Dr. Nwando Olayiwola, Associate Director, Center for Excellence in Primary Care, Assistant Professor, University of California, San Francisco addresses the 2014 Weitzman Symposium on The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Review of Evidence

1. CHCI Weitzman symposium May 2014
J. Nwando Olayiwola, MD, MPH, FAAFP
Associate Director, Center for Excellence in Primary Care
Assistant Professor, Department of Family & Community Medicine
University of California, San Francisco
The Patient-Centered Medical Home’s
Impact on Cost and Quality: A Review
of the Evidence from 2012-2013

3. Authors
Marci Nielsen, PhD, MPH
Chief Executive Officer, PCPCC
J. Nwando Olayiwola, MD, MPH, FAAFP
Associate Director, Center for Excellence in Primary Care; Assistant Professor,
Department of Family and Community Medicine, University of California, San Francisco
Paul Grundy, MD, MPH
President, PCPCC; Global Director, Healthcare Transformation, IBM
Kevin Grumbach, MD
Professor and Chair, Department of Family and Community Medicine; University of
California, San Francisco
Lisa Dulsky Watkins, MD
Former Associate Director, Vermont Blueprint for Health

4. Reviewers
Melinda Abrams, MS
Vice President, Health Care Delivery System Reform; The Commonwealth Fund
Asaf Bitton, MD, MPH
Instructor, Division of General Medicine, Brigham and Women's Hospital; Instructor, Department
of Health Care Policy, Harvard Medical School
Mark Gibson
Director, Center for Evidence-Based Policy; Oregon Health & Science University
Bruce Landon, MD, MBA, MSc
Professor of Health Care Policy, Harvard Medical School; Professor of Medicine, Division of General
Medicine and Primary Care; Beth Israel Deaconess Medical Center
Len Nichols, PhD
Director, Center for Health Policy Research and Ethics; George Mason University
Kavita Patel, MD
Managing Director for Clinical Transformation and Delivery; Engelberg Center for Health Care
Reform; Fellow, Economic Studies The Brookings Institution
Mary Takach, MPH, RN
Senior Program Director; National Academy for State Health Policy

5. Take Home Points
PCMH evaluations over the past year reported
significant improvements across a broad range
of clinical and financial outcomes
The PCMH is playing an increasingly critical role
in delivery system reform, including ACOs and
the medical neighborhood
Significant payment reforms continue to
incorporate the PCMH

6. The Landscape: PCMH Momentum

7. NCQA Recognized PCMH By State –
12/31/10
Source: Analysis by the National Committee for Quality Assurance, Dec. 2010.

8. NCQA-Recognized Practices Across the
United States
ME
VT
RI
NJ
MD
MA
DE
NY
WA
OR
AZ
NV
WI
NM
NE
MN
KS
FL
CO
IA
NC
MI
PA
OH
VAMO
HI
OK
GA
SC
TN
MT
KY
WV
AR
LA
AL
INIL
SD
ND
TX
ID
WY
UT
AK
CA
CT
NH
MS
61–200 sites
21–60 sites
0 sites
1–20 sites
201+ sites
Source: Analysis by the National Committee for Quality Assurance, Oct. 2012.
4,937 sites & 23,396 clinicians as of 10/31/2012

9. PCMH Recognized Physicians and Sites:
Growth Over Time

10. National Imperative: Triple Aim
Source : Berwick, Donald M., Thomas W. Nolan, and John Whittington. "The triple aim: care, health, and cost." Health Affairs
27.3 (2008): 759-769.

11. Methods
• Examined medical home/PCMH studies published
between August 2012 and December 2013
– Peer-reviewed scholarly articles
– Industry reports
• Explored relationship between “medical
home/PCMH” model of care and Triple Aim
outcomes
– Predictor variable: “Medical home” or “PCMH”
– Outcome variables: Cost & utilization; care experience
(access & patient satisfaction); health outcomes
(population health & preventive services)
• Resulted in 13 peer reviewed (academic) studies,
and 7 industry reports

12. 13 Peer-Reviewed (Academic) Studies
• Alaska Southcentral Foundation
• Colorado Multi-Payer PCMH Pilot
• BlueCross BlueShield Michigan
• Military Health System
• Veterans Health Administration
• New Hampshire Citizens Health Initiative
• Horizon BlueCross BlueShield
• EmblemHealth – New York
• WellPoint - New York
• UPMC Health Plan
• Rhode Island Chronic Care Sustainability Initiative
• University of Utah
• Group Health Cooperative

13. • BlueCross BlueShield Alabama
• Connecticut Health Enhancement Program
• Horizon Blue Cross Blue Shield
• BlueCross BlueShield Michigan
• CareFirst BlueCross BlueShield
• Oregon Coordinated Care Organizations
• Highmark PCMH Pilot
7 Industry generated Reports

14. Key Point #1:
PCMH evaluations report
improvements across a broad range
of clinical and financial outcomes

15. PCMH Peer ReviewedPeer Reviewed Outcomes

16. PCMH Industry GeneratedIndustry Generated Outcomes

17. Key Point #2:
PCMHs play a critical role in delivery
system reform, including ACOs and the
medical neighborhood

18. Public
Health
Employers
Schools
Faith-Based
Organizations
Community
Centers Home
Health Hospital
Pharmacy Diagnostics
Specialty &
Subspecialty
Patient-Centered
Medical Home
Community
Organizations
Connected via
Health IT
$
$
PCMH: Foundation to ACOs & the Medical
Neighborhood

19. Emerging Trends

20. ACO Climate and Opportunities

21. ACO Growth Over Time
Source: Muhlestein D. Accountable Care Growth in 2014: A Look Ahead. Health Affairs Blog. January 2014

22. ACOs by Sponsoring Entity
Source: Muhlestein D. Accountable Care Growth in 2014: A Look Ahead. Health Affairs Blog. January 2014

23. Estimated ACO Lives 2014
Source: Muhlestein D. Accountable Care Growth in 2014: A Look Ahead. Health Affairs Blog. January 2014

24. Key Point #3:
Significant payment reforms continue
to incorporate the PCMH

25. Payment Reform Drivers – Making the Case

26. Policy Influences
Sustainable Growth Rate
(SGR)
• “Volume to Value”
• Federal legislation = long term
adoption
• Encourages more providers to
accept risk-based payments (5%
Medicare increase)
• Repeal calls for PCMH as
supportive framework
• Will lead to broader acceptance
of PCMH and ACOs
State Medicaid Activity and
Expansions
• “Volume to Value”
• State based = short term
adoption
• Oregon and Utah pioneers in
state Medicaid ACO
• Providers bear some risk while
meeting quality benchmarks
• State based reimbursements for
PCMH recognition important
driver

27. Payment Reforms
Source: S. Guterman, M. Zezza, C. Schoen, Paying for Value: Replacing Medicare's Sustainable Growth Rate Formula
with Incentives to Improve Care, The Commonwealth Fund, March 2013.

28. Private Sector Reforms
• Commercial health plans moving from traditional
fee-for-service models
• Transition from PCMH “demonstrations” to standard
business operations
– Incentives for primary care
– PCMH incentives
– Care coordination reimbursements
– PMPM add ons

29. Overview of Medicaid Medical Home Activity
42 State Medicaid/CHIP Programs Planning/Implementing PCMH
27 Making Medical Home Payments
Source: National Academy for State Health Policy State Scan, October 2012, http://www.nashp.org/med-home-map.
WA
OR
TX
CO
NC
LA
PA
NY
IA
VA
NE
OK
RI
AL
MD
MT
ID
KS
MN
MA
ME
AZ
VT
MOCA
WY
NM
IL
WI
MI
WV
SC
GA
FL
HI
UT
NV
ND
SD
AR
IN
OH
KY
TN
MS
AK
Significant activity for Medicaid/CHIP PCMH advancement (15 states)
No PCMH Medicaid activity (8 states)
States making payments for PCMH (27 states)
NJ
DE
NH
CT

30. Overview of Medicaid Medical Home Activity
47 State Medicaid/CHIP Programs Planning/Implementing PCMH
30 Making Medical Home Payments, 22 Involved in Multi-payer Pilots
WA
OR
TX
CO
NC
LA
PA
NY
IA
VA
NE
OK
RI
AL
MD
MT
ID
KS
MN NH
MA
ME
AZ
VT
MOCA
WY
NM
IL
WI
MI
WV
SC
GA
FL
HI
UT
NV
ND
SD
AR
IN
OH
KY
TN
MS
AK
Significant activity for Medicaid/CHIP PCMH advancement (26 states + DC)
Medicaid multi-payer activity/involvement (22 states)
States making payments for PCMH (30 states)
NJ
DE
Source: National Academy for State Health Policy State Scan, May 2014, http://www.nashp.org/med-home-map.
CT
DC

31. WA
OR
TX
CO
NC
LA
PA
NY
IA
VA
NE
OK
AL
MD
MT
ID
KS
MN
ME
AZ
VT
MOCA
WY
NM
IL
WI
MI
WV
SC
GA
FL
HI
UT
NV
ND
SD
AR
IN
OH
KY
TN
MS
AK
National Momentum: Spread of Medical Homes
At Least One Payer in 49 States Testing PCMH
Multi-payer payment (22 states)
Identified pilot activity (49 states)
No identified pilot activity (1 state)
Source: Patient Centered Primary Care Collaborative and National Academy for State Health Policy, updated May 2014
DE
NH
RI
MA
CT
NJ

32. The Year in Review:
Case Study Snapshots

33. Veterans Health
Administration
Patient Aligned Care Team
• Optimize workflow and
coordinate care through the use
of an interprofessional “teamlet”
model
• Enact advanced scheduling, such
as same-day appointments
• Add phone consults and group
appointments
1. PCMH studies continue to demonstrate impressive improvements
range of categories including: cost, utilization, population health
access to care, and patient satisfaction, while a gap still exists in
on clinician satisfaction.
• Decreases in the cost of care,
PEER-REVIEW/ACADEMIA
61% 61% 31% 13% 31% 31%
57% 57% 57% 29% 29% 14%
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
PopulationHealth
Improved
Access
INDUSTRY REPORTS
(n= 13)
(n= 8) (n= 4) (n= 1) (n= 4) (n= 4)
(n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1)
Total
Studies
(n= 7)
(n= 8)
Reported
outcomes
Reported
outcomes
udies continue to demonstrate impressive improvements across a broad
categories including: cost, utilization, population health, prevention,
o care, and patient satisfaction, while a gap still exists in reporting impact
an satisfaction.
EMIA
61% 61% 31% 13% 31% 31% 31%
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
PopulationHealth
Improved
Access
Improvement in
Satisfaction
IncreaseinPreventive
Services
S
= 13)
(n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4)
23%
(n= 3)
otal
udies
(n= 8)
1. PCMH studies continue to demonstrate impressive improvements across a
range of categories including: cost, utilization, population health, prevent
access to care, and patient satisfaction, while a gap still exists in reportin
on clinician satisfaction.
PEER-REVIEW/ACADEMIA
61% 61% 31% 13% 31% 31% 31%
57% 57% 57% 29% 29% 14% 29%
Cost
Reductions FewerEDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
PopulationHealth
Improved
Access
IncreaseinPrevent
Services
INDUSTRY REPORTS
(n= 13)
(n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4)
(n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2)
Total
Studies
(n= 7)
(n= 8)
Reported
outcomes
Reported
outcomes
National program
5 million patients
ResultsPCMH Strategies
• 8% fewer urgent
care visits
• 4% fewer inpatient
admissions
• Decrease in face-to-face visits
• Increase in phone encounters,
personal health record use,
and electronic messaging to
providers
Source: Rosland, A.M., Nelson, K., Sun, H., Dolan, E.D., Maynard, C., Bryson, C.,
Stark, R., Schectman, D., (2013). The Patient-Centered Medical Home in the Veterans
Health Administration. American Journal of Managed Care. 1-4.

34. BlueCross BlueShield of
Michigan Physician Group
Incentive Program
Michigan
3 million patients
ResultsPCMH Strategies
• 13.5% fewer pediatric
ED visits
• 10% fewer adult ED
visits
• 17% fewer inpatient
admissions
• 6% fewer hospital
readmissions
1. PCMH studies continue to demonstrate impressive improvement
range of categories including: cost, utilization, population healt
access to care, and patient satisfaction, while a gap still exists i
on clinician satisfaction.
• Decreases in the cost of care,
PEER-REVIEW/ACADEMIA
61% 61% 31% 13% 31% 31%
57% 57% 57% 29% 29% 14%
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
PopulationHealth
Improved
Access
INDUSTRY REPORTS
(n= 13)
(n= 8) (n= 4) (n= 1) (n= 4) (n= 4)
(n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1)
Total
Studies
(n= 7)
(n= 8)
Reported
outcomes
Reported
outcomes
1. PCMH studies continue to demonstrate impressive improvements across
range of categories including: cost, utilization, population health, preven
access to care, and patient satisfaction, while a gap still exists in reporti
on clinician satisfaction.
PEER-REVIEW/ACADEMIA
61% 61% 31% 13% 31% 31% 31%
57% 57% 57% 29% 29% 14% 29%
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
PopulationHealth
Improved
Access
IncreaseinPrev
Services
INDUSTRY REPORTS
(n= 13)
(n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4)
(n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2)
Total
Studies
(n= 7)
(n= 8)
Reported
outcomes
Reported
outcomes
1. PCMH studies continue to demonstrate impressive improvements across a broad
range of categories including: cost, utilization, population health, prevention,
access to care, and patient satisfaction, while a gap still exists in reporting impac
on clinician satisfaction.
PEER-REVIEW/ACADEMIA
61% 61% 31% 13% 31% 31% 31%
Cost
Reductions FewerEDVisits
FewerInpatient
Admissions
Fewer
Readmissions
Improvementin
PopulationHealth
Improved
Access
Improvement
Satisfaction
IncreaseinPreventive
Services
INDUSTRY REPORTS
(n= 13)
(n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4)
23%
(n= 3)
Total
Studies
(n= 8)
Reported
outcomes
1. PCMH studies continue to demonstrate impressive imp
range of categories including: cost, utilization, popula
access to care, and patient satisfaction, while a gap s
on clinician satisfaction.
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvem
Population
Total
Studies
• Savings of $26.37 PMPM
• $155 million in cost
savings
Source: Blue Cross Blue Shield of Michigan. Patient-Centered Medical Home
Fact Sheet. July 2013. Retrieved from http://www.valuepartnerships.com/wp-
content/uploads/2013/07/2013-PCMH-Fact-Sheet.pdf.
• Develop patient registries to track
and monitor patients’ care
• Offer 24-hour patient access to a
clinical decision-maker through
• extended office hours
• telephone access
• a linkage to urgent care
• Provide online patient resources that
allow for electronic communication
and greater patient access to medical
information

35. UPMC Health Plan Medical
Home Pilot
Pennsylvania
23,390 patients
ResultsPCMH Strategies
• 2.6% reduction in total costs
• 160% ROI
• 2.8% fewer inpatient
admission
• 6.6% increase in patients
with controlled HbA1c
1. PCMH studies continue to demonstrate impressive improvements across a broad
range of categories including: cost, utilization, population health, prevention,
access to care, and patient satisfaction, while a gap still exists in reporting impa
on clinician satisfaction.
• Decreases in the cost of care,
• Reductions in the use of unnecessary or avoidable services,
PEER-REVIEW/ACADEMIA
61% 61% 31% 13% 31% 31% 31%
57% 57% 57% 29% 29% 14% 29%
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
PopulationHealth
Improved
Access
Improveme
Satisfact
IncreaseinPreventive
Services
INDUSTRY REPO RTS
(n= 13)
(n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4)
(n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2)
23%
14%
(n= 3
(n= 1
Total
Studies
(n= 7)
(n= 8)
Reported
outcomes
Reported
outcomes
PAGE 6
1. PCMH studies continue to demonstrate impressive improveme
range of categories including: cost, utilization, population he
access to care, and patient satisfaction, while a gap still exist
on clinician satisfaction.
• Decreases in the cost of care,
• Reductions in the use of unnecessary or avoidable services,
PEER-REVIEW/ACADEMIA
61% 61% 31% 13% 31% 31
57% 57% 57% 29% 29% 14
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
PopulationHealth
Imp
Ac
INDUSTRY REPO RTS
(n= 13)
(n= 8) (n= 4) (n= 1) (n= 4) (n
(n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n
Total
Studies
(n= 7)
(n= 8)
Reported
outcomes
Reported
outcomes
1. PCMH studies continue to demonstrate impressive improvements across a broad
range of categories including: cost, utilization, population health, prevention,
access to care, and patient satisfaction, while a gap still exists in reporting impact
on clinician satisfaction.
PEER-REVIEW/ACADEMIA
61% 61% 31% 13% 31% 31% 31%
57% 57% 57% 29% 29% 14% 29%
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
PopulationHealth
Improved
Access
Improvement in
Satisfaction
IncreaseinPreventive
Services
INDUSTRY REPORTS
(n= 13)
(n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4)
(n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2)
23%
14%
(n= 3)
(n= 1)
Total
Studies
(n= 7)
(n= 8)
Reported
outcomes
Reported
outcomes
CMH studies continue to demonstrate impressive improvements across a broad
ange of categories including: cost, utilization, population health, prevention,
ccess to care, and patient satisfaction, while a gap still exists in reporting impact
n clinician satisfaction.
EVIEW/ACADEMIA
61% 61% 31% 13% 31% 31% 31%
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
PopulationHealth
Improved
Access
Improvement in
Satisfaction
IncreaseinPreventive
Services
TRY REPORTS
(n= 13)
(n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4)
23%
(n= 3)
Total
Studies
(n= 8)
ted
mes
1. PCMH studies continue to demonstrate impressive improvements across a broad
range of categories including: cost, utilization, population health, prevention,
access to care, and patient satisfaction, while a gap still exists in reporting impact
on clinician satisfaction.
PEER-REVIEW/ACADEMIA
61% 61% 31% 13% 31% 31% 31%
57% 57% 57% 29% 29% 14% 29%
Cost
Reductions Fewer EDVisits
FewerInpatient
Admissions
Fewer
Readmissions
Improvement in
PopulationHealth
Improved
Access
Improvement in
Satisfaction
IncreaseinPreventive
Services
INDUSTRY REPORTS
(n= 13)
(n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4)
(n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2)
23%
14%
(n= 3)
(n= 1)
Total
Studies
(n= 7)
(n= 8)
Reported
outcomes
Reported
outcomes
• 18.3% fewer hospital
readmissions
• 23.2% increase in eye exams
• 9.7% increase in LDL
screenings
• Practice-based nurses provide care
management
• Create telehealth options for care
managers to connect to patients
when in-office visits are not
possible or necessary
• Offer incentives to payers to enter
into PCMH contracts
Source: Rosenberg, C.N., Peele, P., Keyser, D., McAnallen, S., & Holder, D.
(2012) Results from a patient-centered medical home pilot at UPMC Health
Plan hold lessons for broader adoption of the model. Health Affairs. 31(11).

36. CareFirst BlueCross
BlueShield Maryland
Maryland
1 million patients
ResultsPCMH Strategies
• $98 million in total cost
savings
• 4.7% lower costs for
physicians that received an
incentive award
1. PCMH studies continue to demonstrate impres
range of categories including: cost, utilization
access to care, and patient satisfaction, while
on clinician satisfaction.
PEER-REVIEW/ACADEMIA
61% 61% 31% 13%
57% 57% 57% 29%
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissi
INDUSTRY REPO RTS
(n= 13)
(n= 8) (n= 4) (n= 1
(n= 4) (n= 4) (n= 4) (n= 2
Total
Studies
(n= 7)
(n= 8)
Reported
outcomes
Reported
outcomes
ontinue to demonstrate impressive improvements across a broad
ories including: cost, utilization, population health, prevention,
and patient satisfaction, while a gap still exists in reporting impa
isfaction.
61% 61% 31% 13% 31% 31% 31%
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
PopulationHealth
Improved
Access
Improveme
Satisfact
IncreaseinPreventive
Services
(n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4)
23%
(n= 3(n= 8)
• 3.7% higher quality scores
for panels that received
incentives
• Quality scores for PCMH
panels rose by 9.3% from
2011 to 2012
Source: CareFirst Blue Cross Blue Shield. Patient-centered medical home program trims expected health care
costs by $98 million in second year. Press Release, June 2013. Retrieved from
https://member.carefirst.com/wps/portal/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hLbzN_Q09LYwN
• Use local care coordination
teams to track high-risk
members
• Create an infrastructure for
nursing support, easily-
accessible online tools and data,
and targeted health programs
• Offer increased reimbursements
to physicians based on
performance in the program

37. Oregon Health Authority
Coordinated Care
Organizations (CCOs)
Statewide Medicaid program
600,000 patients
ResultsPCMH Strategies
• 9% reduction in ED visits
• 14-29% fewer ED visits for
chronic disease patients
• 12% fewer hospital
readmissions
• 18% reduction in ED visit
spending
• Reduced per capital health
spending growth by >1%
1. PCMH studies continue to demonstrate impressive improvements
range of categories including: cost, utilization, population health
access to care, and patient satisfaction, while a gap still exists in
on clinician satisfaction.
• Decreases in the cost of care,
PEER-REVIEW/ACADEMIA
61% 61% 31% 13% 31% 31%
57% 57% 57% 29% 29% 14%
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
PopulationHealth
Improved
Access
INDUSTRY REPORTS
(n= 13)
(n= 8) (n= 4) (n= 1) (n= 4) (n= 4)
(n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1)
Total
Studies
(n= 7)
(n= 8)
Reported
outcomes
Reported
outcomes
1. PCMH studies continue to demonstrate impressive improvements across a broad
range of categories including: cost, utilization, population health, prevention,
access to care, and patient satisfaction, while a gap still exists in reporting impact
on clinician satisfaction.
PEER-REVIEW/ACADEMIA
61% 61% 31% 13% 31% 31% 31%
57% 57% 57% 29% 29% 14% 29%
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvement in
PopulationHealth
Improved
Access
Improvement in
Satisfaction
IncreaseinPreventive
Services
INDUSTRY REPORTS
(n= 13)
(n= 8) (n= 4) (n= 1) (n= 4) (n= 4) (n= 4)
(n= 4) (n= 4) (n= 4) (n= 2) (n= 2) (n= 1) (n= 2)
23%
14%
(n= 3)
(n= 1)
Total
Studies
(n= 7)
(n= 8)
Reported
outcomes
Reported
outcomes
1. PCMH studies continue to demonstrate impressive impr
range of categories including: cost, utilization, populat
access to care, and patient satisfaction, while a gap st
on clinician satisfaction.
PEER-REVIEW/ACADEMIA
61% 61% 31% 13% 31%
Cost
Reductions Fewer EDVisits
Fewer Inpatient
Admissions
Fewer
Readmissions
Improvemen
PopulationHe
(n= 13)
Total
Studies
Reported
outcomes
Source: Oregon Health Authority. (2013). Oregon’s Health System
Transformation: Quarterly Progress Report. Retrieved from
http://www.oregon.gov/oha/Metrics/Documents/report-november-2013.pdf.
• Establish a primary care
infrastructure that includes 450
PCMH practices and clinics
• Increase the use of outpatient care to
promote prevention
• Increase well-care visits to
adolescents to reduce unnecessary
ED visits
• Provide follow-up care to patients
within 7 days of being discharged

38. The Challenge of Studying the PCMH:
The Right Metrics?
• Right metrics?
– Gap in clinician satisfaction measures – tied to
workforce needs
– Need for better/more patient satisfaction measures
of self-reported health status/well-being
– Measures need to account for patient diversity,
socioeconomics and social determinants of health
– Need for standard core measures – including
behavioral health and oral health integration
– Stronger case for connection to health equity

39. • Right methods?
– Study designs appropriate for investigating
complexity of health system reforms
– Recognition that the model/philosophy is evolving
– Evaluation often in the midst of multimodal
change processes
Source: Grumbach, Kevin. "The Patient-Centered Medical Home Is Not a Pill: Implications for Evaluating Primary Care
Reforms." JAMA internal medicine 173.20 (2013): 1913-1914.
The Challenge of Studying the PCMH: The Right
Methods?

40. Take Home Points
PCMH evaluations over the past year reported
significant improvements across a broad range
of clinical and financial outcomes
The PCMH is playing an increasingly critical role
in delivery system reform, including ACOs and
the medical neighborhood
Significant payment reforms continue to
incorporate the PCMH

41. Thank You!
Contact:
J. Nwando Olayiwola, MD, MPH, FAAFP
Associate Director, Center for Excellence in Primary Care
University of California, San Francisco
OlayiwolaJ@fcm.ucsf.edu
Twitter: @DrNwando
(415) 206-2970 (O)