson County multi-stakeholder

500 OR Portland Metro

Northern Maine (Greater Bangor)

North Texas (initial phase)

10,000 GA Atlanta insurer-based

400 SC Columbia, SC

NE multi-stakeholder

OH

TBD TN Memphis multi-stakeholder

TBD MA statewide multi-stakeholder

50,000 NC insurer-based

750 TN

50,000 PA

110,000 OR

targeting rural counties that are not part of Medicaid Managed Care: Scottsbluff, Sidney,

Central and Northeastern PA

NY Western NY multi-stakeholder

AL

850 GA Atlanta multi-stakeholder

NE

KS

Payment Model

HRSA

N/A

Convening Organization Name

Stakeholder Hospitals Quality Measurement

Minnesota Department of Health

funded by both HRSA-MCHB and Minnesota Legislature

3 outcome measures: Reduction in ED Visits, Reduction in Unplanned Hospitalizations,

Blue Cross Blue Shield of North Dakota

Care Management Fee (CMF) allowed on a six month basis.CMF is in addition to the Fee for Service Payment System currently in force.

Clinical Quality, Cost, Patient Experience/Satisfaction, Provider Experience/Satisfactio

Taconic IPA, THINC, Inc.

The payers in the pilot have agreed that in addition to a fee-for-service reimbursement

Hudson Headwaters Health Network

5 hospitals: Champlain Valley Physicians Hospital Medical Center, Elizabethtown

doctors are paid an additional $7 month (PMPM), bonus for quality performance; state providing grant

Diabetes plus two additional chronic conditions for adults; well child care/prevention plus

Maryland Department of Health

Pilot practices to be paid combination of fixed (PMPM) amount and incentive bonus based on quality.

Pediatric measures: TBD Adult measures: pilot practices must report on performance for at

Johns Hopkins Bloomberg School of Public Health

Johns Hopkins Hospital

During the cRCT, the costs of providing Guided Care were split between grant funding (50%) and

Patients: health and functional status, quality of care, satisfaction with care, use/cost of care.

TransforMED (subsidiary of AAFP)

Ambulatory Care Quality Alliance (ACQA) starter set, 5 depression measures specific to this study,

Louisiana Health Care Quality Forum

Tulane University; Ochsner Medical Center; Medical Center of Louisiana; Franciscan

Benefits package design with payment incentives to be developed.

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider

Blue Cross Blue Shield of North Dakota

DM fee allowed on an annual basis and sharing of demonstrated cost savings.

Reduce inpatient admissions; Reduce emergency department visits; Increase patient

BCBS of MI N/A

EmblemHealth N/A

NNMC-Bethesda

N/A

CIGNA HealthCare N/A

N/A

N/A

Humana N/A N/A

Louisiana Public Health Institute as the local partner of the Louisiana Department of Health and

LSU Health Sciences Center; Medical Center of Louisiana at New Orleans; New Orleans Adolescent

Grant funds are distributed every six months according to number of patients served by each

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider

PGIP-enrolled primary care physicians who are members of a designated PCMH practice receive a

Clinical quality/cost/efficiency; patient experience/satisfaction; provider

Three-part payment model: 1) Fee-for-service; (2) Care management payment—equal to

Clinical Quality—Clinical quality process and outcome data at the practice level using data based

National Naval Medical Center Bethesda

Governor's Office of Health Care Reform

University of Pennsylvania Health System; Jefferson Health System

Practices receive increased reimbursement for attaining PCC-PCMH recognition, and also

diabetes, pediatric asthma

Capital District Physician’s Health Plan (CDPHP)

The CDPHP payment model is a capitation plus bonus incentive (based on quality and efficiency) model,

Clinical Quality—Practices will be measured on 18 HEDIS Quality Metrics at the practice level.

Enhanced fee schedule plus reward for outcomes based on improvements in quality and

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Are the practices

Vermont Department of Health

Northeast Vermont Regional Hospital; Northern Counties Health Care; Fletcher Allen Health Care;

PMPM varies based on NCQA score; up to $2.39 month.Practices also receive funding for expanded HITOklahoma Health

Care Authority (Medicaid) payor

Fee for service payments are provided for services delivered by participating

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider

RI Office of the Health Insurance Commissioner

Practices receive $3 per member per month for all members covered by participating insurers.

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider

Priority Health N/A

Humana N/A

N/A

THINC, Inc. N/A

N/A TBD TBD

N/A

UnitedHealthGroup N/A

Grantees received up-front funding in form of grants and the whole contracted Priority Health

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider

Colorado Clinical Guidelines Collaborative, University of Colorado Denver Department

Centura Health,Exempla Healthcare, HealthONE Hospitals,Memorial Health System

No health plan support for project (no change in the payment system). However, there will

Clinical Quality Patient Experience/Satisfaction Provider Experience/Satisfactio

Additional care coordination payment.

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Patient

CareFirst BlueCross BlueShield

Care coordination fee, technology grants and outcomes rewards

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction

Practices in the medical home group will be eligible to receive incentive payments for

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider

New Hampshire Citizens Initiative

Prospective PMPMfeethat increases withNCQA RecognitionLevel paid every 6

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider

Quality Quest for Health

NJ Academy of Family Physicians

Practices in the project will be receiving a defined payment, or care coordination fee,

process and outcomes measures for diabetes, as well screenings for breast, colon, and cervical

University of South Carolina Department of Family and Preventive Medicine, University of North

Variable - mostly FFS, but with state-specific enhancements based on payers

Access measures, by site

Continuity measures, by site

Commonwealth Fund, Qualis Health, MacColl Institute for Healthcare Innovation at the Group Health

Commonwealth is funding a Medical Home Facilitator (who will lead clinic-based quality improvement Prospective Care Management PMPM Fee and retrospective Performance Bonus PMPM.

Practices compared to market on basic cost and quality metrics. Satisfaction surveys for providers, staff,

Humana N/A

N/A

N/A

N/A

BCBS of Kansas City N/A

CIGNA HealthCare N/A

N/A N/A

N/A

Colorado Clinical Guidelines Collaborative

Centura Health,Exempla Healthcare, HealthONE Hospitals,Memorial Health System

• Fee for Service • Per Member Per Month (PMPM) care management/coordination fee • Pay for

Clinical QualityCost/EfficiencyPatient Experience/Satisfaction

Additional care coordination payment

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider

WA Department of Health jointly with Washington Academy of Family Physicians

Currently the teams receive a modest stipend ($6400) to compensate for time out of office to attend

1. Patent experience;using a modified version of CHAPS 2. Provider burnout using Malacsh inventory and team satisfaction using a

Blue Cross Blue Shield-Alabama

We will provide some monetary assistance at the onset that can be used at the practices’ discretion

Clinical QualityCost/EfficiencyPatient Experience/Satisfaction

Health Improvement Collaborative of Greater Cincinnati

FFS, care management fee, quality incentives

data to be collected include: Clinical Quality Cost/Efficiency Patient

Maine Quality Forum, Quality Counts, and Maine Health Management Coalition

Prospective care management fee (pmpm payment)

The evaluation will use nationally recognized measures that reflect the six aims of

West Virginia Health Improvement Institute

Pilot includes an incentive system but no initial changes to ongoing reimbursement

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider

There is a small up front enhanced care coordination fee to support the care coordination activities

Reduce inappropriate use of ER

· Reduce readmissions

Texas Chapter of the ACP

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider

Horizon Health Center, Inc.

Jersey City Medical Center, Bayonne Medical Center; Newark Beth Israel; Hoboken Hospital;

Fee for service for patient visits, plus an overall management fee, plus incentives for specific

Maximization of access to care; effectiveness of rendered care, effectiveness of

Doctors Family Clinic and Immediate Care

CIGNA HealthCare N/A

N/A TBD

TBD

BCBS of NC

blended payment model, using fee for service, enhanced care coordination fee for enhanced medical

EBM, total cost improvement

BCBS South Carolina & Palmetto Health Family Medicine Center

Blue Cross will pay incentives to MDs if they can show improved health results in patients

Nebraska Health & Human Services

FFS; incentives include Per Member Per Month (capitation), enhanced FFS (+5%);

Wright State University

Memphis Business Group on Health

Discussions have included 4 components; coordination payments at PPM,

Massachusetts Executive Office of Health & Human Services

Includes start-up infrastructure payments payments (max. $15,000 per site in year 1, $3,500 in

Humana

Western New York Community Health Planning Institute

Process and outcome measures will depend based on the project goals. For example, if the PEAs are following

University of Alabama at Birmingham Health System

Wellstar Health System

Additional care coordination payment

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider

Population Served Additional Notes

yes

Results (if available)

Publication Name (if available)

children with special needs

In 2008, the Minnesota legislature required the development of PCMH. Collaboratives

A report is available on collaborative learning best practices. An additional report of

Minnesota_collaborative_2009.pdf Minnesota Medical Home

State Title V Programs (children and youth with special health care needs)

First national collaborative on PCMH

HRSA_children_PCMH_collaborative_2004-2005.pdf

40,000-60,000 chronic disease patients covered by BCBSND are expected to be enrolled. Medicare,

listed in Bitton et al., 2010 and on a 2008 PCPCC report, though NOT on the PCPCC website listing of This may be part of the Hudson Valley P4P project (stakeholders are same), but I have not

Medicaid, CHIP, state employees, and private pay patients of the participating practices

marketing itself as one of the nation's first multi-system, region-wide medical home

Patient participation is voluntary, but certain Medicaid beneficiaries may be required to enroll. Medicare beneficiaires who are not dual eligibles will be able to join CCNC in 2012. chronically ill older adults

* Guided Care won the American Public Health Association’s 2008 Archstone Foundation Award for

Several peer-reviewed studies are available

See the following link for citation information: http://www.pcpcc.net/content/guided-care

In addition to the NDP, TransforMED has several different sites, each with their own pilot programs.

http://www.transformed.com/evaluatorsReports/index.cfmTransforMED_results_AnnalsofFamMed.pdf

enrollees in Medicaid managed care

chronic disease patients (diabetes)

is this related to the MediQHome project - or just a subset of diabetes patients?

BCBS of MI enrollees

high-risk patients

all residents

Thirteen of the 25 organizations achieved recognition by NCQA as PCMHs at 36 clinic locations

BCBSA joined PCPCC in 2007 and called for demonstration projects.

A rigorous evaluation of the PCMH Designation program will be completed in fall of 2010, after year

EmblemHealth enrollees

A stakeholder includes the Ethel Donaghue Center for Translating Research into Practice and

enrollees to NNMC-Bethesda

only existing PCMH pilot in the MHS

PCM continuity of care increase of 33%; 20.8% decrease in network ER visits per 100 enrollees; 39.5%

All beneficiaries enrolled in practices participating in regional medical home pilotsCDPHP enrollees at 3 sites

Preliminary information about the program. The 2010 Annual Report will contain information

Vermont_2008_AnnualReport.pdf

Medicaid Managed Care

The project is designed to transform the teaching clinics of the University of Oklahoma School of

All of the practices have assigned patients to physician directed care teams. Health risk appraisals, Sample of self-reported clinical quality improvement in the first nine months of program

Medicare Advantage members

Improvement in key diabetes indicators, Metcare’s utilization and financial indicators better than

Medicaid

safety net

UHG enrollees

Priority Health enrollees

entirely funded by The Colorado Trust and The Commonwealth Fund

Humana enrollees at Queen City Physicians in commercial and Medicare Advantage

Improvement in key diabetes indicators, reduction in key and overall medical expenses.

CareFirst BCBS enrollees

State Medicaid converted to a PCMH is January 2009.

listed in PCPCC 2008 report - did this pilot happen? Website has this listed in the past tense and future

Horizon BCBS Enrollees

Four completed national meeting presentations

Three manuscripts under preparationInitiative calls for

partnerships between safety net providers and community stakeholders.

BCBS of AL enrollees

BCBS enrollees

CIGNA enrollees

users of this FQHC

funding from Colorado Trust, Commonwealth Fund

Humana enrollees in TriHelath Physician practice in commercial and Medicare Advantage

The Puget Sound Health Alliance and the Health Care Authority are planning a mutli-

Initial rollout of data in September 2010

Progress report available

Ohio_Cincinnati_AF4Q_PCMH_progress_June2009.htm

Year 1 (2009) report is available

Maine_PCMH_Pilot_Year1results.pdf

Primarily adults; however, the project will also include patients younger than 18 with severe

pediatrics

patients with diabetes or congestive heart failure who are seen in Palmetto Health Family Medicine Nebraska Medicaid (not Medicaid Managed Care)

Unfunfed by the State. Will likely apply to be one of the 6 states in the CMS program. listed in PCPCC 2008 report - did this pilot happen? MBGOH website doesn't give any information$500K in support for community centers from the Commonwealth Fund SNMHI. Goal for all

will be done by Umass Medical School

listed in Bitton et al., 2010

listed in Bitton et al., 2010

To be implemented after implementation of Advanced PC Initiative (listed above). CMS plans to announce sites later in 2010.

listed in Bitton et al., 2010

listed in Bitton et al., 2010

UAB IM-1 Clinic (Kirklin Medical Home) is also participating in Alabama BCBS

Improvement in key diabetes indicators, increase in primary care services while medical expenses

Has adopted a PCMH model to train residents.

Has adopted the PCMH. No pilot. Is a TransforMED Practice Transformation site.

Website

http://www.health.state.mn.us/healthreform/homes/collaborative/index.html

http://www.nichq.org/medical_home.html

https://www.bcbsnd.com/mediqhome/

http://www.transformed.com/TaconicIPA.cfm

http://www.adkmedicalhome.org/

http://mhcc.maryland.gov/pcmh/index.aspx

http://www.guidedcare.org/

http://www.transformed.com/ndp.cfm

http://www.lhcqf.org/

N/A

N/A

N/A

N/A

http://lphi.org/home2/section/generic-146/

http://www.valuepartnerships.com/programs/home.shtml

http://www.rxforpa.com/chroniccare.html

http://www.cdphp.com/

http://healthvermont.gov/blueprint.aspx

http://tulsa.ou.edu/docs/index.html

http://www.metcare.com/

N/A

N/A

N/A

N/A

N/A

http://www.priorityhealth.com/provider/manual/performance/medical-home

http://www.coloradoguidelines.org/pcmh/residency.asp

http://www.queencityphysicians.net/

http://citizenshealthinitiative.org/

http://okhca.org/providers.aspx?id=8470&menu=74&parts=8482_10165

http://www.qualityquest.org/quest-projects/medical-home/

http://www.qhmedicalhome.org/safety-net/index.cfm

N/A

N/A

N/A

http://www.coloradoguidelines.org/pcmh/

http://www.trihealth.com/

http://www.doh.wa.gov/cfh/MH-Coll/default.htm

https://www.bcbsal.org/providers/alabamaHealthImprovementInitiative/medicalHome/index.cfm

http://www.the-collaborative.org/

http://www.mainequalitycounts.org/

http://www.wvhealthimprovement.org/wvhii/innovation/MedhomeBasics.aspx

http://www.transformed.com/news-eventsdetailpage.cfm?listingID=71

http://www.horizonhealth.org/

N/A

N/A

N/A

http://www.bcbs.com/news/plans/bcbssc-palmetto-health-family-medicine-center-launch-hcr-project.html?templateName=template-28767547&print=t

http://www.hhs.state.ne.us/med/Pilot/

http://studentre.wordpress.com/2010/06/17/ohio-to-launch-patient-centered-http://www.memphisbusinessgroup.org/

http://www.mass.gov/hhs/medicalhome

http://www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?filterType=none&filterhttp://www.cms.gov/demoprojectsevalrpts/md/itemdetail.asp?itemid=CMS1230016

http://p2wny.org/provider/peas.php

http://www.uabhealth.org/76262/

http://www.wellstar.org/

http://app1.unmc.edu/publicaffairs/todaysite/sitefiles/today_full.cfm?match=6034

http://www.transformed.com/SmokyHillResidency.cfm

Program Timeframe Funder Hospitals Involved Geographic Location

1991-1996 HCFA (CMS) 4

1993-1996 CMS

2006- Geisinger Geisinger Health System

1987-

2009- CMS various

2009- various

BCBS of MA

Late 2010

CaroMont Health Gaston Memorial Hospital North Carolina

State of Minnesota Jan-10 Minnesota

Medicare’s Participating Heart Bypass Center DemoMedicare’s Cataract Surgery Alternate Payment DemoGeisinger’s ProvenCare

Dr. Johnson and Ingham Medical Center

Medicare’s Acute Care Episode Demo

Hillcrest Medical Center (Tulsa, OK); Exempla Health Care (Denver); Baptist Health System (San Antonio); Oklahoma PROMETHEUS

Payment, Inc.Commonwealth, RWJ

RWJ is funding HealthPartners in Minnesota, Independence Blue Cross – Crozer Keystone Health System Fairview Health

Services

BlueCross BlueShield of MA Alternative QUALITY ContractIntegrated Health Association

California HealthCare Foundation

Cedars-Sinai Medical Center, Hoag Hospital, UCLA Health System, Saddleback Memorial Medical Center, Tenet-

LA and Orange Counties

Begin end of 2010

Conditions Providers/Services

Unspecified Unspecified

Unspecified Unspecified Unspecified

Unspecified Unspecified

Unspecified

Unspecified

Unspecified Unspecified Unspecified

All conditions None Unspecified

Provider Accountability

Payment Timeframe

Administrator Capabilities

Coronary artery bypass graft surgery

Inpatient and physician services, Medicare hospital pass-throughs, related readmission

Data systems for micro-cost analysis

Outpatient cataract surgery

Physician and facility fees, intraocular lens costs, and costs of selected pre- and postoperative testsInitially, cardiac

surgery; expanded to angioplasty, cataract

Facility and physician costs, follow-up care and all complications within 90 days

Adherence to evidence-based clinical measures

30 days before and 90 days after procedure

Integrated health system

Knee and shoulder arthroscopic surgery

Surgeon and hospital fees

Two year warranty for procedure

Cardiac care (CABG, valves, defibrillators, pacemakers), orthopedic care

Hospital and physician services

Possible reward for clinicians and hospital staff for meeting quality and efficiency

Entities including at least one physician group and at least one hospital

Acute myocardial infarction, hip and knee replacement,

All providers involved in patient care – inpatient and outpatient

Adherence to clinical guidelines

Acute condition (30 days), hip replacements (180 days), 12 “care

packages” for chronic conditions (low back pain,

Hospital and physician (primary care and specialty) services

All services and costs – primary, specialty,and hospital care, ancillary, behavioral health, and pharmacy services

Associated performance measures and incentive paymentBegin with

major surgical procedures (total knee and hip

Theepisode definition includes all physician charges, all inpatient charges (including the

One provider organization acts as a general contractor

"most recognized services"

metrics include potentially avoidable admissions, 30-day readmissions

Setting Payments

Unspecified

Unspecified

Pre-determined fee Unspecified

Unspecified

Unspecified Unspecified

Payment Adjustment

Additional Notes

Bidding by participating hospitals; updated annually per inpatient Negotiated discounts below usual rates

Prior fee-for-service costs plus 50% of historical readmission rate

Historical rates

Competitive bidding

Patient-specific payment based on risk factors, fee schedules, and other negotiated

Payment based on meeting clinical guidelines

Base rate per-member, per month based on historical regional costs and

Patients’ health status, sex, and age; adjusted annually for Prices are

negotiated between individual participants (e.g. each hospital,IPA,

State law allows for bundling payments, though not