Primary Care Innovations and PCMH Map by Outcomes

JAMA Internal Medicine (June 2014)

• PCMH group had higher performance on 41 of 48 measures of clinical quality
• Veterans with chronic disease had small but significant improvements in qualtiy-of-care indicators
• Improvements in clincial outcomes for patients with diabetes, hypetension and heart disease

VA Health Services Research & Development (February 2019)_{In 2012, select Veterans Health Administration (VHA) facilities implemented a homeless-tailored medical home model, called Homeless Patient Aligned Care Teams (H-PACT), to improve care processes and outcomes for homeless Veterans.}

• H-PACT patients were more likely than standard primary care patients in the same facilities to report positive experiences with access [adjusted risk difference (RD)=17.4], communication (RD=13.9), office staff (RD=13.1), provider ratings (RD=11.0), and comprehensiveness (RD=9.3

American Journal of Managed Care (March 2015) _{During the study period from just prior to widespread PACT implementation to 2 years after PACT implementation began}

• 17% decreased in mean number of primary care visits (from 4.81 to 3.99 visits per patient) and 85% increase in telephone visits (P <.001) 
• "Features such as team huddles and tracking lab tests were actually associated with fewer primary care visits per patient, possibly through better efficiency of primary care practice. Greater specialty care visits were modestly related to higher care coordination/transitions in care scores, so better procedures to coordinate care appeared to facilitate referrals to specialty care." 

Journal of Health Care Quality (November 2014) _{study evaluated PACT patients with post traumatic stress disorder using a pre/post study design}

• PACT were associated with an increase in primary care visits (IE: 0.96; 95% CI: 0.67, 1.25)

Health Affairs (June 2014)

• 3.5% increase in primary care visits for veterans over age 65
• 1% increase in primary care visits across VHA system (all age groups)

American Journal of Managed Care (July 2013)

• Increase in phone encounters (2.7 to 28.8 per 100 patients per quarter)
• increase in personal health record use (3% to 13% of patients enrolled)
• increase in electronic messaging to providers (.01% to 2.3% of patients per quarter)
• increase in same day appointments (p<.01)
• increase in patients seen within 7 days of desired appointment date (85% to 90% p<.01)

JAMA Internal Medicine (June 2014)

• Veterans receiving care from sites with successful PACT implementation were more likely to:
  • get a flu shot (p<.001)
  • get screeened for cervical cancer (p<.047)
  • ger offered medications for tobacco cessation (P<.001)

American Journal of Managed Care (June 2015)

• no statistically significant association between medical home implementation and improvements in 5 domains of patient care experiences 

JAMA Internal Medicine (June 2014)

• clinician satisfaction: lower staff burnout in PCMH vs nonPCMH (2.29 vs 2.80; P = .02)
• patient satisfaction: higher scores of patient satisfaction (9.33 vs 7.53; P < .001)

American Journal of Managed Care (March 2015) _{During the study period from just prior to widespread PACT implementation to 2 years after PACT implementation began}

• ED visits per patient rose slightly (7%), and ACSC hospitalizations per patient also rose from 0.02 to 0.03 per patient (all P <.001) 

Journal of Health Care Quality (November 2014) _{study evaluated PACT patients with post traumatic stress disorder using a pre/post study design}

• PACT were associated with:
  • a decrease in hospitalizations (incremental effect [IE]: -0.02; 95% confidence interval [CI]: -0.03, -0.01)
  • a decrease in specialty care visits (IE: -0.45; 95% CI: -0.07, -0.23)

Health Services Research (August 2014)

• Slight decline in ED visits among PACT providers (9.7% to 8.0%) while they increased for patients seen by non-PACT providers (7.5% to 8.8%)

JAMA Internal Medicine (June 2014) 

• Lower emergency department use (188 vs 245 visits per 1000 patients; P < .001
• Lower hospitalization rates for ambulatory care–sensitive conditions (4.42 vs 3.68 quarterly admissions for veterans 65 years or older per 1000 patients; P < .001)

Health Affairs (June 2014)

• 1.7% reduction in hospitalizationsf for ambulatory care sensitive conditions across the entire VHA system; 4.2% reduciton for veternas under age 65
• 7.3% reduction in outpation vistisn with mental health specialists across VHA system (likely due to integration of mental health in primary care) 

Plos One (May 2014) 

• Individuals with at least one visit to their assigned primary care provider (PCP) were less likely to visit the ED compared with those lacking a single PCP visit ( 23% v. 32%, p<.001)
• 46% reduction in ED utilization due to continuity of care

American Journal of Managed Care (July 2013) 

• Decrease in face-to-face primary care visits (53 to 43 per 100 patients per calendar quarter (p<.01)
• Patients evaluated within 48 hours of inpatient discharge increaed 6% to 61% (p<.01)

Health Affairs (June 2014)

The study found, "PACT was associated with modest increases in primary care visits and with modest decreases in both hospitalizations for ambulatory care–sensitive conditions and outpatient visits with mental health specialists. We found that these changes avoided $596 million in costs, compared to the investment in PACT of $774 million, for a potential net loss of $178 million in the study period. Although PACT has not generated a positive return, it is still maturing, and trends in costs and use are favorable. Adopting patient-centered care does not appear to have been a major financial risk for the VHA."

Now available in 18 regions.

Now available in 18 regions

Montana Medicaid has approximately 45,500 members attributed to CPC+ providers. The Medicaid expansion (HELP) and Healthy Montana Kids (HMK) populations are both included in CPC+ as well.

Now available in 18 regions.

• Overall Humana's Medicare Advantage ACO reduced costs by 19% 
• Total health care costs were 15% lower vs. original fee-for-service Medicare
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings

• Results show that ACO providers under a value-based reimbursement model had an average HEDIS Star score of 4.25 compared with providers not in an ACO, who averaged 3.65.

• 8% increase in providing medication reviews for older patients
• 16% increase in screening osteoporosis management in women with fractures
• 7% increase in colorectal cancer screening
• 5% increase in adult BMI assessment 
• "Other screening compliance improvements included cholesterol control, eye exams and diabetic blood sugar (up 7%), and cholesterol screening for cardiovascular care (up 5%)"

• 7% fewer emergency room visits
• 6% fewer inpatient admissions 

• Total health care costs were 15% lower vs. original fee-for-service Medicare*
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings*
  

• 7% more blood pressure control*
• 7% greater diabetes patients with blood sugar controlled*
• 2% greate diabetes patients renal disease controlled*

• 13% increase on colorectal cancer screenings*
• 8% increase in breast cancer screenings*

• 7% fewer emergency department visits*
• 6% fewer hospital inpatient admissions*

• Total health care costs were 15% lower vs. original fee-for-service Medicare*
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings*

• 7% more blood pressure control*
• 7% greater diabetes patients with blood sugar controlled*
• 2% greate diabetes patients renal disease controlled*

• 13% increase on colorectal cancer screenings*
• 8% increase in breast cancer screenings*

• 7% fewer emergency department visits*
• 6% fewer hospital inpatient admissions*

• Total health care costs were 15% lower vs. original fee-for-service Medicare*
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings*

• 7% more blood pressure control*
• 7% greater diabetes patients with blood sugar controlled*
• 2% greate diabetes patients renal disease controlled*
  

• 13% increase on colorectal cancer screenings*
• 8% increase in breast cancer screenings*
  

• 7% fewer emergency department visits*
• 6% fewer hospital inpatient admissions*

• Total health care costs were 15% lower vs. original fee-for-service Medicare*
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings*
  

• 7% more blood pressure control*
• 7% greater diabetes patients with blood sugar controlled*
• 2% greate diabetes patients renal disease controlled*

• 13% increase on colorectal cancer screenings*
• 8% increase in breast cancer screenings*

• 7% fewer emergency department visits*
• 6% fewer hospital inpatient admissions*

• Total health care costs were 15% lower vs. original fee-for-service Medicare*
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings*
  

• 7% more blood pressure control*
• 7% greater diabetes patients with blood sugar controlled*
• 2% greate diabetes patients renal disease controlled*

• 13% increase on colorectal cancer screenings*
• 8% increase in breast cancer screenings*

• 7% fewer emergency department visits*
• 6% fewer hospital inpatient admissions*

• Total health care costs were 15% lower vs. original fee-for-service Medicare*
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings*

• 7% more blood pressure control*
• 7% greater diabetes patients with blood sugar controlled*
• 2% greate diabetes patients renal disease controlled*

• 13% increase on colorectal cancer screenings*
• 8% increase in breast cancer screenings*

• 7% fewer emergency department visits*
• 6% fewer hospital inpatient admissions*
  

• Total health care costs were 15% lower vs. original fee-for-service Medicare*
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings*
  

• 7% more blood pressure control*
• 7% greater diabetes patients with blood sugar controlled*
• 2% greate diabetes patients renal disease controlled*

• 13% increase on colorectal cancer screenings*
• 8% increase in breast cancer screenings*

• 7% fewer emergency department visits*
• 6% fewer hospital inpatient admissions*

• Total health care costs were 15% lower vs. original fee-for-service Medicare*
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings*
  

• 7% more blood pressure control*
• 7% greater diabetes patients with blood sugar controlled*
• 2% greate diabetes patients renal disease controlled*

• 13% increase on colorectal cancer screenings*
• 8% increase in breast cancer screenings*
  

• 7% fewer emergency department visits*
• 6% fewer hospital inpatient admissions*

• Total health care costs were 15% lower vs. original fee-for-service Medicare*
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings*
  

• 7% more blood pressure control*
• 7% greater diabetes patients with blood sugar controlled*
• 2% greate diabetes patients renal disease controlled*

• 13% increase on colorectal cancer screenings*
• 8% increase in breast cancer screenings*

• 7% fewer emergency department visits*
• 6% fewer hospital inpatient admissions*

• Total health care costs were 15% lower vs. original fee-for-service Medicare*
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings*

• 7% more blood pressure control*
• 7% greater diabetes patients with blood sugar controlled*
• 2% greate diabetes patients renal disease controlled*

• 13% increase on colorectal cancer screenings*
• 8% increase in breast cancer screenings*
  

• 7% fewer emergency department visits*
• 6% fewer hospital inpatient admissions*

• Total health care costs were 15% lower vs. original fee-for-service Medicare*
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings*

• 7% more blood pressure control*
• 7% greater diabetes patients with blood sugar controlled*
• 2% greate diabetes patients renal disease controlled*

• 13% increase on colorectal cancer screenings*
• 8% increase in breast cancer screenings*
  

• 7% fewer emergency department visits*
• 6% fewer hospital inpatient admissions*

• Total health care costs were 15% lower vs. original fee-for-service Medicare*
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings*

• 7% more blood pressure control*
• 7% greater diabetes patients with blood sugar controlled*
• 2% greate diabetes patients renal disease controlled*

• 13% increase on colorectal cancer screenings*
• 8% increase in breast cancer screenings*
  

• 7% fewer emergency department visits*
• 6% fewer hospital inpatient admissions*
  

• Total health care costs were 15% lower vs. original fee-for-service Medicare*
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings*
  

• 7% more blood pressure control*
• 7% greater diabetes patients with blood sugar controlled*
• 2% greate diabetes patients renal disease controlled*

• 13% increase on colorectal cancer screenings*
• 8% increase in breast cancer screenings*

• 7% fewer emergency department visits*
• 6% fewer hospital inpatient admissions*
  

Cost savings were also found for the first 18 months of Iowa’s program. Estimates indicated that on average, $132 in Medicaid spending was saved in the first month of each beneficiary’s enrollment in the health home program. Estimated cost savings increased thereafter by about $11 per additional month of enrollment in the health home program. In the first 18 months of the program in Iowa, total savings of about $9.0 million were achieved, or nearly 20 percent of total projected Medicaid spending on health home enrollees.

Average hospital inpatient health costs for participants in the Health Homes study group decreased from CY 2013 to CY 2015, while costs for participants in the comparison group increased during this study period. Total inpatient costs for the study group decreased slightly from $10,884 in CY 2013 to $10,125 in CY 2015, while total inpatient costs for the comparison group increased from $10,741 in CY 2013 to $11,821 in CY 2015.

ED utilization rates were highest during a participant’s first six months of enrollment, with 37.6 percent of total participants visiting the ED at least one time during that enrollment span. The ED utilization rate declined the longer those participants stayed in the Health Home program. Participants who were in a Health Home program between 19 to 24 months had the lowest ED utilization rate at 27.5 percent of participants with at least one ED visit during that enrollment span.

Mathematica Policy Research (April 2016) independent evaluation prepared for CMS evaluating Year 2 of the program's implementation

• CPC has not generated savings net of care management fees
  • The change in average expenditures including the care management fees was $7 higher for CPC than comparison beneficiaries (p = 0.27, 90 percent CI -$3, $17)
• CPC reduced average monthly Medicare expenditures without care management fees by $11 per beneficiary per month (PBPM), or 1 percent (p = 0.074), over the initiative’s first two years, with the 90 percent confidence interval ranging from a reduction of $1 to $21.
• Based on the total number of eligible beneficiary months among beneficiaries attributed to CPC practices in the first two years, the impact estimate of $11 per beneficiary per month translates to an estimated cumulative savings in Medicare expenditures without fees of $91.6 million. 
•  3 percent reduction in primary care visits (p < 0.01) contributed minimally to savings​

CMS Blog (October 2015) _{results from first shared savings performance year (2014)}

• The CPC initiative generated a total of $24 million in gross savings overall (excluding the CPC care management fees)
• Arkansas, Colorado, Cincinnati-Dayton region of Ohio, and Oregon generated gross savings
• The Greater Tulsa region generated net savings of $10.8 million and earning more than $500,000 in shared savings payments

Mathematica Policy Research (January 2015) independent evaluation prepared for CMS

• Across all seven regions in the first year, early results suggest that CPC has generated enough savings in Medicare health care expenditures to nearly cover the CPC care management fees paid by CMS for attributed Medicare FFS beneficiaries, although not enough to generate net savings
• The bulk of the savings was generated by patients in the highest-risk quartile, but favorable results were also seen in other patients
• Across the seven regions, CPC reduced Medicare Part A and Part B expenditures per beneficiary by $14 or 2%
  • These reductions are relative to a matched comparison group and do not include the care management fees (~$20 per beneficiary per month)

CMS Blog (October 2015) _{results from first shared savings performance year (2014)}

• Over 90% of CPC practices successfully met quality targets on patient experience (as determined by CAHPS surveys) and utilization (hospital admission and readmission) measures, indicating quality scores that matched or exceeded national comparisons

CMS (November 2014) _{summary of practice reports from July 2014 for the second quarter of 2014, which spanned the period from April through June 2014​} 

• 99 percent of practices offer patients around-the-clock access to a care team member with real-time access to the EHR (2014)

CMS Blog (October 2015) _{results from first shared savings performance year (2014)}

• All regions had lower-than-targeted hospital readmission rates.
• Lower readmissions indicate better coordination of care during transitions and patient support during the post-discharge period.

Mathematica Policy Research (January 2015) _{independent evaluation prepared for CMS}

• "CPC generated reductions in hospitalizations, outpatient ED visits, primary care physician visits, and specialist visits," however evaluators recommend that these findings be interpreted with caution 
• 2% reduction in hospital admissions and 3% reduction in ED visits, contributing to the reduction of expenditures nearly enough to offset care management fees paid by CMS
• There was a sizable (4 percent) CPC-wide decline (that was not quite statistically significant) in unplanned 30-day readmissions

Anthem Press Release (June 2015) _{Collective results from UC Davis, Sharp Rees-Stealy Medical Group, Sharp Community Medical Group, HealthCare Partners, Sante Community Physicians IPA and SeaView IPA over one year.}

• The ACOs under Enhanced Personal Health Care saved $7.9 million

HealthCare Partners Press Release (June 2014)

• $4.7 million saved in six months

HealthCare Partners Press Release (June 2014)

• Increase in quality measures: 
  • 7.5% Diabetes LDL
  • 3.8% in cholesterol management for patients with heart disease

Results showed an increase of 22.9 per 1,000 PCP visits for high-risk patients.*

Anthem Press Release (June 2015) _{Collective results from UC Davis, Sharp Rees-Stealy Medical Group, Sharp Community Medical Group, HealthCare Partners, Sante Community Physicians IPA and SeaView IPA over one year.}

• 7.3% reduction in inpatent admissions per 1000 patients
• 3.2% reduction in inpatient days per 1000 patients
• 2.3% reduction in outpatient claims per 1000 patients
• 2.2% reduction in outpatient visits per 1000 patients

HealthCare Partners Press Release (June 2014)

• 18% reduction in hospital inpatient days (per 1000 members)
• 4% reduction in inpatient admissions (per 1000 members)
• 4% reduction in outpatient visits, including ER visits (per 1000 members)

RTI independent evaluation (January 2016) _{evaluates first demonstration performance period, from July 2013 – December 2014}

• $21.6 million in Medicare spending relative to a comparison group, representing more than 6% savings

RTI independent evaluation (January 2016) _{evaluates first demonstration performance period, from July 2013 – December 2014}

• More than half of the participants reported that they had experienced a significant improvement in their health or quality of life as a result of the health home services. 

RTI independent evaluation (January 2016) _{evaluates first demonstration performance period, from July 2013 – December 2014}

• the rates of inpatient hospital admission in general and ACSC admissions were either flat or increasing during the baseline period and appear to be falling in the demonstration period

University of Minnesota Evaluation (February 2016) _{report evaluated the program from July 2010- December 2014}

• Overall spending on medical services for Medicaid, Medicare and Dual Eligible beneficiaries in HCHs was approximately $1 billion less than if those patients had been attributed to a non-HCH settings
• Overall, medical costs for enrollees who could be attributed to a HCH clinic were 9% less than enrollees at non-HCH clinics.
  • This is primarily due to lower spending for inpatient hospital admissions, hospital outpatient visits, and pharmacy.

Minnesota Department of Health (January 2014):

• Medicaid HCH enrollees had 9.2% lower costs than Medicaid enrollees in non-HCH clinics

HealthPartners Industry Report (2009):

• 20% reduction in inpatient costs
• Outpatient cost savings of $1

University of Minnesota Evaluation (February 2016) _{report evaluated the program from July 2010- December 2014}

• Using Statewide Quality Reporting and Measurement System (SQRMS) data, HCH clinics had better quality of care for Diabetes, Vascular, Asthma (for children and adults), Depression, and Colorectal Cancer screening.
• Using Medicare and Medicaid data, both number of hospital admissions and the length of hospital stays showed modest benefits that were significant among Medicaid enrollees, but non-significant among Medicare and Dual Eligible enrollees.

Minnesota Department of Health (January 2014):

• Improved colorectal cancer screenings, asthma care, diabetes care, vasucal care and follow up care for depression

Minnesota Department of Health (January 2014):

• Increased access to HCHs across all regions in 2013

University of Minnesota Evaluation (February 2016) _{report evaluated the program from July 2010- December 2014}

• Patient experience, as measured by the 2013 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, was positive across both HCH and non-HCH clinics, with little differences between the two. However, Communication with one’s doctor showed a significant, but small, benefit for HCH clinics.

University of Minnesota Evaluation (February 2016) _{report evaluated the program from July 2010- December 2014}

• While Health Care Homes saw an increase in emergency department and skilled nursing home use relative to non-Health Care Homes, they also saw major decreases in the use of hospital services, which was the primary driver of cost savings.

HealthPartners Industry Report (2009):

• 39% fewer ER visits
• 24% fewer hospital admissions
• 40% reduction in readmission rates
• 30% reduction in length of stay

Mathematica Evaluation (January 2015) _{Independent evaluation of first program year prepared for CMS}

Among all patients and high-risk patients, there was only one favorable statistically significant impact and one unfavorable statistically significant impact on the claims-based quality-of-care process or outcome measures in Arkansas:

• The percentage of beneficiaries with IVD who received a lipid test increased by 2 percentage points (3 percent) for all patients.
• The percentage of beneficiaries receiving a 14-day follow-up visit after hospital discharge declined by 4 percentage points (6 percent) for high-risk patients only. 

Mathematica Evaluation (January 2015) _{Independent evaluation of first program year prepared for CMS}

• Among all patients in Arkansas, there was one statistically significant, favorable result for the CPC group relative to the comparison group:
  • An annual decline of 328 primary care clinician visits per 1,000 patients in all settings (4 percent).
• Among high-risk patients, as Table 8.5 shows, there were statistically significant annual declines per 1,000 beneficiaries of:
  • 859 primary care clinician visits per 1,000 patients across all settings (6 percent).
  • 762 specialist visits across all settings (4 percent).

BCBS Rhode Island Press Release (2015) evaluated more than 89,000 commercial and 14,000 Medicare Advantage members within BCBSRI’s PCMH over the 2009 – 2014 time period

• Return on investment in the PCMH program was more than 250 percent

BCBS Rhode Island Press Release (2015) evaluated more than 89,000 commercial and 14,000 Medicare Advantage members within BCBSRI’s PCMH over the 2009 – 2014 time period

• patients at PCMH practices saw marked improvements in a range of quality measures including diabetes care and colorectal screening. 

BCBS Industry Report (2011) 

Improved quality of care measures with a median rate of improvement of:

• 44% for family and children’s health
• 35% for women’s care
• 24% for internal medicine

BCBS Rhode Island Press Release (2015) _{evaluated more than 89,000 commercial and 14,000 Medicare Advantage members within BCBSRI’s PCMH over the 2009 – 2014 time period}

• patients with complex medical conditions, like diabetes or cardiac health issues, are 16 percent less likely to be hospitalized or need to visit an emergency department (vs. comparison practices)
• readmissions to hospitals were 30 percent lower among this population (vs. comparison practices)

BCBS of Michigan Press Release (July 2015) 

• Blue Cross Patient-Centered Medical Home program has saved an estimated $512 million over six years through:
  • disease prevention
  • reduced hospitalizations and emergency room visits
  • management of common acute and chronic medical conditions that have improved patient care outcomes

Health Affairs (April 2015) _{study included over 3.2 million people under age 65 enrolled for at least twelve continuous months during the study period (2008–2011)}

• Participating practices decreased their total PMPM spending by $4.00 more than control practices did (a 1.1% difference)
• Participating providers spent $5.44 less than nonparticipants for pediatric patients, a savings of 5.1 percent.

Health Services Research (July 2013)

• Savings of $26.37 PMPM (2009-2010)
• $155 million in cost savings (2008-2011)

Health Affairs (April 2015) _{study included over 3.2 million people under age 65 enrolled for at least twelve continuous months during the study period (2008–2010 for quality measures)}

• PCMH practices achieved the same or better performance over time on 11 of 14 quality measures
• Statistically significant improvement in 4 of 7 quality measures for diabetes care (screenings for HbA1c, low-density lipoprotein cholesterol, and nephropathy; and delivery of angiotensinconverting enzyme [ACE] inhibitors to patients with hypertension)

Health Services Research (July 2013)

• 3.5% higher quality composite score

Blue Cross Blue Shield of Michigan (July 2014)

• 21.3% lower rate of ER visits for pediatric patients due to appropriate and timely in-office care

Health Affairs (April 2015) study included over 3.2 million people under age 65 enrolled for at least twelve continuous months during the study period (2008–2010 for quality measures)

• Statistically significant improvement in 3 of 7 quality measures for preventive care (adolescent well care, adolescent immunization, and wellchild visits at ages 3–6)

JAMA Internal Medicine (February 2015) _{(Three-year study of 2,218 practices)}

• In multivariable models, the PCMH was associated with a higher rate of screening in the lowest socioeconomic group for:
  • breast cancer (5.4%; 95% CI, 1.5% to 9.3%)
  • cervical cancer (4.2%; 95% CI, 1.4% to 6.9%)
  • colorectal cancer (7.0%; 95% CI, 3.6% to 10.5%) 
  • and a higher rate of screening for colorectal cancer (4.5%; 95% CI, 1.8% to 7.3%) in the highest socioeconomic group 
• The study also found nonsignificant differences in screening for breast cancer (2.6%; 95% CI, −0.1% to 5.3%) and cervical cancer (−0.5%; 95% CI, −2.7% to 1.7%) in the highest socioeconomic group

Health Services Research (July 2013)

• 5.1% higher adult prevention composite score (2009-2010)
• 4.9 - 12.2% higher pediatric prevention composite score (2009-2010)

Medical Care Research and Review (August 2015)

• Practices beginning the study with high implementation scores ("full implementation") versus those with low implementation scores ("no implementation")  had $16.73 PMPM lower costs for adult patients after 3 years (4.4%, p=.02)

BCBS of Michigan Press Release (July 2015) _{based on 2015 claims data of patients who visit BCBSM PCMH-designated practices}

• 26% lower rate of hospital admissions for common conditions
• 10.9% lower rate of adult ER visits
• 16.3% lower rate of pediatric ER visits
• 22.4% lower rate of pedatric ER visits for common chronic and acute conditions (i.e. asthma)

Blue Cross Blue Shield of Michigan (July 2014)

• 27.5% lower rate of hospital stays for certain conditions
• 11.8 percent lower rate of adult primary care sensitive ER visits
•  9.9 percent lower rate of adult ER visits over non-PCMH doctors
• 14.9 percent lower rate of ER visits overall for pediatric patients

Blue Cross Blue Shield of Michigan (July 2013)

• 8.8% fewer adult ED visits
• 17.7% lower rate of pediatric ED visits
• 19.1% lower rate of adult ambulatory care sensitive inpatient admissions
• 11.2% lower rate of adult primary care sensistive ER visits
• 23.8% lower rate of pediatric primary-care sensitive ER visits

Managed Healthcare Executive (December 2011)

• 13.5% fewer pediatric ED visits (2011)
• 10% fewer adult ED visits (2011)

Health Affairs (July 2015) _{evaluation of 49,000 program enrollees in Orange County from 2007-2010}

• enrollees were much more adherent to their designated primary care providers after intervention (69.6% vs. 31.4%)
• after the program intervention, enrollees had a 41.8% higher probability of always seeing the same primary care provider

Health Affairs (July 2015) _{evaluation of 49,000 program enrollees in Orange County from 2007-2010}

• among enrollees who saw their assigned primary care providers:
  • percentage of patients with 2 or more annual ED visits decreased from 4.11% (before intervention)  to 3.13% (after intervention)
  • percentage of patients with 2 or more annual hospitalizations decreased from 1.37% to 1.17%
  • had a 2.1% higher probability of NO ED visits
  • had a 1.7% higher probability of NO hospitalizations

JAMA Internal Medicine (November 2013)

• improvements across diabetes cares measures in PCMHs vs control groups (not statistically significant) 

CSI-RI 2013 Annual Report (May 2014)

• practices collectively met every targeted patient heath outcome, including areas of weight management, diabetes, high blood pressure and tobacco cessation, and practices are showing improvement over time in all of the targeted areas

CTC-RI 2014 Annual Report (May 2015)

• CTC-RI practices reported higher patient experience compared with other MAPCP states

CSI-RI 2013 Annual Report (May 2014)

• CSI-RI practices received increased, positive patient experience ratings, including access to care, communication with their care team, office staff responsiveness, shared decision making, and self-management support

CTC-RI 2014 Annual Report (May 2015)

• 7.2% reduction in hospital admissions in most experienced CTC-RI practices

CSI-RI 2013 Annual Report (May 2014)

• More experienced CSI-RI practices saw reduced inpatient hospitalization, while the comparison group (primary care practices that are not CSI-RI patient-centered medical homes) experienced an increase

JAMA Internal Medicine (November 2013)

• 11.6% reduction in ambulatory care-sensitive emergency department visits
• Fewer overall ED visits, inpatient admissions and ambulatory care sensitive inpatient admissions (not statistically significant)

CareFirst Industry Report (July 2015)  _{evaluation of the 4th year of the program. Service area includes Northern Virginia and DC}

• Health care costs for CareFirst members in a PCMH were $345 million less than projected in 2014
  • this is an improvement over 2013 data when costs were $130 million less than expected
• Since 2011, medical costs for PCMH members have been $609 million less than expected
• Approximately 84% of provider panels earned Outcome Incentive Awards (OIA) based on quality and degree of savings they achieved
  • An average award, in addition to a particiaption fee, amounted to $41,000 -$49,000 in increased revenue

CareFirst Industry Report (July 2014)

• In all, the PCMH Program has saved $267 million in avoided costs when measured against the projected cost of care from 2011 to 2013

CareFirst Industry Report (June 2013)

• average of 4.7% savings for primary care panels that received an Outcome Incentive Award
• $98 million in total costs savings 

CareFirst Press Release (June 2013)

• 3.7% higher quality scores for panels that received incentives
• Quality scores for PCMH panels rose by 9.3% from 2011 to 2012

CareFirst Industry Report (July 2015)  _{evaluation of the 4th year of the program. Service area includes Northern Virginia and DC}

• Since the beginning of the program in 2011, PCMH members have had*:
  • 19% fewer hospital admissions
  • 15% fewer days in the hospital
  • 20% fewer hospital readmissions for all causes
  • 5% fewer outpatient health facility visits
• In 2014 alone, PCMH members experienced*:
  • 5.1% fewer hospital admissions
  • 10.7% fewer days in the hospital
  • 8.5% fewer hospital readmissions for all causes
  • 12.5% fewer outpatient health facility visits

CareFirst Press Release (July 2014)

• 6.4% fewer hospital admissions*
• 8.1% fewer hospital readmissions for all causes*
• 11.1% fewer days in the hospital*

* results per 1000 CareFirst members

Cigna press release (May 2015)

• total medical cost is trending 1.9 percent better than market 
• use of scans per thousand is trending 12 percent better than market
• advanced imaging cost has decreased 14 percent

Cigna press release (May 2015)

• success rate with evidence-based medicine guidelines is better than market at 85.3 percent.
• treatment of high cholesterol at 2 percent better than market and epilepsy at 15 percent better than market.
• 96 percent of diabetes patients have the HbA1c (blood sugar) test. 

Cigna press release (May 2015)

• 23% reduction in avoidable ER visits per thousand
• 10% reduction in ER visits
• 12% reduction in ER visits  “frequent users” 

Cigna press release (May 2015)

• 9 percent better than market on diabetes measures
  • due to diabetic patients receiving testing and treatment according to the recommended guidelines.

Cigna press release (May 2015)

• ER use is 7 percent lower than market

Cigna press release (May 2015)

• medical cost trend is beating the Connecticut market by 4.2 percent.

Cigna press release (May 2015)

• improved breast cancer screening, diabetes care and cervical screening

Cigna press release (May 2015)

• overall emergency room use is down and is trending 3.4 percent better than market
• avoidable emergency room visits (visits for non-emergency care) are down 9 percent year over year

Mathematica Policy Research (April 2016) independent evaluation prepared for CMS evaluating Year 2 of the program's implementation

• CPC has not generated savings net of care management fees
  • The change in average expenditures including the care management fees was $7 higher for CPC than comparison beneficiaries (p = 0.27, 90 percent CI -$3, $17)
• CPC reduced average monthly Medicare expenditures without care management fees by $11 per beneficiary per month (PBPM), or 1 percent (p = 0.074), over the initiative’s first two years, with the 90 percent confidence interval ranging from a reduction of $1 to $21.
• Based on the total number of eligible beneficiary months among beneficiaries attributed to CPC practices in the first two years, the impact estimate of $11 per beneficiary per month translates to an estimated cumulative savings in Medicare expenditures without fees of $91.6 million. 
•  3 percent reduction in primary care visits (p < 0.01) contributed minimally to savings​

CMS Blog (October 2015) _{results from first shared savings performance year (2014)}

• The CPC initiative generated a total of $24 million in gross savings overall (excluding the CPC care management fees)
• Arkansas, Colorado, Cincinnati-Dayton region of Ohio, and Oregon generated gross savings
• The Greater Tulsa region generated net savings of $10.8 million and earning more than $500,000 in shared savings payments

Mathematica Policy Research (January 2015) independent evaluation prepared for CMS

• Across all seven regions in the first year, early results suggest that CPC has generated enough savings in Medicare health care expenditures to nearly cover the CPC care management fees paid by CMS for attributed Medicare FFS beneficiaries, although not enough to generate net savings
• The bulk of the savings was generated by patients in the highest-risk quartile, but favorable results were also seen in other patients
• Across the seven regions, CPC reduced Medicare Part A and Part B expenditures per beneficiary by $14 or 2%
  • These reductions are relative to a matched comparison group and do not include the care management fees (~$20 per beneficiary per month)

CMS Blog (October 2015) _{results from first shared savings performance year (2014)}

• Over 90% of CPC practices successfully met quality targets on patient experience (as determined by CAHPS surveys) and utilization (hospital admission and readmission) measures, indicating quality scores that matched or exceeded national comparisons

CMS (November 2014) _{summary of practice reports from July 2014 for the second quarter of 2014, which spanned the period from April through June 2014​} 

• 99 percent of practices offer patients around-the-clock access to a care team member with real-time access to the EHR (2014)

CMS Blog (October 2015) _{results from first shared savings performance year (2014)}

• All regions had lower-than-targeted hospital readmission rates.
• Lower readmissions indicate better coordination of care during transitions and patient support during the post-discharge period.

Mathematica Policy Research (January 2015) _{independent evaluation prepared for CMS}

• "CPC generated reductions in hospitalizations, outpatient ED visits, primary care physician visits, and specialist visits," however evaluators recommend that these findings be interpreted with caution 
• 2% reduction in hospital admissions and 3% reduction in ED visits, contributing to the reduction of expenditures nearly enough to offset care management fees paid by CMS
• There was a sizable (4 percent) CPC-wide decline (that was not quite statistically significant) in unplanned 30-day readmissions

CMS Fact Sheet (August 2015) _{based on an evaluation of 2014 quality and financial performance results}

• Pioneer participants saved $120 million in 2014, compared with $96 million in 2013
• Of 15 Pioneer ACOs who generated savings, 11 generated savings outside a minimum savings rate and earned a total shared savings of $82 million.
  • Of 5 Pioneer ACOs who generated losses, 3 generated losses outside a minimum loss rate and owed a total of $9 million in shared losses to CMS
• Total model savings per ACO increased from $2.7 million per ACO in Performance Year 1 to $4.2 million per ACO in Performance Year 2 to $6.0 million per ACO in Performance Year 3

JAMA (May 2015) _{study of 600,000 patients assistned to a Pioneer ACO in 2012 or 2013}

• ~$36 reduction PMPM in 2012 and ~$11 reduction PMPM in 2013 for patients attributed to a Pioneer ACO vs non-affiliated patients
• The rate of savings was 4 percent in the first year, or a total of $212 million, and less than 1.5 percent, or $105 million in the second year

Government Accountability Office (April 2015) _{report evaluated 23 ACOs that participated in the Pioneer Model in 2012 and 2013} 

• Forty-one percent of the ACOs produced $139 million in total shared savings in 2012, and 48 percent produced $121 million in total shared savings in 2013.
• In 2012 and 2013 CMS paid ACOs $77 million and $68 million, respectively, for their shared savings.
• The Pioneer ACO Model produced net shared savings of $134 million in 2012 and $99 million in 2013.

CMS Fact Sheet (September 2014) 

• During the second performance year, Pioneer ACOs generated estimated total model savings of over $96 million and at the same time qualified for shared savings payments of $68 million. They saved the Medicare Trust Funds approximately $41 million. The total model savings and other financial results are subject to revision.
• Pioneer ACOs achieved lower per capita growth in spending for the Medicare program at 1.4 percent, which is about 0.45 percent lower than Medicare fee-for-service.
• Eleven Pioneer ACOs earned shared savings, 3 generated shared losses, and 3 elected to defer reconciliation until after the completion of performance year three.

CMS Press Release (January 2014)

• CMS Pioneer ACOs generated gross savings of $147 million in their first year while continuing to deliver high quality care.
• Results showed that of the 23 Pioneer ACOs, nine had significantly lower spending growth relative to Medicare fee for service while exceeding quality reporting requirements. 

CMS Fact Sheet (August 2015) _{based on an evaluation of 2014 quality and financial performance results}

• The ACOs showed improvements in 28 of 33 quality measures and experienced average improvements of 3.6% across all quality measures compared to Performance Year 2.
• Particularly strong improvement was seen in:
  • medication reconciliation (70% to 84%)
  • screening for clinical depression and follow-up plan (50% to 60%)
  • qualification for an electronic health record incentive payment (77% to 86%)

Government Accountability Office (April 2015) _{report evaluated 23 ACOs that participated in the Pioneer Model in 2012 and 2013} 

• Pioneer ACOs had significantly higher quality scores in the second year than in the first year for two-thirds of the quality measures (22 of the 33, or 67 percent)
  • Significantly higher scores for measures in care coordination and disease management for at-risk populations.

CMS Fact Sheet (September 2014) (Results for second performance year)

• The mean quality score among Pioneer ACOs increased by 19 percent, from 71.8 percent in 2012 to 85.2 percent in 2013
• The organizations showed improvements in 28 of the 33 quality measures and experienced average improvements of 14.8 percent across all quality measures. Some of these measures included controlling high blood pressure, screening for future fall risk, screening for tobacco use and cessation, and patient experience in health promotion and education

JAMA (May 2015) _{study of 600,000 patients assistned to a Pioneer ACO in 2012 or 2013}

• "Despite differential decreases in primary care office visits for evaluation and management, hospital discharge follow-up visits within 7 days had significant differential increases from 11.3 (95% CI, 4.6 to 18.0) visits per 1000 discharges in 2012 to 14.8 (95% CI, 8.5 to 21.0) visits per 1000 discharges in 2013 for beneficiaries aligned with ACOs."
• "A significant differential increase was also seen in 2013 for follow-up visits within 14 days of discharge (10.7 [95% CI, 4.9 to 16.4] per 1000 discharges) but not within 30 days in either year."

Government Accountability Office (April 2015) _{report evaluated 23 ACOs that participated in the Pioneer Model in 2012 and 2013} 

• Pioneer ACOs had significantly higher scores for measures of preventive health care

CMS Fact Sheet (August 2015) _{based on an evaluation of 2014 quality and financial performance results}

• Pioneer ACOs improved the average performance score for patient and caregiver experience in 5 out of 7 measures compared to Performance Year 2

JAMA (May 2015) _{study of 600,000 patients assistned to a Pioneer ACO in 2012 or 2013}

• Compared with other Medicare beneficiaries, Pioneer ACO-aligned beneficiaries reported higher mean scores for timely care (77.2 [ACO] vs 71.2 [FFS] vs 72.7 [Medicare Advantage]) and for clinician communication (91.9 [ACO] vs 88.3 [FFS] vs 88.7 [Medicare Advantage])

Government Accountability Office (April 2015) _{report evaluated 23 ACOs that participated in the Pioneer Model in 2012 and 2013} 

• Pioneer ACOs had significantly higher scores for measures of patient experiences of care

CMS Fact Sheet (September 2014) (Results for second performance year)

• Improved the average performance score for patient and caregiver experience in 6 out of 7 measures. These results suggest that Medicare beneficiaries who obtain care from a provider participating in Pioneer ACOs report a positive patient and caregiver experience

JAMA (May 2015) _{study of 600,000 patients assistned to a Pioneer ACO in 2012 or 2013}

• Acute inpatient days per 1000 beneficiary months decreased more for ACOs than for the comparison group in 2012 (−0.05 days [95% CI, −0.065 to −0.039]) and 2013 (−0.02 days [95% CI, −0.029 to −0.004])
• Differences in emergency department visits and inpatient admissions through the emergency department were statistically significant and either decreased more or increased less in 2012 and 2013

Mathematica Evaluation (January 2015) _{Independent evaluation of first program year prepared for CMS}

• There was only one statistically significant finding for quality-of-care outcomes (Table 8.8). Among all patients, relative to the comparison group, the CPC group:
  • Improved one measure of continuity of care, because there was a significant increase in the percentage of all office visits with the patients’ attributed practice of 2 percentage points (4 percent)

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)

Health Affairs (September 2012)

• Improvements across all measures of diabetes care

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)

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

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)

 State Auditor Report (August 2015) _{based on data from July 1, 2003, through December 31, 2012}

• Savings of approximately $78 per quarter per beneficiary, approximately $312 a year in 2009 inflation-adjusted dollars (approximately a 9% savings)
• CCNC saved the state Medicaid program about $134 million in 2009
• 17.6% reduction in spending on inpatient admissions

Population Health Management (September 2013) data review 2007-2011 for non-elderly Medicaid recipients with disabilities

• A model using a non-matched CCNC enrollment sample found:
  • statistically significant cost savings:
  • 2007: $190.91 PMPM (p<.0001)
  • 2008: $ 153.71 PMPM (p<.0001)
  • 2009: $117.54 PMPM (p<.0001)
  • 2010: $97.22 PMPM (p<.0001)
  • 2011: $63.74 PMPM (p<.0001)
• This analysis estimates total cost savings of $184,064,611 for the first 4.75 years of the program; a 7.87% relative savings form the average PMPM cost.
• A  model using a matched CCNC enrollment sample found: 
  • ​statistically significant cost savings: 
  • 2008: $52.54 PMPM (p=.005)
  • 2009: $80.75 PMPM (p<.0001)
  • 2010: $72.65 PMPM (p<.0001)
  • 2011: $120.69 PMPM (p<.0001)

North Carolina Medical Journal (January 2012) 

• Medicaid spending for ABD eligible beneficiaries (nondual) enrolled in CCNC declined by $122 PMPM from FY2009 to FY 2011
  • despite the enrollment of higher-risk patients into the CCNC program during that period

Milliman Medicaid Cost Savings Report (Dec 2011)

• Estimated cost savings of $382 million in 2010; 11% reduction in pharmacy costs; 25% reduction in outpatient care costs
• An analysis by health care analytics consultant Treo Solutions found that CCNC saved nearly $1.5 billion in health care costs from 2007 through 2009.

State Auditor Report (August 2015) _{based on data from July 1, 2003, through December 31, 2012}

• Approximately a 20% increase in physician services (increased physician services is expected to prevent more expensive health care in the future)

Population Health Management (September 2013)

• ​Statistically significant increase in access to ambulatory physician services (2007-2011)

State Auditor Report (August 2015) _{based on data from July 1, 2003, through December 31, 2012}

• ~ 25% reduction in inpatient admissions
• Statistically significant reduction in readmissions, inpatient admissions for diabetes, and emergency department visits for asthma
• No statistically significant effect on overall emergency department use

Population Health Management (September 2013)

• In every year after the first year of evaluation (2007)  the rate of hospitalizations for Medicaid enrollees with a disability was significantly lower. Inpatient admission rates declined from 420 visits per 1000 patients in 2007 to 384 visits per 1000 patients in 2011. 
• ED visits increased from 396 to 552 among unenrolled from 2007-2011.

Health Affairs (August 2013)

• In a study of patients hospitalized during 2010–11, patients who received transitional care were 20 percent less likely to experience a readmission during the subsequent year
• One readmission was averted for every six patients who received transitional care services and one for every three of the highest-risk patients.

North Carolina Medical Journal (January 2012) _{evaluation of CCNC medical home enrollees vs. non-enrollees in 2010}

• Statistically significant reduction in readmissions
• Projections estimate, based on these findings, that CCNC will prevent more than 6000 additional admissions for the non aged, blind, or and disabled (ABD) cohort, and more than 4000 additional admissions for the ABD cohort

Anthem Press Release (June 2015) _{Collective results from UC Davis, Sharp Rees-Stealy Medical Group, Sharp Community Medical Group, HealthCare Partners, Sante Community Physicians IPA and SeaView IPA over one year.}

• The ACOs under Enhanced Personal Health Care saved $7.9 million

HealthCare Partners Press Release (June 2014)

• $4.7 million saved in six months

HealthCare Partners Press Release (June 2014)

• Increase in quality measures: 
  • 7.5% Diabetes LDL
  • 3.8% in cholesterol management for patients with heart disease

Results showed an increase of 22.9 per 1,000 PCP visits for high-risk patients.*

Anthem Press Release (June 2015) _{Collective results from UC Davis, Sharp Rees-Stealy Medical Group, Sharp Community Medical Group, HealthCare Partners, Sante Community Physicians IPA and SeaView IPA over one year.}

• 7.3% reduction in inpatent admissions per 1000 patients
• 3.2% reduction in inpatient days per 1000 patients
• 2.3% reduction in outpatient claims per 1000 patients
• 2.2% reduction in outpatient visits per 1000 patients

HealthCare Partners Press Release (June 2014)

• 18% reduction in hospital inpatient days (per 1000 members)
• 4% reduction in inpatient admissions (per 1000 members)
• 4% reduction in outpatient visits, including ER visits (per 1000 members)

Health Affairs (April 2015) _{study of Medicare Advantage patients from 2006-2013}

• 7.9% total cost savings, on average, across the ninety-month study period
• The largest source of savings was acute inpatient cost, which accounts for about 64% of the total estimated savings of $53 (PMPM per practice site)
• Other cost components also show some cost savings, but these estimates are not statistically significant
• Greater exposure to PCMH (longer implemenation time) is associated with a greater magnitude of cost savings

American Journal of Managed Care (March 2012) _{retrospective claims data analysis of 43 primary care clinics converted into PHN sites between 2006 and 2010}

• 7.1% lower cumulative cost savings from 2006-2010 with an ROI of 1.7

Population Health Management (June 2013) _{study compared 499 PHN patients with 359 non-PHN patients}

• Patients in a PHN were:
  • twice as likely to report noticable difference in care, care coordination, and service
  • more likely to report that the quality of care at their primary clinic site is different and has improved
  • more likely to cite their primary care office as their usual source of care (83% vs. 68%)
  • likely to cite the (ER) as their usual source of care (11% vs. 23%)
• No significant difference in PHN patient reported access to care or perception of PCP performance

Blue Shield of California (December 2015)

• achieved more than $325 million in healthcare cost savings in the program’s first five years

Health Affairs Blog (April 2014):

• Overall cost of health care (COHC) savings reported a gross savings of more than $105 million, with net savings of $95 million to CalPERS members, since 2010

Blue Cross Blue Shield Industry Report (2012):

• $15.5 million saved (2010)
• $37 million in savings to CalPERS based on the pilot trend versus non-pilot trend. The parties beat the 2011 cost-of-healthcare target by $8 million, which was shared by the parties. 

Health Affairs (September 2012):

• Health care costs for CalPERS members were $393.08 PMPM in 2010, a 1.6 percent decrease from the 2009 baseline amount. For members not in the organization, costs were $435.94 PMPM, which was a 9.9 percent increase from 2009 for that group

Noteworthy examples include achieving 67% HbA1c testing mong diabetics, with 77% demonstrating control within clinically accepted standards. Additionally, sharpening our focus on women’s health, we set a target of achieving over 76% compliance in breast cancer screening among those due for a mammogram. We achieved 79% compliance.

Blue Shield of California (December 2015)

• reduction hospital admissions by up to 13 percent over the first 5 years
• reduction in hospital bed days by up to 27 percent over the first 5 years

Blue Cross Blue Shield Industry Report (2012):

• 15% reduction in inpatient readmission (2010)
• 15% decrease in inpatient days (2010)
• 50% decrease in inpatient stays of 20 or more days (2010)
• a half-day reduction in average patient length of stay (2010)

Health Affairs (September 2012):

• The thirty-day readmission rate continued to decline, from 4.3 percent in 2010 to 4.1 percent in 2011. Average length-of-stay, which decreased from 4.05 days in 2009 to 3.53 in 2010, increased to 3.74 in 2011 because of a considerable increase in catastrophic cases. But it remained below 2009 levels and was well below that of Northern California CalPERS members who were not in the pilot accountable care organization

Horizon Press Release (August 2015) _{evaluation of 750,000 patients participating in Horizon patient-centered practices}

• 9% lower total cost of care (compared to patients served by traditional practices)

Horizon Industry Report (July 2014) 

• aproximate savings of $4.5 million (due to reduction in ER visits and inpatient hospital amissions)
• 4% lower cost of care for diabetic patients (among all patient-centered practices)
• 4% lower total cost of care (among all patient-centered practices)

Horizon Industry Report (July 2013)

• 9% lower cost of care for diabetic patients

Horizon Press Release (August 2015) _{evaluation of 750,000 patients participating in Horizon patient-centered practices}

• 6% higher rate in improved diabetes control (compared to patients served by traditional practices)
• 7% higher rate in cholesterol management for diabetic patients (compared to patients served by traditional practices)
   

Horizon Industry Report (July 2014) 

• 14% higher rate in improved diabetes control
• 12% higher rate in cholesterol management

Horizon Industry Report (July 2013)

• 5% higher rate in improved diabetes control (HbA1c)

Horizon Press Release (August 2015) _{evaluation of 750,000 patients participating in Horizon patient-centered practices}

• 8% higher rate in colorectal cancer screenings (compared to patients served by traditional practices)
• 3% higher rate in breast cancer screenings (compared to patients served by traditional practices)

Horizon Industry Report (July 2014) 

• 8% higher rate in breast cancer screenings
• 6% higher rate in colorectal screenings

Horizon Industry Report (July 2013)

• 3% higher rate in breast cancer screenings
• 11% higher rate in pneumonia vaccinations

Horizon Press Release (August 2015) _{evaluation of 750,000 patients participating in Horizon patient-centered practices}

• 8% lower rate of hospital admissions (compared to patients served by traditional practices)
• 5% lower rate of ED visits (compared to patients served by traditional practices)

Horizon Industry Report (July 2014) 

• 4% lower rate of Emergency Room visits (among all patient-centered practices)
• 2% lower rate of hospital admissions (among all patient-centered practices)

Horizon Industry Report (July 2013)

• 23% lower rate in hospital inpatient admissions.
• 12% lower rate in Emergency Room (ER) visits.

Journal of Graduate Medical Education (June 2015)

• 82% of sites saw improvement in breast cancer screening (rates significantly improved from 47% to 60%, P 5 .01)
• 80% of sites saw improvement in colorectal screening rates since baseline (rates improved from 48% to 59%, P # .001)
• 75% improved rates of tobacco use screening and cessation counseling (rates improved from 70% to 86%, P # .001).

Journal of Graduate Medical Education (June 2015)

• Improved access and coordination between primary and specialty care composite increased from 72% to 79% (P , .001)
• Integration of physical and behavioral health care composite increased from 40% to 73% (P , .001).

Final Report (2018)

• Breast cancer screening increased by 13%
• Cervical cancer screening increased by 12%
• Colorectal cancer screening increased by 11%
• Childhood immunization increased by 14%
• TObacco use assessment increased by 16%

Uses NCQA accreditation. 

Mathematica Evaluation (January 2015) _{Independent evaluation of first program year prepared for CMS}

Among all patients in New York, there were several statistically significant improvements for the CPC group relative to the comparison group in the quality-of-care measures during the first year of CPC:

• HbA1c testing for patients with diabetes increased by 4 percentage points (5 percent).
• Lipid testing for patients with diabetes increased by 2 percentage points (3 percent). 
• The likelihood of not complying with all four diabetes tests/exams declined by 1 percentage point (29 percent).
• Lipid testing among patients with IVD increased by 3 percentage points (4 percent).
• 14-day follow-up visits after a hospital discharge rose by 3 percentage points (4 percent).

Similarly, among high-risk patients in New York, there were also many statistically significant improvements in quality-of-care measures for the CPC group relative to the comparison group, including: 

• HbA1c testing among patients with diabetes increased by 7 percentage points (9 percent).
• Lipid testing among patients with diabetes increased by 5 percentage points (6 percent).
• Urine protein testing among patients with diabetes increased by 8 percentage points (14 percent).
• All four tests for patients for diabetes increased by 7 percentage points (22 percent).  
• Lipid testing among patients with IVD increased by 4 percentage points (5 percent).
• 14-day follow-up visits after a hospital discharge increased by 4 percentage points (6 percent)

Mathematica Evaluation (January 2015) _{Independent evaluation of first program year prepared for CMS}

Among all patients in New York, there were two statistically significant impacts for the CPC group relative to the comparison group:

• A decline in annual hospitalizations of 19 per 1,000 patients (6 percent), beginning in Quarters 1 and 2  
• An increase in annual specialist visits in all settings of 455 per 1,000 patients (3 percent), with quarterly impacts indicating effects occurring in Quarters 1 and 3

Among high-risk patients in New York, there were two statistically significant findings for the CPC group relative to the comparison group during Year 1:

• A decline in annual hospitalizations of 59 per 1,000 patients (9 percent).
• An increase in annual observation stays of 13 per 1,000 patients (21 percent). 

Hartford Courant (July 2014)

• 2% reduction in per person costs
• state distributed $2.4 million in enhanced payments to 15 certified medical homes and 1 hospital outpatient primary care clinic 

Hartford Courant (July 2014)

• children seen in a medical home were 10% more likely to receive recommended EPSDT screenings

Connecticut Department of Social Services Report (FY 2015)

• Achieved an overall member satisfaction rating of 91.1% among adults and 96.1% on behalf of children
• Immediate access to care increased to 92.5% of the time, when requested by adults, and 96.7% of the time, when requested on behalf of children.
• Among a number of measures of courtesy and respect shown to HUSKY members, communication before and during care, PCMH providers were rated overwhelmingly positively by HUSKY members.

Academic Pediatrics (May 2015) _{study sample includes 33,895 publicly insured children attributed to 32 practices}

• Children who received care in practices with high medical homeness were less likely to have a nonurgent, preventable, or avoidable ED visit than children in practices with low medical homeness.
  • They were also marginally less likely to have a nonurgent, preventable, or avoidable ED visit than children in practices with medium medical homeness 

Minnesota Department of Human Services (June 2015)

• $61.5 million in savings in 2014 for 9 provider groups serving 165,000 Minnesotans
• Based on initial 2014 data, all 9 provider groups were eligible for shared savings

Minnesota Department of Human Services (July 2014)

• $14.8 million in savings for six health care providers serving 100,000 Minnesotans. _{*preliminary data reported 10.5 million in savings, but final numbers determined the amount to be $14.8 million}

Strategies for success: 

Medical Home Network (December 2014)

• "A decrease in the overall cost of care for each patient since the introduction of the new care model in December of 2012" (for patients served by Esperanza Health Centers)

Medical Home Network (January 2015)

• 145% increase in timely follow-up visits to a primary care physician after hospital discharge, with some months reaching as high as 45.7%. The follow-up care target after hospital discharge is 29 percent (for patients served by La Rabida Children's Hospital in one year)

Medical Home Network (December 2014)

• As high as a 130.4% increase in timely patient follow-up visits (for patients served by Esperanza Health Centers since December 2012)
• "Illinois Medicaid patients who were a part of Medical Home Network's program and visited their assigned primary care physician at Esperanza Health Centers within seven days after being discharged from the hospital or Emergency Department, increased from a 25.3% pre-implementation baseline to as high as 58.3% in certain months (Esperanza's first intervention year averaged a 47.2% follow-up rate)" (for patients served by Esperanza Health Centers since December 2012)

Medical Home Network (January 2015)

• 10.3% decrease in seven-day hospital readmissions (for patients served by La Rabida Children's Hospital in one year)

Medical Home Network (December 2014)

• 25% decrease in 30-day hospital readmissions (for patients served by Esperanza Health Centers since December 2012)

Tenet Health Press Release (August 2015)

• Michigan Pioneer ACO yielded nearly $39 million of savings over a three-year period, during which time the ACO also experienced consecutive year-over-year improvement in quality results
• generated an estimated savings of nearly $17 million in its third performance year

RTI International (January 2015) _{independent evaluation prepared for CMS}

• The MAPCP Demonstration generated an estimated $4.2 million in savings in its first year through the use of advanced primary care initiatives
• The rate of growth in Medicare FFS health care expenditures was reduced in Vermont and Michigan, driven largely by reduced growth in inpatient expenditures

The Brookings Institution, a nonprofit public policy organization based in Washington, DC, will evaluate the program’s impact on cost and quality.

Mathematica Policy Research (January 2015) _{Independent evaluation of first program year prepared for CMS}

During the first year, statistically significant findings for the CPC group relative to the comparison group include:

• Average monthly Medicare expenditures (without care management fees) declined relative to the comparison group by $45 (5 percent) among all patients in New Jersey. The CPC-comparison difference suggests savings of $26, but was not quite statistically significant (p = 0.103) for Medicare expenditures with care management fees.
• Sizable differences in Medicare expenditures (of about 5 percent) between CPC and the comparison group began in Quarter 1, and became statistically significant in Medicare expenditures in Quarter 3 and continued to Quarter 4
• About half the decline in Medicare expenditures without fees was due to a reduction in inpatient expenditures ($22), nearly a fifth was due to a reduction in physician expenditures ($8), another fifth due to a reduction in outpatient expenditures ($8), and about 5 percent was due to a reduction in expenditures on home health services ($2). (A reduction in expenditures for skilled nursing facility use also contributed to the decline, but was not statistically significant.)

Mathematica Policy Research (January 2015) _{Independent evaluation of first program year prepared for CMS}

Among all patients in New Jersey, there were several favorable impacts on Medicare service use outcomes:

• Hospitalizations per 1,000 patients per year declined by 15 (5 percent).
• Annual specialist visits in all settings declined by 1,142 per 1,000 patients (6 percent).
• Annual primary care clinician visits in all settings declined by 574 per 1,000 patients (7 percent)

Mathematica Evaluation (January 2015) _{Independent evaluation of first program year prepared for CMS}

• There were very few statistically significant effects on the quality-of-care measures among either all or high-risk patients in Ohio/Kentucky during the first year of the initiative (Table 8.14). Specifically, relative to the comparison group:
  • The percentage of CPC beneficiaries with diabetes who received a urine protein test increased by 5 percentage points (7 percent) for high-risk patients only. 

Mathematica Policy Research (January 2015) _{Independent evaluation of first program year prepared for CMS}

• Medicare expenditures and hospitalizations fell over time in Oregon for CPC practices relative to comparison practices; however, the declines were not statistically significant. 
  • DME increased by $5 (10%) among high-risk patients only (this was the only statistically significant effect on expenditures)

Mathematica Policy Research (January 2015) _{Independent evaluation of first program year prepared for CMS}

• HbA1c testing increased by 3 percentage points (4%) for both all patients and high-risk patients, although it was only statistically significant for all patients.
• An eye exam increased by 8 percentage points (14%) for high-risk patients.
• All four tests for diabetes being performed increased by 4 percentage points (11%) for all patients and by 7 percentage points (20%) for high-risk patients.

Mathematica Policy Research (January 2015) _{Independent evaluation of first program year prepared for CMS}

• Outpatient ED visits per 1,000 patients declined by 29 (6 percent) for all patients. 

Oregon Health System Transformation 2014 Performance Report (June 2015) _{evaluation of CCOs on quality measures in 2014} 

• Financial data indicate that CCOs are continuing to hold down costs and continuing to reduce the groth in spending by 2 percentage points per member, per year. 

Oregon Health System Transformation 2013 Performance Report (June 2014)

• 19% reduction in ED visit spending

Oregon Health Transformation Quarterly Report (November 2013)

• 18% reduction in ED visit spending

Oregon Health System Transformation 2014 Performance Report (June 2015) _{evaluation of CCOs on quality measures in 2014} 

• Improved access to care, even through the program added 434,000 additional enrollees in 2014
• 56% increase in PCMH enrollment since 2011
• Primary care costs continue to increase, meaning more services happening in primary care instead of other settings such as ERs
• Increase in child well-care visits, but still below benchmark

Oregon Health Transformation 2013 Performance Report (June 2014)

• 11% increase in outpatient primary care visits
• 52% increase in PCMH enrollment since 2012
• Increase in adolescent well-care visits (27.1% to 29.2%)

Oregon Health Transformation Report (November 2013)

• 18% increase in outpatient primary care visits
• 36% increase in PCMH enrollment

Oregon Health System Transformation 2014 Performance Report (June 2015) _{evaluation of CCOs on quality measures in 2014} 

• Increased use and improved performance on Screening, Brief Intervention, and Referral to Treatment (SBIRT) from 2% in 2013 to 7.3% in 2014

Oregon Health System Transformation 2013 Performance Report (June 2014)

• 58% increase in the percentage of children screened for the risk of developmental, behavioral, and social delays from the baseline in 2011

Oregon Health System Transformation 2013 Performance Report (June 2014)

• Increase in patient satisfaction with care (78% to 83.1%)

Oregon Health System Transformation 2014 Performance Report (June 2015) _{evaluation of CCOs on quality measures in 2014} 

• ED visits by people served by CCOs have decreased by 22% since 2011 baseline data
• 26.9% reduction in admissions for patients with diabetes with short-term complication since 2011 baseline data
• 60% reduction in admissions for patients with COPD or asthma since 2011 baseline data

Oregon Health System Transformation 2013 Performance Report (June 2014)​

• ED visits by people served by CCOs have decreased 17% since 2011 baseline data
• 27% reduction in hospital admissions for patients with congestive heart failure
• 32% reduction in hosptial admissions for patients with chronic obstructive pulmonary disease 
• 18% reduction in hosptial admissions for patients with adult asthma

Oregon Health Transformation Quarterly Report (November 2013)

• 9% fewer ED visits
• 14-29% fewer hospital admissions for chronic disease patients
• 12% fewer hospital readmissions

American Journal of Managed Care (February 2015)

• Total costs were significantly lower in PCMH practices during all 3 follow-up years (P <.05).
• Relative to baseline, overall PMPM costs were:
  • $16.50 lower in 2009, a difference of 5.5%.
  • $13.00 lower in 2010
  • $13.70 lower in 2011 
• This reduction was driven by significantly lower inpatient (P <.01) and specialist (P <.0001) costs among PCMH practices over all 3 program years.
• The relative reduction in specialist costs was particularly pronounced: in 2009, adjusted costs for PCMH were 17.5% lower than those in non-PCMH practices.
• While significant relative increases in ED PMPM costs (P <.0001) partially offset these reductions, PCMH practices did not experience a significant increase in outpatient costs despite the observed increase in outpatient utilization 

JAMA Internal Medicine (June 2015)

• Statistically significant higher performance in all 4 examined measures of diabetes care quality including: HbA1c testing, LDL-C testing, nephropathy monitoring, and eye examinations (vs. comparison practices)

JAMA (February 2014)

• Postive trend in quality measures, with one reaching statistical significance 

Pennsylvania Academy of Family Physicians (2012)

• Decrease the percent of patients with DM in participating practices who have an A1C measure of greater than 9% from 33% to 20% (target: <5 %). 
• Increase the percent of patients with DM in participating practices whose BP is documented in the past year < than 130/80 mm Hg from 40% to 49% (target: >70%). 
• Increase the percent of patients with DM in participating practices with LDL < 100 mg/dl from 38% to 50% (target: >70%).
• Increase the percent of patients with DM in participating practices who have a self-management goal documented within the past 12 months from 33% to 62% (target: >90%).

Joint Commission Journal on Quality and Patient Safety (June 2011)

• "After the first implementation year, PCCI noted significant improvement in diabetes measures, including HbA1c, and in cardiovascular risk factors, including blood pressure and cholesterol"

JAMA Internal Medicine (June 2015)

• By year 3, pilot participation was associated with higher rates of ambulatory primary care visits (+77.5) per 1000 patients per month 

JAMA Internal Medicine (June 2015)

• 5.6% higher performance on breast cancer screening (vs. comparison practices)
• no statistically significant improvement in colorectal screening (vs. comparison practices)

Joint Commission Journal on Quality and Patient Safety (June 2011)

• All practices in the group received NCQA status with a significant increase in patients meeting diabetes self-management goals, and preventive screening and treatments, including eye and foot exams, microalbumin screen, pneumococcal vaccine, smoking cessation, and aspirin, statin, and blood pressure medicine use

JAMA Internal Medicine (June 2015)

• By year 3, pilot participation was associated with:*
  • lower rate for all-cause hospitalization (-1.7)
  • lower rate for all-cause ED vists (-4.7)
  • lower rate for ambulatory-care sensitive ED visits (-3.2)
  • lower rate for ambulatory visits for specialists (-17.3)

_{* (per 1000 patients per month vs. comparison)}

American Journal of Managed Care (February 2015)

• Controlling for baseline differences, PCMH practices maintained significantly lower utilization for hospital admissions (P <.0001) and specialist visits (P <.01) for each year in the follow-up period. 
• PCMH practices also saw 0.3 fewer admissions per patient in 2009, and 0.2 fewer admissions per patient in both 2010 and 2011.
• Specialist visits were reduced by 12.3 visits per 1000 patients in 2009, and by more than 10 visits per 1000 patients in 2010 and 2011.
• However, PCMH practices observed significantly higher utilization in ED and outpatient visits, though the adjusted difference in ED visits shrank over the period from 2009 to 2011 

Qliance Press Release (January 2015) 

• Savings of $679,000 per 1,000 Qliance patients on total claims –19.6 percent less than the total claims for non-Qliance patients during the same period.

Qliance Press Release (January 2015) 

• A 2014 assessment of Qliance's patients' experience, conducted using the national CAHPS survey, placed Qliance above the 95th percentile in overall patient satisfaction, well above the 90th percentile nationally

Qliance Press Release (January 2015) _{analysis examined insurance claims data from 2013 and 2014 for approximately 4,000 Qliance patients covered by employer benefit plans, and compared the cost of their care to that of non-Qliance patients who worked for the same employers.}

• The ~20% savings were driven by a marked reduction in expensive emergency room visits, inpatient care, specialist visits, and advanced radiology

practices that received global payments from RMHP for integrated care showed a 4.8 percent lower total cost of care for attributed patients, in a normalized comparison with a control group

Arkansas Department of Human Services (October 2015)

• In 2014, the state avoided $34 million in Medicaid costs in 2014
• 19 providers received shared savings payments for a total of over $5 million

RTI International (January 2015)

• Michigan is one of 2 states that reduced rate of growth in Medicare FFS expenditures in the first year of implementation
• estimated reductions of about $148 per full-year eligible medicare benificiary

Annals of Family Medicine (May 2013)

For the composite scores based on team-based care, 2 measures of productivity and cost were statistically significant: 

• Staff cost, clinician FTE (-0.94)
• Visits/clinician FTE (-0.70)

Annals of Family Medicine (May 2013)

• Improvement across a number of clinical quality measures (see article for detailed results)

Annals of Family Medicine (May 2013)

• Decrease in wait time at clinic

Annals of Family Medicine (May 2013)

• Improvement in patient satisfaction: explanation of care, clinician instructions, likely to recommend, overall satisfaction
• Improvement in clinician satisfaction: time spent working, relationship with patient 

Journal of Healthcare Quality (January 2015) (retrospective study of 118 patients)

• all-cause 30-day hospital readmission rate decreased from 17.9% to 8.0%
• mean time to hospital readmission within 180 days was delayed from 95 to 115 days

Population Health Management (September 2015)

• Participant expenditures were reduced by -$482 PMPY* (p<.001)
• Reduction in inpatient (-$218 PMPY*; p<.001) and outpatient hospital expenditures (-$154 PMPY*; p<.001)
• Increase in expenditures for dental, social, and community-based support services ($57 PMPY*; p<.001)
• Total annual reduction in expenditures was $104.4 million
• Medical expenditures decreased by approximately $5.8 million for every $1 million spent on the Blueprint initiative

Blueprint for Health Annual report (January 2015)

• In 2013, lower healthcare expenditures for Blueprint participants offset the payments that insurers made for medical homes and community health teams
• In 2013, when comparing Blueprint participants to non-pcmh primary care practices, the total expenditures per capita were:
  • $101 less per Blueprint participant for Medicaid 
  • $565 less per Blueprint participant for commercial payers 

Blueprint for Health Annual Report (January 2014)

Total annual expenditures in 2012 were reduced by:

• $386 (19%) for each commercially insured participant in the 1-17 age group 
• $586 (11%)  for each commercially insured participant in the 18-64 age group 
• $200 for each Mediaid insured participant in the 1-17 age group 
• $447 for each Medicaid insured participant in the 18-64 age group 

Blueprint for Health Annual Report (January 2014)

• Increase in primary care visits for commercially insured children and Medicaid adults

Blueprint for Health Annual Report (January 2014)

Increased preventive services:

• increase in breast cancer screening in commercially insured adults (78.5 vs 77.1 in control group)
• increase in cervicial cancer screenings in commercially insured adults (68.8 vs 67 in control group)
• increase in cervical cancer screenings in Medicaid insured adults (59.6 vs 55.3 in control group)
• increase in adolescent well-care visits in commercially insured participants ( 59.8 vs 53.2 in control group) 

Population Health Management (September 2015)

• Reduction in inpatient discharges reduced by 8.8 per 1000 members (p<.001)
• Reduction in inpatient days reduced by 49.6 per 1000 members (p<.001)
• Significant reduction in standard imaging, advanced imaging, echography

Population Health Management (July 2014)

• inpatient days per 1000 members decreased by nearly 8%

Blueprint for Health Annual Report (January 2014)

• fewer hospitalizations for commercially insured adults (47.1 vs. 53.4 in control group)
• fewer hospitalizations for Medicaid insured children (23.9 vs 33.3 in control group)
• fewer hospitalizations for Medicaid insured adults (137.8 vs. 149.4 in control group)
• fewer ED visits for commercially insured adults (205.1 vs 214.7 in control group)
• fewer ED visits for Medicaid insured children (521 vs 485.1 in control group)

JAMA Internal Medicine (June 2014)

• PCMH group had higher performance on 41 of 48 measures of clinical quality
• Veterans with chronic disease had small but significant improvements in qualtiy-of-care indicators
• Improvements in clincial outcomes for patients with diabetes, hypetension and heart disease

VA Health Services Research & Development (February 2019)_{In 2012, select Veterans Health Administration (VHA) facilities implemented a homeless-tailored medical home model, called Homeless Patient Aligned Care Teams (H-PACT), to improve care processes and outcomes for homeless Veterans.}

• H-PACT patients were more likely than standard primary care patients in the same facilities to report positive experiences with access [adjusted risk difference (RD)=17.4], communication (RD=13.9), office staff (RD=13.1), provider ratings (RD=11.0), and comprehensiveness (RD=9.3

American Journal of Managed Care (March 2015) _{During the study period from just prior to widespread PACT implementation to 2 years after PACT implementation began}

• 17% decreased in mean number of primary care visits (from 4.81 to 3.99 visits per patient) and 85% increase in telephone visits (P <.001) 
• "Features such as team huddles and tracking lab tests were actually associated with fewer primary care visits per patient, possibly through better efficiency of primary care practice. Greater specialty care visits were modestly related to higher care coordination/transitions in care scores, so better procedures to coordinate care appeared to facilitate referrals to specialty care." 

Journal of Health Care Quality (November 2014) _{study evaluated PACT patients with post traumatic stress disorder using a pre/post study design}

• PACT were associated with an increase in primary care visits (IE: 0.96; 95% CI: 0.67, 1.25)

Health Affairs (June 2014)

• 3.5% increase in primary care visits for veterans over age 65
• 1% increase in primary care visits across VHA system (all age groups)

American Journal of Managed Care (July 2013)

• Increase in phone encounters (2.7 to 28.8 per 100 patients per quarter)
• increase in personal health record use (3% to 13% of patients enrolled)
• increase in electronic messaging to providers (.01% to 2.3% of patients per quarter)
• increase in same day appointments (p<.01)
• increase in patients seen within 7 days of desired appointment date (85% to 90% p<.01)

JAMA Internal Medicine (June 2014)

• Veterans receiving care from sites with successful PACT implementation were more likely to:
  • get a flu shot (p<.001)
  • get screeened for cervical cancer (p<.047)
  • ger offered medications for tobacco cessation (P<.001)

American Journal of Managed Care (June 2015)

• no statistically significant association between medical home implementation and improvements in 5 domains of patient care experiences 

JAMA Internal Medicine (June 2014)

• clinician satisfaction: lower staff burnout in PCMH vs nonPCMH (2.29 vs 2.80; P = .02)
• patient satisfaction: higher scores of patient satisfaction (9.33 vs 7.53; P < .001)

American Journal of Managed Care (March 2015) _{During the study period from just prior to widespread PACT implementation to 2 years after PACT implementation began}

• ED visits per patient rose slightly (7%), and ACSC hospitalizations per patient also rose from 0.02 to 0.03 per patient (all P <.001) 

Journal of Health Care Quality (November 2014) _{study evaluated PACT patients with post traumatic stress disorder using a pre/post study design}

• PACT were associated with:
  • a decrease in hospitalizations (incremental effect [IE]: -0.02; 95% confidence interval [CI]: -0.03, -0.01)
  • a decrease in specialty care visits (IE: -0.45; 95% CI: -0.07, -0.23)

Health Services Research (August 2014)

• Slight decline in ED visits among PACT providers (9.7% to 8.0%) while they increased for patients seen by non-PACT providers (7.5% to 8.8%)

JAMA Internal Medicine (June 2014) 

• Lower emergency department use (188 vs 245 visits per 1000 patients; P < .001
• Lower hospitalization rates for ambulatory care–sensitive conditions (4.42 vs 3.68 quarterly admissions for veterans 65 years or older per 1000 patients; P < .001)

Health Affairs (June 2014)

• 1.7% reduction in hospitalizationsf for ambulatory care sensitive conditions across the entire VHA system; 4.2% reduciton for veternas under age 65
• 7.3% reduction in outpation vistisn with mental health specialists across VHA system (likely due to integration of mental health in primary care) 

Plos One (May 2014) 

• Individuals with at least one visit to their assigned primary care provider (PCP) were less likely to visit the ED compared with those lacking a single PCP visit ( 23% v. 32%, p<.001)
• 46% reduction in ED utilization due to continuity of care

American Journal of Managed Care (July 2013) 

• Decrease in face-to-face primary care visits (53 to 43 per 100 patients per calendar quarter (p<.01)
• Patients evaluated within 48 hours of inpatient discharge increaed 6% to 61% (p<.01)

Health Affairs (June 2014)

The study found, "PACT was associated with modest increases in primary care visits and with modest decreases in both hospitalizations for ambulatory care–sensitive conditions and outpatient visits with mental health specialists. We found that these changes avoided $596 million in costs, compared to the investment in PACT of $774 million, for a potential net loss of $178 million in the study period. Although PACT has not generated a positive return, it is still maturing, and trends in costs and use are favorable. Adopting patient-centered care does not appear to have been a major financial risk for the VHA."

Wellmark Press Release (September 2015) _{based on a review of 2014 claims data} 

• 8 of the 13 participating ACOs improved their overall quality scores by 8% and saved more than $17 million during 2014

Wellmark Press Release (August 2014)

• The 5 initial ACOs participating in the shared savings agreement saved more than $12 million during the first two years. As a result, each of these 5 participating ACOs recieved incentive payments from Wellmark for achieving their performance goals

Wellmark Press Release (August 2014)

• The 5 initial ACOs participating in the shared savings agreement improved thier quality scores by over 35% in the first 2 years

Wellmark Press Release (September 2015) _{based on a review of 2014 claims data} 

• In 2014, among participating ACO members, there were an additional 21,000 more visits to primary care physicians
• In 2014, many of the ACOs improved their continuity of care score, which means members received more coordinated care when needed.

Wellmark Press Release (September 2015) _{based on a review of 2014 claims data} 

• In 2014, 1,500 more children received preventive visits and 1,100 more members were screened for colon cancer over the previous year

Wellmark Press Release (September 2015) _{based on a review of 2014 claims data} 

• The 8 ACOs, representing more than 424,000 members, achieved savings by:
  • reducing hospital admissions by nearly 11%
  • reducing readmissions by 8%
  • reducing emergency department visits by 10%

Wellmark Press Release (August 2014)

• The 5 initial ACOs participating in 2013 achieved savings through:
  • reducing hospital admissions by nearly 12%
  • readmissions by 7%
  • and ED visits by nearly 11% 

When compared to potential Health Homes members and health Homes cohorts, the cost savings are significant, despite the fact that total prescription costs increased due to the high cost of treating Hepatitis. For potential enrollees, total medical costs increased by $3.2 million from 2014 to 2015, which Health Homes enrollees only saw an increase of $0.2 million.

There was a 42% reduction in the average length of stay in a hospital for all Health Homes members who had Medicaid coverage in both 2014 and 2015. Members who were enrolled for the entire year saw a decrease of 32% from 2014. THe decrease can be attributed to better discharge planning.

WESTMED Medical Group outcomes (year 1):

• WESTMED physicians met or exceeded 9 of 10 targeted goals on cancer screenings, diabetes management and screening, and heart disease management and screening.

WESTMED Medical Group outcomes (year 1):

• 35% reduction in hospital admissions

HealthCare Partners outcomes (June 2014)

• $4.7 million saved in six months

Health Leaders Media (June 2015)

By focusing on members who have two or more chronic conditions, an Anthem Blue Cross ACO in California has been able to save almost $8 million by reducing incidences of hospital stays and outpatient visits, and increasing the use of generic prescription drugs.

HealthCare Partners outcomes (June 2014)

Increase in quality measures: 

• 7.5% Diabetes LDL
• 3.8% in cholesterol management for patients with heart disease

HealthCare Partners outcomes (June 2014)

• 18% reduction in hospital inpatient days (per 1000 members)
• 4% reduction in inpatient admissions (per 1000 members)
• 4% reduction in outpatient visits, including ER visits (per 1000 members)

•  reduced the cost of care by 4.6% for about 20,000 Medicare beneficiaries in northeast Wisconsin in 2012

BCBS of Michigan Press Release (July 2015) 

• Blue Cross Patient-Centered Medical Home program has saved an estimated $512 million over six years through:
  • disease prevention
  • reduced hospitalizations and emergency room visits
  • management of common acute and chronic medical conditions that have improved patient care outcomes

Health Affairs (April 2015) _{study included over 3.2 million people under age 65 enrolled for at least twelve continuous months during the study period (2008–2011)}

• Participating practices decreased their total PMPM spending by $4.00 more than control practices did (a 1.1% difference)
• Participating providers spent $5.44 less than nonparticipants for pediatric patients, a savings of 5.1 percent.

Health Services Research (July 2013)

• Savings of $26.37 PMPM (2009-2010)
• $155 million in cost savings (2008-2011)

Health Affairs (April 2015) _{study included over 3.2 million people under age 65 enrolled for at least twelve continuous months during the study period (2008–2010 for quality measures)}

• PCMH practices achieved the same or better performance over time on 11 of 14 quality measures
• Statistically significant improvement in 4 of 7 quality measures for diabetes care (screenings for HbA1c, low-density lipoprotein cholesterol, and nephropathy; and delivery of angiotensinconverting enzyme [ACE] inhibitors to patients with hypertension)

Health Services Research (July 2013)

• 3.5% higher quality composite score

Blue Cross Blue Shield of Michigan (July 2014)

• 21.3% lower rate of ER visits for pediatric patients due to appropriate and timely in-office care

Health Affairs (April 2015) study included over 3.2 million people under age 65 enrolled for at least twelve continuous months during the study period (2008–2010 for quality measures)

• Statistically significant improvement in 3 of 7 quality measures for preventive care (adolescent well care, adolescent immunization, and wellchild visits at ages 3–6)

JAMA Internal Medicine (February 2015) _{(Three-year study of 2,218 practices)}

• In multivariable models, the PCMH was associated with a higher rate of screening in the lowest socioeconomic group for:
  • breast cancer (5.4%; 95% CI, 1.5% to 9.3%)
  • cervical cancer (4.2%; 95% CI, 1.4% to 6.9%)
  • colorectal cancer (7.0%; 95% CI, 3.6% to 10.5%) 
  • and a higher rate of screening for colorectal cancer (4.5%; 95% CI, 1.8% to 7.3%) in the highest socioeconomic group 
• The study also found nonsignificant differences in screening for breast cancer (2.6%; 95% CI, −0.1% to 5.3%) and cervical cancer (−0.5%; 95% CI, −2.7% to 1.7%) in the highest socioeconomic group

Health Services Research (July 2013)

• 5.1% higher adult prevention composite score (2009-2010)
• 4.9 - 12.2% higher pediatric prevention composite score (2009-2010)

Medical Care Research and Review (August 2015)

• Practices beginning the study with high implementation scores ("full implementation") versus those with low implementation scores ("no implementation")  had $16.73 PMPM lower costs for adult patients after 3 years (4.4%, p=.02)

BCBS of Michigan Press Release (July 2015) _{based on 2015 claims data of patients who visit BCBSM PCMH-designated practices}

• 26% lower rate of hospital admissions for common conditions
• 10.9% lower rate of adult ER visits
• 16.3% lower rate of pediatric ER visits
• 22.4% lower rate of pedatric ER visits for common chronic and acute conditions (i.e. asthma)

Blue Cross Blue Shield of Michigan (July 2014)

• 27.5% lower rate of hospital stays for certain conditions
• 11.8 percent lower rate of adult primary care sensitive ER visits
•  9.9 percent lower rate of adult ER visits over non-PCMH doctors
• 14.9 percent lower rate of ER visits overall for pediatric patients

Blue Cross Blue Shield of Michigan (July 2013)

• 8.8% fewer adult ED visits
• 17.7% lower rate of pediatric ED visits
• 19.1% lower rate of adult ambulatory care sensitive inpatient admissions
• 11.2% lower rate of adult primary care sensistive ER visits
• 23.8% lower rate of pediatric primary-care sensitive ER visits

Managed Healthcare Executive (December 2011)

• 13.5% fewer pediatric ED visits (2011)
• 10% fewer adult ED visits (2011)

• helped save Medicare $4.5 Million 
• 1 of 11 CMS Pioneer ACOs to earn shared savings

• The cost of total claims decreased by 9% for a gross savings of $972,519
• High-risk member costs decreased by16%

• At the end of the year-long pilot the number of patients with diabetes for whom blood sugar had been confirmed as under control increased by 50%

• Breast cancer screening and body mass index counseling increased across the entire patient population and patient satisfaction improved

• overall improvement in patient satisfaction (no statistic cited)

• Medication adherence among high-risk members increased, while high-risk member costs decreased and overall inpatient admissions and emergency department visits also decreased 
• Inpatient admissions decreased by nearly 22%
• Emergency department visits decreased by more than 3%

JAMA Internal Medicine (November 2013)

• improvements across diabetes cares measures in PCMHs vs control groups (not statistically significant) 

CSI-RI 2013 Annual Report (May 2014)

• practices collectively met every targeted patient heath outcome, including areas of weight management, diabetes, high blood pressure and tobacco cessation, and practices are showing improvement over time in all of the targeted areas

CTC-RI 2014 Annual Report (May 2015)

• CTC-RI practices reported higher patient experience compared with other MAPCP states

CSI-RI 2013 Annual Report (May 2014)

• CSI-RI practices received increased, positive patient experience ratings, including access to care, communication with their care team, office staff responsiveness, shared decision making, and self-management support

CTC-RI 2014 Annual Report (May 2015)

• 7.2% reduction in hospital admissions in most experienced CTC-RI practices

CSI-RI 2013 Annual Report (May 2014)

• More experienced CSI-RI practices saw reduced inpatient hospitalization, while the comparison group (primary care practices that are not CSI-RI patient-centered medical homes) experienced an increase

JAMA Internal Medicine (November 2013)

• 11.6% reduction in ambulatory care-sensitive emergency department visits
• Fewer overall ED visits, inpatient admissions and ambulatory care sensitive inpatient admissions (not statistically significant)

CareFirst Industry Report (July 2015)  _{evaluation of the 4th year of the program. Service area includes Northern Virginia and DC}

• Health care costs for CareFirst members in a PCMH were $345 million less than projected in 2014
  • this is an improvement over 2013 data when costs were $130 million less than expected
• Since 2011, medical costs for PCMH members have been $609 million less than expected
• Approximately 84% of provider panels earned Outcome Incentive Awards (OIA) based on quality and degree of savings they achieved
  • An average award, in addition to a particiaption fee, amounted to $41,000 -$49,000 in increased revenue

CareFirst Industry Report (July 2014)

• In all, the PCMH Program has saved $267 million in avoided costs when measured against the projected cost of care from 2011 to 2013

CareFirst Press Release (June 2013)

• average of 4.7% savings for primary care panels that received an Outcome Incentive Award
• $98 million in total costs savings 

CareFirst Press Release (June 2013)

• 3.7% higher quality scores for panels that received incentives
• Quality scores for PCMH panels rose by 9.3% from 2011 to 2012

CareFirst Industry Report (July 2015)  _{evaluation of the 4th year of the program. Service area includes Northern Virginia and DC}

• Since the beginning of the program in 2011, PCMH members have had*:
  • 19% fewer hospital admissions
  • 15% fewer days in the hospital
  • 20% fewer hospital readmissions for all causes
  • 5% fewer outpatient health facility visits
• In 2014 alone, PCMH members experienced*:
  • 5.1% fewer hospital admissions
  • 10.7% fewer days in the hospital
  • 8.5% fewer hospital readmissions for all causes
  • 12.5% fewer outpatient health facility visits

CareFirst Industry Report (July 2014)

• 6.4% fewer hospital admissions
• 8.1% fewer hospital readmissions for all causes
• 11.1% fewer days in the hospital

* results per 1000 CareFirst members

CareFirst Industry Report (July 2015)  _{evaluation of the 4th year of the program. Service area includes Northern Virginia and DC}

• Health care costs for CareFirst members in a PCMH were $345 million less than projected in 2014
  • this is an improvement over 2013 data when costs were $130 million less than expected
• Since 2011, medical costs for PCMH members have been $609 million less than expected
• Approximately 84% of provider panels earned Outcome Incentive Awards (OIA) based on quality and degree of savings they achieved
  • An average award, in addition to a particiaption fee, amounted to $41,000 -$49,000 in increased revenue

CareFirst Industry Report (July 2014)

• In all, the PCMH Program has saved $267 million in avoided costs when measured against the projected cost of care from 2011 to 2013

CareFirst Industry Report (June 2013)

• average of 4.7% savings for primary care panels that received an Outcome Incentive Award
• $98 million in total costs savings 

CareFirst Press Release (June 2013)

• 3.7% higher quality scores for panels that received incentives
• Quality scores for PCMH panels rose by 9.3% from 2011 to 2012

CareFirst Industry Report (July 2015)  _{evaluation of the 4th year of the program. Service area includes Northern Virginia and DC}

• Since the beginning of the program in 2011, PCMH members have had*:
  • 19% fewer hospital admissions
  • 15% fewer days in the hospital
  • 20% fewer hospital readmissions for all causes
  • 5% fewer outpatient health facility visits
• In 2014 alone, PCMH members experienced*:
  • 5.1% fewer hospital admissions
  • 10.7% fewer days in the hospital
  • 8.5% fewer hospital readmissions for all causes
  • 12.5% fewer outpatient health facility visits

CareFirst Press Release (July 2014)

• 6.4% fewer hospital admissions*
• 8.1% fewer hospital readmissions for all causes*
• 11.1% fewer days in the hospital*

* results per 1000 CareFirst members

CareFirst Industry Report (July 2015)  _{evaluation of the 4th year of the program. Service area includes Northern Virginia and DC}

• Health care costs for CareFirst members in a PCMH were $345 million less than projected in 2014
  • this is an improvement over 2013 data when costs were $130 million less than expected
• Since 2011, medical costs for PCMH members have been $609 million less than expected
• Approximately 84% of provider panels earned Outcome Incentive Awards (OIA) based on quality and degree of savings they achieved
  • An average award, in addition to a particiaption fee, amounted to $41,000 -$49,000 in increased revenue

CareFirst Industry Report (June 2013)

• average of 4.7% savings for primary care panels that received an Outcome Incentive Award
• $98 million in total costs savings 

CareFirst Industry Report (June 2013)

• 3.7% higher quality scores for panels that received incentives
• Quality scores for PCMH panels rose by 9.3% from 2011 to 2012

CareFirst Industry Report (July 2015)  _{evaluation of the 4th year of the program. Service area includes Northern Virginia and DC}

• Since the beginning of the program in 2011, PCMH members have had*:
  • 19% fewer hospital admissions
  • 15% fewer days in the hospital
  • 20% fewer hospital readmissions for all causes
  • 5% fewer outpatient health facility visits
• In 2014 alone, PCMH members experienced*:
  • 5.1% fewer hospital admissions
  • 10.7% fewer days in the hospital
  • 8.5% fewer hospital readmissions for all causes
  • 12.5% fewer outpatient health facility visits

CareFirst Press Release (July 2014)

• 6.4% fewer hospital admissions*
• 8.1% fewer hospital readmissions for all causes*
• 11.1% fewer days in the hospital*

* results per 1000 CareFirst members

CareFirst Industry Report (July 2014)

• 6.4% fewer hospital admissions
• 8.1% fewer hospital readmissions for all causes
• 11.1% fewer days in the hospital

* results per 1000 CareFirst members

• $2,597,466 in accrued savings in performance year one, but did not qualify for federal shared savings payment

• CAHPS score for health status/health functioning at 76.60 compared to the ACO mean of 73.05

• Preventive Care and Screening: Influenza Immunization at 94.66 compared to ACO mean of 72.52

• Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up at 93.55 compared to ACO mean of 70.69

• Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention at 99.19 compared to ACO mean of 90.48

Mathematica Policy Research (April 2016) independent evaluation prepared for CMS evaluating Year 2 of the program's implementation

• CPC has not generated savings net of care management fees
  • The change in average expenditures including the care management fees was $7 higher for CPC than comparison beneficiaries (p = 0.27, 90 percent CI -$3, $17)
• CPC reduced average monthly Medicare expenditures without care management fees by $11 per beneficiary per month (PBPM), or 1 percent (p = 0.074), over the initiative’s first two years, with the 90 percent confidence interval ranging from a reduction of $1 to $21.
• Based on the total number of eligible beneficiary months among beneficiaries attributed to CPC practices in the first two years, the impact estimate of $11 per beneficiary per month translates to an estimated cumulative savings in Medicare expenditures without fees of $91.6 million. 
•  3 percent reduction in primary care visits (p < 0.01) contributed minimally to savings​

CMS Blog (October 2015) _{results from first shared savings performance year (2014)}

• The CPC initiative generated a total of $24 million in gross savings overall (excluding the CPC care management fees)
• Arkansas, Colorado, Cincinnati-Dayton region of Ohio, and Oregon generated gross savings
• The Greater Tulsa region generated net savings of $10.8 million and earning more than $500,000 in shared savings payments

Mathematica Policy Research (January 2015) independent evaluation prepared for CMS

• Across all seven regions in the first year, early results suggest that CPC has generated enough savings in Medicare health care expenditures to nearly cover the CPC care management fees paid by CMS for attributed Medicare FFS beneficiaries, although not enough to generate net savings
• The bulk of the savings was generated by patients in the highest-risk quartile, but favorable results were also seen in other patients
• Across the seven regions, CPC reduced Medicare Part A and Part B expenditures per beneficiary by $14 or 2%
  • These reductions are relative to a matched comparison group and do not include the care management fees (~$20 per beneficiary per month)

CMS Blog (October 2015) _{results from first shared savings performance year (2014)}

• Over 90% of CPC practices successfully met quality targets on patient experience (as determined by CAHPS surveys) and utilization (hospital admission and readmission) measures, indicating quality scores that matched or exceeded national comparisons

CMS (November 2014) _{summary of practice reports from July 2014 for the second quarter of 2014, which spanned the period from April through June 2014​} 

• 99 percent of practices offer patients around-the-clock access to a care team member with real-time access to the EHR (2014)

CMS Blog (October 2015) _{results from first shared savings performance year (2014)}

• All regions had lower-than-targeted hospital readmission rates.
• Lower readmissions indicate better coordination of care during transitions and patient support during the post-discharge period.

Mathematica Policy Research (January 2015) _{independent evaluation prepared for CMS}

• "CPC generated reductions in hospitalizations, outpatient ED visits, primary care physician visits, and specialist visits," however evaluators recommend that these findings be interpreted with caution 
• 2% reduction in hospital admissions and 3% reduction in ED visits, contributing to the reduction of expenditures nearly enough to offset care management fees paid by CMS
• There was a sizable (4 percent) CPC-wide decline (that was not quite statistically significant) in unplanned 30-day readmissions

CMS Fact Sheet (August 2015) _{based on an evaluation of 2014 quality and financial performance results}

• Pioneer participants saved $120 million in 2014, compared with $96 million in 2013
• Of 15 Pioneer ACOs who generated savings, 11 generated savings outside a minimum savings rate and earned a total shared savings of $82 million.
  • Of 5 Pioneer ACOs who generated losses, 3 generated losses outside a minimum loss rate and owed a total of $9 million in shared losses to CMS
• Total model savings per ACO increased from $2.7 million per ACO in Performance Year 1 to $4.2 million per ACO in Performance Year 2 to $6.0 million per ACO in Performance Year 3

JAMA (May 2015) _{study of 600,000 patients assistned to a Pioneer ACO in 2012 or 2013}

• ~$36 reduction PMPM in 2012 and ~$11 reduction PMPM in 2013 for patients attributed to a Pioneer ACO vs non-affiliated patients
• The rate of savings was 4 percent in the first year, or a total of $212 million, and less than 1.5 percent, or $105 million in the second year

Government Accountability Office (April 2015) _{report evaluated 23 ACOs that participated in the Pioneer Model in 2012 and 2013} 

• Forty-one percent of the ACOs produced $139 million in total shared savings in 2012, and 48 percent produced $121 million in total shared savings in 2013.
• In 2012 and 2013 CMS paid ACOs $77 million and $68 million, respectively, for their shared savings.
• The Pioneer ACO Model produced net shared savings of $134 million in 2012 and $99 million in 2013.

CMS Fact Sheet (September 2014) 

• During the second performance year, Pioneer ACOs generated estimated total model savings of over $96 million and at the same time qualified for shared savings payments of $68 million. They saved the Medicare Trust Funds approximately $41 million. The total model savings and other financial results are subject to revision.
• Pioneer ACOs achieved lower per capita growth in spending for the Medicare program at 1.4 percent, which is about 0.45 percent lower than Medicare fee-for-service.
• Eleven Pioneer ACOs earned shared savings, 3 generated shared losses, and 3 elected to defer reconciliation until after the completion of performance year three.

CMS Press Release (January 2014)

• CMS Pioneer ACOs generated gross savings of $147 million in their first year while continuing to deliver high quality care.
• Results showed that of the 23 Pioneer ACOs, nine had significantly lower spending growth relative to Medicare fee for service while exceeding quality reporting requirements. 

CMS Fact Sheet (August 2015) _{based on an evaluation of 2014 quality and financial performance results}

• The ACOs showed improvements in 28 of 33 quality measures and experienced average improvements of 3.6% across all quality measures compared to Performance Year 2.
• Particularly strong improvement was seen in:
  • medication reconciliation (70% to 84%)
  • screening for clinical depression and follow-up plan (50% to 60%)
  • qualification for an electronic health record incentive payment (77% to 86%)

Government Accountability Office (April 2015) _{report evaluated 23 ACOs that participated in the Pioneer Model in 2012 and 2013} 

• Pioneer ACOs had significantly higher quality scores in the second year than in the first year for two-thirds of the quality measures (22 of the 33, or 67 percent)
  • Significantly higher scores for measures in care coordination and disease management for at-risk populations.

CMS Fact Sheet (September 2014) (Results for second performance year)

• The mean quality score among Pioneer ACOs increased by 19 percent, from 71.8 percent in 2012 to 85.2 percent in 2013
• The organizations showed improvements in 28 of the 33 quality measures and experienced average improvements of 14.8 percent across all quality measures. Some of these measures included controlling high blood pressure, screening for future fall risk, screening for tobacco use and cessation, and patient experience in health promotion and education

JAMA (May 2015) _{study of 600,000 patients assistned to a Pioneer ACO in 2012 or 2013}

• "Despite differential decreases in primary care office visits for evaluation and management, hospital discharge follow-up visits within 7 days had significant differential increases from 11.3 (95% CI, 4.6 to 18.0) visits per 1000 discharges in 2012 to 14.8 (95% CI, 8.5 to 21.0) visits per 1000 discharges in 2013 for beneficiaries aligned with ACOs."
• "A significant differential increase was also seen in 2013 for follow-up visits within 14 days of discharge (10.7 [95% CI, 4.9 to 16.4] per 1000 discharges) but not within 30 days in either year."

Government Accountability Office (April 2015) _{report evaluated 23 ACOs that participated in the Pioneer Model in 2012 and 2013} 

• Pioneer ACOs had significantly higher scores for measures of preventive health care

CMS Fact Sheet (August 2015) _{based on an evaluation of 2014 quality and financial performance results}

• Pioneer ACOs improved the average performance score for patient and caregiver experience in 5 out of 7 measures compared to Performance Year 2

JAMA (May 2015) _{study of 600,000 patients assistned to a Pioneer ACO in 2012 or 2013}

• Compared with other Medicare beneficiaries, Pioneer ACO-aligned beneficiaries reported higher mean scores for timely care (77.2 [ACO] vs 71.2 [FFS] vs 72.7 [Medicare Advantage]) and for clinician communication (91.9 [ACO] vs 88.3 [FFS] vs 88.7 [Medicare Advantage])

Government Accountability Office (April 2015) _{report evaluated 23 ACOs that participated in the Pioneer Model in 2012 and 2013} 

• Pioneer ACOs had significantly higher scores for measures of patient experiences of care

CMS Fact Sheet (September 2014) (Results for second performance year)

• Improved the average performance score for patient and caregiver experience in 6 out of 7 measures. These results suggest that Medicare beneficiaries who obtain care from a provider participating in Pioneer ACOs report a positive patient and caregiver experience

JAMA (May 2015) _{study of 600,000 patients assistned to a Pioneer ACO in 2012 or 2013}

• Acute inpatient days per 1000 beneficiary months decreased more for ACOs than for the comparison group in 2012 (−0.05 days [95% CI, −0.065 to −0.039]) and 2013 (−0.02 days [95% CI, −0.029 to −0.004])
• Differences in emergency department visits and inpatient admissions through the emergency department were statistically significant and either decreased more or increased less in 2012 and 2013

PCPCC 2018 Evidence Report

• Reduced costs about $60 per member per month (PMPM) on adults and $20 PMPM on children as compared to eligible members who were not enrolled in an ACC over the same time period.

• In dual eligible beneficiaries this cost savings was about $120 PMPM.

ACC 2014 Annual Report (November 2014)

• The ACC program generated approximately $100 million in gross program savings ($31 million in net savings) in FY2013-2014

• In FY2013-2014, approximately $14 million was reinvested into providers by the program (including incentive payments)

Colorado Legislative Report (November 2013)

• $44 million gross, $6 million net reduction in total cost of care (cost avoidance) for clients enrolled in the ACC Program

Colorado Legislative Report (November 2013)

• Lower rates of exacerbated chronic health conditions such as hypertension (5%) and diabetes (9%) relative to clients not enrolled in the ACC Program

Colorado Legislative Report (November 2013)

• Increased preventive services for individuals with diabetes

ACC 2014 Annual Report (November 2014)

• 8% fewer ER services for adults enrolled in ACC for more than 6 months vs not enrolled
• Fewer readmissions for children and adult ACC members without disabilities vs. non-enrolled
• Use of ER services for ACC members with disabilities was slightly higher than for those not enrolled
• 3% fewer imaging services for ACC members with disabilities (vs. not enrolled)
• 16% fewer imaging services for adult ACC members (vs. not enrolled)
• 12% fewer imaging services for children ACC members (vs. not enrolled)

Colorado Legislative Report (November 2013) _{outcomes relative to a comparison population prior to program implementation:}

• 15-20% reduction for hospital readmissions
• 25% reduction in high cost imaging services 
• Reduction in hospital admissions
  • 9% among members with diabetes
  • 5% among members with hypertension
  • 22% among ACC members with COPD who have been enrolled in the program six months or more, compared to those not enrolled
• Emergency room utilization by ACC enrollees increased 0.9 percentage points less than utilization by those not enrolled in the ACC program, or an increase of (1.9%) for ACC enrollees compared to an increase of (2.8%) for those not enrolled

Anthem Press Release (June 2015) _{Collective results from UC Davis, Sharp Rees-Stealy Medical Group, Sharp Community Medical Group, HealthCare Partners, Sante Community Physicians IPA and SeaView IPA over one year.}

• The ACOs under Enhanced Personal Health Care saved $7.9 million

HealthCare Partners Press Release (June 2014)

• $4.7 million saved in six months

HealthCare Partners Press Release (June 2014)

• Increase in quality measures: 
  • 7.5% Diabetes LDL
  • 3.8% in cholesterol management for patients with heart disease

Results showed an increase of 22.9 per 1,000 PCP visits for high-risk patients.*

Anthem Press Release (June 2015) _{Collective results from UC Davis, Sharp Rees-Stealy Medical Group, Sharp Community Medical Group, HealthCare Partners, Sante Community Physicians IPA and SeaView IPA over one year.}

• 7.3% reduction in inpatent admissions per 1000 patients
• 3.2% reduction in inpatient days per 1000 patients
• 2.3% reduction in outpatient claims per 1000 patients
• 2.2% reduction in outpatient visits per 1000 patients

HealthCare Partners Press Release (June 2014)

• 18% reduction in hospital inpatient days (per 1000 members)
• 4% reduction in inpatient admissions (per 1000 members)
• 4% reduction in outpatient visits, including ER visits (per 1000 members)

Health Services Research (June 2014)

• PSNs reduced expenditures by $135 PMPM for individuals on Supplimental Social Security Income (SSI) compared with non-demonstration sites
• PMPM expenditures for Temporary Assistance for Needy Families (TANF) recipients decresased by $4 PMPM for PSN enrollees and increased $28 for individuals in non-demonstration sites
• The PSN demonstration was successful in bending the cost curve

Department of Health Services Research (March 2011)

• PSNs in demonstration counties had slightly greater levels of enrollee satisfaction with their health care, health plan, personal doctor and specialty care

• A multi-physician practice achieved a 2.6 percent increase, to over 70 percent, in the number of hypertensive patients whose blood pressure was below 140/90.

• A large multi-site practice reported a 15 percent reduction in hospital admissions for its population in its first year of PCMH implementation, accompanied by an increase in primary care visits and revenue.

• Hennepin Health has realized savings and reinvested them in future improvements

Improvements in the quality of care for patients with chronic conditions:

• The percentage of patients receiving optimal diabetes care increased from 8.6 percent in the second half of 2012 to 10 percent in the second half of 2013.
• The percentage of patients receiving optimal vascular care increased from 25.0 percent to 36.1 percent in the same period.
• The percentage of patients receiving optimal asthma care increased from 10.6 percent in the last five months of 2012 to 13.8 percent in the last five months of 2013.

• high patient satisfaction rating: 87 percent of members report that they are satisfied with their care.

In a comparison of data for 2012 (the first year of Hennepin Health) and 2013:

• 9.1 percent reduction in ED visits. (This is likely due in part to the creation of an urgent care center adjacent to the ED, which patients could access for nonemergency care.)
• Hospitalizations remained stable, at approximately 16 per 1,000 member month
• Increase in outpatient visits of 3.3 percent

Blue Shield of California (December 2015)

• achieved more than $325 million in healthcare cost savings in the program’s first five years

Health Affairs Blog (April 2014):

• Overall cost of health care (COHC) savings reported a gross savings of more than $105 million, with net savings of $95 million to CalPERS members, since 2010

Blue Cross Blue Shield Industry Report (2012):

• $15.5 million saved (2010)
• $37 million in savings to CalPERS based on the pilot trend versus non-pilot trend. The parties beat the 2011 cost-of-healthcare target by $8 million, which was shared by the parties. 

Health Affairs (September 2012):

• Health care costs for CalPERS members were $393.08 PMPM in 2010, a 1.6 percent decrease from the 2009 baseline amount. For members not in the organization, costs were $435.94 PMPM, which was a 9.9 percent increase from 2009 for that group

Noteworthy examples include achieving 67% HbA1c testing mong diabetics, with 77% demonstrating control within clinically accepted standards. Additionally, sharpening our focus on women’s health, we set a target of achieving over 76% compliance in breast cancer screening among those due for a mammogram. We achieved 79% compliance.

Blue Shield of California (December 2015)

• reduction hospital admissions by up to 13 percent over the first 5 years
• reduction in hospital bed days by up to 27 percent over the first 5 years

Blue Cross Blue Shield Industry Report (2012):

• 15% reduction in inpatient readmission (2010)
• 15% decrease in inpatient days (2010)
• 50% decrease in inpatient stays of 20 or more days (2010)
• a half-day reduction in average patient length of stay (2010)

Health Affairs (September 2012):

• The thirty-day readmission rate continued to decline, from 4.3 percent in 2010 to 4.1 percent in 2011. Average length-of-stay, which decreased from 4.05 days in 2009 to 3.53 in 2010, increased to 3.74 in 2011 because of a considerable increase in catastrophic cases. But it remained below 2009 levels and was well below that of Northern California CalPERS members who were not in the pilot accountable care organization

Horizon Press Release (August 2015) _{evaluation of 750,000 patients participating in Horizon patient-centered practices}

• 9% lower total cost of care (compared to patients served by traditional practices)

Horizon Industry Report (July 2014) 

• aproximate savings of $4.5 million (due to reduction in ER visits and inpatient hospital amissions)
• 4% lower cost of care for diabetic patients (among all patient-centered practices)
• 4% lower total cost of care (among all patient-centered practices)

Horizon Industry Report (July 2013)

• 9% lower cost of care for diabetic patients

Horizon Press Release (August 2015) _{evaluation of 750,000 patients participating in Horizon patient-centered practices}

• 6% higher rate in improved diabetes control (compared to patients served by traditional practices)
• 7% higher rate in cholesterol management for diabetic patients (compared to patients served by traditional practices)
   

Horizon Industry Report (July 2014) 

• 14% higher rate in improved diabetes control
• 12% higher rate in cholesterol management

Horizon Industry Report (July 2013)

• 5% higher rate in improved diabetes control (HbA1c)

Horizon Press Release (August 2015) _{evaluation of 750,000 patients participating in Horizon patient-centered practices}

• 8% higher rate in colorectal cancer screenings (compared to patients served by traditional practices)
• 3% higher rate in breast cancer screenings (compared to patients served by traditional practices)

Horizon Industry Report (July 2014) 

• 8% higher rate in breast cancer screenings
• 6% higher rate in colorectal screenings

Horizon Industry Report (July 2013)

• 3% higher rate in breast cancer screenings
• 11% higher rate in pneumonia vaccinations

Horizon Press Release (August 2015) _{evaluation of 750,000 patients participating in Horizon patient-centered practices}

• 8% lower rate of hospital admissions (compared to patients served by traditional practices)
• 5% lower rate of ED visits (compared to patients served by traditional practices)

Horizon Industry Report (July 2014) 

• 4% lower rate of Emergency Room visits (among all patient-centered practices)
• 2% lower rate of hospital admissions (among all patient-centered practices)

Horizon Industry Report (July 2013)

• 23% lower rate in hospital inpatient admissions.
• 12% lower rate in Emergency Room (ER) visits.

• Overall Humana's Medicare Advantage ACO reduced costs by 19% 
• Total health care costs were 15% lower vs. original fee-for-service Medicare
• Total health care costs were 4% lower vs. Humana standard Medicare Advantage settings

• Results show that ACO providers under a value-based reimbursement model had an average HEDIS Star score of 4.25 compared with providers not in an ACO, who averaged 3.65.

• 8% increase in providing medication reviews for older patients
• 16% increase in screening osteoporosis management in women with fractures
• 7% increase in colorectal cancer screening
• 5% increase in adult BMI assessment 
• "Other screening compliance improvements included cholesterol control, eye exams and diabetic blood sugar (up 7%), and cholesterol screening for cardiovascular care (up 5%)"

• 7% fewer emergency room visits
• 6% fewer inpatient admissions 

Hartford Courant (July 2014)

• 2% reduction in per person costs
• state distributed $2.4 million in enhanced payments to 15 certified medical homes and 1 hospital outpatient primary care clinic 

Hartford Courant (July 2014)

• children seen in a medical home were 10% more likely to receive recommended EPSDT screenings

Connecticut Department of Social Services Report (FY 2015)

• Achieved an overall member satisfaction rating of 91.1% among adults and 96.1% on behalf of children
• Immediate access to care increased to 92.5% of the time, when requested by adults, and 96.7% of the time, when requested on behalf of children.
• Among a number of measures of courtesy and respect shown to HUSKY members, communication before and during care, PCMH providers were rated overwhelmingly positively by HUSKY members.

• estimated gross savings from 2007 to 2010 of $237 million 
• The rate of estimated annual savings increased about 2% per year to 6.5% in 2010 

• Quality improved significantly for 9 out of 10 metrics

• Most prevention measures show substantial improvements, particularly those with low levels of compliance in 2007 (early in the PCMH intervention)

2012 physician satisfaction survey results: 

• 80.2% agreed or strongly agreed that the IHC Panel Roster helped them manage patients’ care (12.2% reported not using it).
• 67.3% agreed or strongly agreed that IHC Provider Portal provided useful tools such as Claims History and online Panel Rosters (25.3% reported not using them)
• 81.9% agreed or strongly agreed that the mailed Provider Profiles, which featured physicians' quality measures, were useful for quality improvment (10.7% had not seen them)
• 75.2% agreed or strongly agreed that the bonus payment program stimulated quality improvement in their practice (10.6% were unaware of the bonus program). 
• 36.6% agreed or strongly agreed that the IHC Quality Assurance Nurse (academic detailing) service was helpful for understanding their Profile quality measures and how to achieve maxiumum bonus payments (61.8% had not used the Quality Assurance Nurse service). 
• 85.8% agreed or strongly agreed that they would recommend IHC to their colleagues (2.5% strongly diagreed). 

• The adjusted hospitalization rate for IHC-eligible beneficiaries fell by 18.1% between 2006 and 2010
• The bed-day rate fell 15.6% between 2006-2010
• The adjusted ED visit rate decline 5% over the study period
• From 2006 to 2010, the overall Medicaid program also realized substantial reductions in hospitalization (15.1%), bed-day rates (18.6%) and avoidable hospitalizations (19.4%).

• Half of the hospitals participating successfully reduced their medical costs in the first year of the program, determined by customized targets based on historical costs 

• 100 percent of the health systems improved at least one hospital-acquired infection measure or received a top distinction from the Pennsylvania Department of Health for infection control in the first year of program implementation

• Nearly all participants scored better in measures that assess patients’ experience during their hospital stay such as their understanding of information about recovery at home in the first year of program implementation.

• Nearly 90 percent of the participants lowered hospital readmission rates with an average reduction of 16 percent in the first year

American Journal of Managed Care Evaluation (March 2014):

• total medical cost savings of 11.2 percent (2009) in PCMH high-risk group
• total medical cost savings of 7.9 percent (2010) in PCMH high-risk group

IBC Press Release (July 2013):

• diabetic members treated in a medical home practice had 21 percent lower total medical costs, driven by a 44-percent reduction in hospital costs
• Lower emergency room costs were seen after one year
• IBC also found reductions in costs for members with chronic conditions such as coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, asthma, and hypertension

BlueCross BlueShield Industry Report (2008-2011)

Better diabetes care:

• Increased diabetes screenings from 40% to 92%
• 49% improvement in HbA1c levels
• 25% improvement in BP control
• 27% increase in cholesterol control
• 56% increase in patients with self-management goals

Health Services Research (August 2014):

• 5-8% reduction in ED utilization for patients with chronic illness (data review 2008-2012)
• 9.5-12% reduction in ED utilization for patients with Diabetes (data review 2008-2012)

American Journal of Managed Care Evaluation (March 2014):

• 10.8 percent fewer readmissions than control group (2009)
• 8.6 percent fewer readmissions than control group (2010)
• 16.6 percent fewer readmissions than control group (2011)

American Journal of Managed Care Evaluation (March 2014):

• No significant cost or utilization differences for overall population

Minnesota Department of Human Services (June 2015)

• $61.5 million in savings in 2014 for 9 provider groups serving 165,000 Minnesotans
• Based on initial 2014 data, all 9 provider groups were eligible for shared savings

Minnesota Department of Human Services (July 2014)

• $14.8 million in savings for six health care providers serving 100,000 Minnesotans. _{*preliminary data reported 10.5 million in savings, but final numbers determined the amount to be $14.8 million}

Strategies for success: 

• Compliance with the post-discharge follow-up appointments with the PCMH increased from 69% to 90% (p < .001)

• Compliance with both CAC-1 (bronchodilator/reliever medication use) and CAC-2 (systemic corticosteroid use) remained >99% during the entire study
• Compliance with CAC-3 (completion of a home management plan of care) increased from a mean of 74% in stage 1 (Jan 2008 - Sept 2009) to 95% in stage 2 (Oct 2009 - June 2012) of the study (p<.001). 

• In children hospitalized with an acute asthma exacerbation, compliance with asthma core measures and attendance at a discharge follow-up appointment with the PCMH was associated with a 71% reduction in readmission rates at 91 to 180 days post discharge.  Overall, readmission rates were numerically lower post-implementation, but only the 91 to 180 days post-discharge results reached statistical significance.

• Compliance with the post-discharge follow-up appointments with the PCMH increased signifcantly (p<.001) after implementation. Follow-up appointments were 69% during the period from January 1, 2009 through September 30, 2009, and increased to 90% from the period October 1, 2009 through June 30, 2012.

• $1,902,705 in total accrued savings, but program did not save enough to qualify for federal shared savings payment

• For the 2016 performance year, CCPM achieved $4.3 million in total savings for Medicare, with $2.1 million in shared savings returning to CCPM and its member organizations – all of which are federally qualified health centers or critical access and community hospitals who are collectively committed to improving the quality and effectiveness of health care delivery and reducing unnecessary healthcare costs.

In the areas of preventive care and the treatment of at-risk populations with chronic disease, CCPM performed better than the mean performance rate of all participating MSSP ACOs for 14 out of 17 metrics.

CCPM performed well in patient/caregiver experience, which is assessed through random surveys of Medicare members for the 2016 performance year.

• $19,196,823 in accrued savings for performance year 1, and $9,406,443 in earned shared savings payments from federal government 

Improved diabetes management:

• HTN control at 75.1%
• HbA1c>9% at a rate of 16.4%

• An average of 67.3% of patients said they received timely care, appointments, and information

• Exceeded depression screening goal of 82% with 85.2% screening rate
• Breast cancer screening rate at 79.4%
• Adolescent well visit goal of 50% exceeded at 59.8%

Maryland Health Care Commission (December 2013)

• a relative decrease in total other payments (excluding inpatient, outpatient, emergency department, office visits, home health, nursing home, hospice, radiology, and lab).
• only one respondent (a PCMH lead) reported shared savings. The practice recently received $13,000 from the MMPP, which it plans to use to recoup administrative expenses and to develop programs that incentivize staff to meet targeted quality metrics

Journal of Health Care for the Poor and Underserved (February 2014)

• statistically significant improvement in patient access to care (based on survey data)

Maryland Health Care Commission (December 2013)

• a relative increase in the annual rates of well-care visits among adolescent
• an increase in the proportion of patients with one or more office visits to th attributed primary care physician

Maryland Health Care Commission (December 2013)

Patient Satisfaction

• Patients are generally pleased with the care they received from MMPP participating providers.
• Although there were few statistically significant differences, generally the more vulnerable populations (African-American, Medicaid, and patients with chronic conditions) rated their provider or practice more highly.
• For patients with chronic conditions, providers pay attention to their mental health, discuss medication decisions with them, how well providers communicate with patients, and the overall rating of the provider.

Provider Satisfaction

• MMPP providers expressed greater satisfaction in their current job than the comparison group of PCMH providers.
• At MMPP practices, medical assistants and administrative staff are more likely to take responsibility for some duties that clinicians perform in the comparison practices.
• Providers in the MMPP group, however, were more likely to feel that their compensation plans rewarded hard workers and that the business office and administration are valued by the practice.

Maryland Health Care Commission (December 2013)

• Larger decrease in the proportion of young adults with a hospital admission due to asthma

Medical Home Network (December 2014)

• "A decrease in the overall cost of care for each patient since the introduction of the new care model in December of 2012" (for patients served by Esperanza Health Centers)

Medical Home Network (January 2015)

• 145% increase in timely follow-up visits to a primary care physician after hospital discharge, with some months reaching as high as 45.7%. The follow-up care target after hospital discharge is 29 percent (for patients served by La Rabida Children's Hospital in one year)

Medical Home Network (December 2014)

• As high as a 130.4% increase in timely patient follow-up visits (for patients served by Esperanza Health Centers since December 2012)
• "Illinois Medicaid patients who were a part of Medical Home Network's program and visited their assigned primary care physician at Esperanza Health Centers within seven days after being discharged from the hospital or Emergency Department, increased from a 25.3% pre-implementation baseline to as high as 58.3% in certain months (Esperanza's first intervention year averaged a 47.2% follow-up rate)" (for patients served by Esperanza Health Centers since December 2012)

Medical Home Network (January 2015)

• 10.3% decrease in seven-day hospital readmissions (for patients served by La Rabida Children's Hospital in one year)

Medical Home Network (December 2014)

• 25% decrease in 30-day hospital readmissions (for patients served by Esperanza Health Centers since December 2012)

• In 2012, previously undiagnosed conditions were diagnosed and preventative screening rates increased dramatically due to a 95% participation rate in the annual physical 

• 88% satisfaction rating among Direct Care Health Plan members in 2013

University of Minnesota Evaluation (February 2016) _{report evaluated the program from July 2010- December 2014}

• Overall spending on medical services for Medicaid, Medicare and Dual Eligible beneficiaries in HCHs was approximately $1 billion less than if those patients had been attributed to a non-HCH settings
• Overall, medical costs for enrollees who could be attributed to a HCH clinic were 9% less than enrollees at non-HCH clinics.
  • This is primarily due to lower spending for inpatient hospital admissions, hospital outpatient visits, and pharmacy.

Minnesota Department of Health (January 2014):

• Medicaid HCH enrollees had 9.2% lower costs than Medicaid enrollees in non-HCH clinics

HealthPartners Industry Report (2009):

• 20% reduction in inpatient costs
• Outpatient cost savings of $1

University of Minnesota Evaluation (February 2016) _{report evaluated the program from July 2010- December 2014}

• Using Statewide Quality Reporting and Measurement System (SQRMS) data, HCH clinics had better quality of care for Diabetes, Vascular, Asthma (for children and adults), Depression, and Colorectal Cancer screening.
• Using Medicare and Medicaid data, both number of hospital admissions and the length of hospital stays showed modest benefits that were significant among Medicaid enrollees, but non-significant among Medicare and Dual Eligible enrollees.

Minnesota Department of Health (January 2014):

• Improved colorectal cancer screenings, asthma care, diabetes care, vasucal care and follow up care for depression

Minnesota Department of Health (January 2014):

• Increased access to HCHs across all regions in 2013

University of Minnesota Evaluation (February 2016) _{report evaluated the program from July 2010- December 2014}

• Patient experience, as measured by the 2013 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, was positive across both HCH and non-HCH clinics, with little differences between the two. However, Communication with one’s doctor showed a significant, but small, benefit for HCH clinics.

University of Minnesota Evaluation (February 2016) _{report evaluated the program from July 2010- December 2014}

• While Health Care Homes saw an increase in emergency department and skilled nursing home use relative to non-Health Care Homes, they also saw major decreases in the use of hospital services, which was the primary driver of cost savings.

HealthPartners Industry Report (2009):

• 39% fewer ER visits
• 24% fewer hospital admissions
• 40% reduction in readmission rates
• 30% reduction in length of stay

• Monarch cut medical costs by 5.4% in 2012 from its baseline, which looks at the last three years of medical expenses, while national medical costs grew by 1.1% for a comparable population
• This favorable expense trend was driven primarily by reductions in hospital admissions and skilled nursing facilities utilization and unit costs

• 7% savings in the first year
• gross savings of more than $96 million in the second year, compared to $87.6 million in 2012

• Montefiore’s ACO made great strides in improving quality performance in key areas like depression screening and screening for risk of future falls.

• 14% increase in primary care visits

• 23% decrease in hospital admissions and emergency room visits