The Urban Institute, Washington, DC, USA.
J Gen Intern Med. 2018 Jul;33(7):1028-1034. doi: 10.1007/s11606-018-4309-x. Epub 2018 Feb 5.
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.
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.
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.
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.
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.
Designers of future PCMH initiatives may increase their likelihood of generating net savings by incorporating the demonstration features we identified.
通过多付款方高级初级保健实践（MAPCP）示范项目，医疗保险、医疗补助和私人支付者向 8 个州的 849 个初级保健诊所提供额外支付，这些诊所成为以患者为中心的医疗之家（PCMH）；诊所还获得了技术援助和数据报告。在每个州，平均医疗保险支付上限为每位受益人每月 10 美元。
由于参与的 8 个州的示范设计、经验和结果存在差异，我们进行了定性多案例分析，以确定将预计为医疗保险节省资金的州与没有节省资金的州区分开来的关键因素。
根据二次文献回顾、对州工作人员、支付者、诊所和其他利益相关者的三轮年度访谈以及其他数据源，对各州的 MAPCP 示范倡议进行了全面的案例研究。
案例研究结果总结在案例排序的预测结果矩阵中，该矩阵确定了关键示范设计特征和经验的存在或缺失，并根据为医疗保险产生的净节省或损失量对各州进行排列。然后，我们使用该矩阵确定至少在四个产生净节省的州中的三个州存在、而在四个没有产生节省的州中的三个州不存在的倡议特征。
大多数产生净节省的州：要求诊所成为公认的 PCMH 才能进入示范项目，不允许示范项目的后期参与者进入，在参与的支付者中使用一致的示范支付模式，并为诊所提供获得绩效奖金的机会。产生净节省的州的诊所也倾向于报告收到预期的示范支付和奖金，没有任何问题。
未来 PCMH 倡议的设计者可以通过纳入我们确定的示范特征来增加产生净节省的可能性。
