Colorado Multi-Payer Patient-Centered Medical Home Pilot
Program Location:
Denver, CO
Number of Practices:
16
Payer Type:
Multi-Payer
Partner Organizations:
HealthTeamWorks
Payers:
Anthem-Wellpoint
United Healthcare
Humana
Aetna
Cigna
Colorado Medicaid
CoverColorado
Accreditation/Recognition:
NCQA
Reported Outcomes
Description:
Completed in June 2012, this 3-year project was one of the first multi-payer medical home pilots. The project involved 5 private health plans and the State's hig-risk pool carrier, Cover Colorado, who provided additional compensation to 16 primary care practices. All participating practices were required to achieve at least level 1 PCMH recognition by the National Committee for Quality Assurance. HealthTeamWorks provided support to practices on quality improvement and transformation to PCMH through individual coaching and learning collaboratives. Preliminary evaluation results showed reduction in emergency department utilization and reduced hospital addmissions. This project laid the foundation for a significant expansion of support to PCMH in Colorado including the Colorado Comprehensive Primary Care Initiative, Colorado Medicaid Accountable Care Collaborative, and the Colorado Medical Home Initiative.
** This program is no longer active.
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Payment Model:
All of the participating plans agreed to provide a per member per month care management fee to participating practices for up to 20,000 plan members in addition to traditional fee-for-service and a pay-for-performance bonus.
Fewer ED / Hospital Visits:
Journal of General Internal Medicine (October 2015)
- Statistically significant reduction in emergency department use by 1.4 visits per 1000 member months, or approximately 7.9 % (p = 0.02) at the end of 2 years
- 1.6 fewer emergency department visits per 1000 member months, or a 9.3 % reduction from baseline (p = 0.01) at the end of 3 years
Health Affairs (September 2012)
- 15% fewer ED visits
- 18% fewer inpatient admissions
- Number of specialty visits remained flat (v. 10% increase in non-PCMH practices)
Improved Health:
Health Affairs (September 2012)
- Improvements across all measures of diabetes care
Improved Patient/Clinician Satisfaction:
Health Affairs (September 2012)
- 95% of patient said care setting was well organized and efficient
- 97% said they would recommend it to family/friends
- 90% said it was easy to speak to a physician when they called
Cost Savings:
Journal of General Internal Medicine (October 2015)
- No net overall cost savings in study period, possibly due to offsetting increases in other spending categories
Two years after initiation of pilot, PCMH practices (vs. baseline) had:
- Reduction in ED costs of $4.11 PMPM (13.9%; p<0.001) and $11.54 PMPM for patients with 2 or more comorbidities (25.2%; p<.0001)
Three years after initiation, PCMH practices showed sustained improvements with:
- Reduction in ED costs of $3.50 PMPM (11.8% p=0.001) and $6.61 PMPM for patients with 2 or more comorbidities (14.5%; p=.003)
Health Affairs (September 2012)
- 250-400% health plan ROI (WellPoint)
Increased Preventive Services:
Journal of General Internal Medicine (October 2015)
- Increased cervical cancer screening rates after 2 years (12.5% increase, p<.001) and 3 years (9.0% increase, p<.001)
Other Outcomes:
Journal of General Internal Medicine (October 2015)
- Lower rates of HbA1c testing in patients with diabetes (.7% reduction at 3 years, p=.03)
- Lower rates of colon cancer screening (21.2% and 18.1% at 2 and 3 years respectively p<.001)
- Decreased primary care visits (1.5% at 3 years, p=.02)
Last updated March 2019
