National Demonstration Projects & State Initiatives
This page hosts information and links related to multi-payer (private and public) demonstration projects and various medical home initiatives across the country that are piloting the medical home model.
Catalogue of Federal Patient-Centered Medical Home (PCMH) Activities
Agency for Healthcare Research and Quality (AHRQ)
The catalogue summarizes the PCMH-related work and collaborations of departments and agencies participating in a federal PCMH collaborative. In addition to the catalogue, the Web site contains the AHRQ definition of the PCMH, white papers on care coordination and the medical neighborhood, decision makers’ briefs on health IT and patient engagement, and a searchable database of articles relating to the PCMH.
Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration 
Maine, Vermont, Rhode Island, New York, Pennsylvania, North Carolina, Michigan, and Minnesota will participate in the MAPCP Demonstration that will include up to approximately 1,200 medical homes serving up to one million Medicare beneficiaries. This demonstration will evaluate whether the APCP, when supported by Medicare, Medicaid, and private health plans, will:
- Reduce unjustified variation in utilization and expenditures;
- Improve the safety, effectiveness, timeliness, and efficiency of health care;
- Increase the ability of beneficiaries to participate in decisions concerning their care;
- Increase the availability and delivery of care that is consistent with evidence-based guidelines in historically underserved areas; and
- Reduce unjustified variation in utilization and expenditures under the Medicare program.
All major payers in the states or proposed regions (Medicare, Medicaid, as well as a significant representation of the large private insurers/managed care organizations) will be participating, thereby assuring the availability of sufficient resources to the primary care practice for implementation of the advanced primary care model.
The Safety Net Medical Home Initiative
In May 2008, The Commonwealth Fund, Qualis Health and the MacColl Institute for Healthcare Innovation at the Group Health Research Institute initiated a demonstration project to help safety net primary care clinics become high-performing patient-centered medical homes (PCMHs). The goal of the Safety Net Medical Home Initiative is to develop a replicable and sustainable implementation model for medical home transformation.Five Regional Coordinating Centers were selected to participate in the demonstration project, and each partnered with 12-15 safety net clinics in their state. The work of the Regional Coordinating Centers began in April 2009 and the Initiative will continue through April 2013.
- Video—Safety Net Medical Home Initiative
The Commonwealth Fund is sponsoring a five-year demonstration program to help 65 low-income or safety net clinics in five states transform into patient-centered medical homes. Three years into the program, administrators and participants discuss their progress thus far in this video.
Children’s Health Insurance Program Reauthorization Act (CHIPRA) Grants
In February 2010, Health and Human Services awarded 10 states, representing single-state projects and multi-state collaborations, with grant funds to improve health care quality and delivery systems for children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The grants, which will be awarded over a five-year period, were funded by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). The money will help states implement and evaluate provider performance measures and utilize health information technologies such as pediatric electronic health records and other quality improvement initiatives. Click here for more information about CHIPRA Children's Health Care Quality Measurement and Improvement Activities.
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CHIPRA Pediatric Quality Measures Program (PQMP)
The PQMP is intended to increase the portfolio of evidence-based, consensus pediatric quality measures available to public and private purchasers of children's health care services, providers, and consumers. The work of the PQMP will culminate in the annual posting of improved core sets of children's health care quality measures for voluntary use by State Medicaid and CHIP programs, private sector insurers, providers, families, and patients beginning on January 1, 2013.
Consortium to Advance Medical Homes for Medicaid and CHIP Participants
In 2009, the National Academy for State Health Policy (NASHP) created the Consortium to Advance Medical Homes for Medicaid and Children's Health Insurance Program (CHIP) Participants, which is comprised of eight state teams (Alabama, Iowa, Kansas, Maryland, Montana, Nebraska, Texas, and Virginia). These states worked together during this one-year program, with the support of NASHP through a grant from The Commonwealth Fund, to develop and implement policies that increase Medicaid and CHIP program participants' access to high performing medical homes.
In March 2011, fifteen states joined NASHP's 3rd State Consortium to Advance Medical Homes in Medicaid and CHIP, supported by The Commonwealth Fund. Alabama, Colorado, Maryland, Massachusetts, Michigan, Minnesota, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, Vermont and Washington will continue the progress made in the first two Medical Home consortia by engaging each other in learning communities designed to strengthen, sustain and expand current initiatives. NASHP monitors state efforts to advance medical homes for Medicaid and CHIP participants and describes them on their Web site's medical home state map.
Healthy Tomorrows Partnership for Children
The federal Maternal and Child Health Bureau (MCHB) awarded nine new five-year Healthy Tomorrows grants on March 1, 2010. These five-year grants provide approximately $50,000 per year to improve child health through community-based initiatives on prevention and access to health service for vulnerable populations. These projects focus on various topics, such as oral health, obesity, mental health, and school health. For full project summaries and contact information, click here.
National Asthma Control Initiative (NACI) Demonstration Projects (2012-2013)
The National Heart, Lung, and Blood Institute’s NACI has announced funding of 13 demonstration projects across the US, aimed to develop, implement, and test science-based approaches to improve asthma control using evidence-based national guidelines for diagnosis and managing asthma. Additionally, the NACI Web site hosts a variety of tools for health care professionals related to diagnosis and treatment of asthma.
State Implementation Grants/D70 Grantees
State Implementation Grants for Integrated Community Systems for Children with Special Needs are funded by the Health Resources and Services Administration (HRSA) under two funding cycles: 12 grants have a funding cycle ending in 2011, while six grants have a funding cycle ending in 2012. The purpose of this initiative is to support statewide implementation of inclusive community based systems of services for children and youth with special health care needs as defined by the following components: family professional partnership, comprehensive health care through a medical home, access to adequate health insurance, early and continuous screening, organization of community services for easy use by families, and transition to adult health care work and independence.
Building Medical Homes: Lessons from Eight States with Emerging Programs
The Commonwealth Fund—December 2011
This report discusses the progress and experiences of eight states (Alabama, Iowa, Kansas, Maryland, Montana, Nebraska, Texas, and Virginia) that are at various stages of implementing a medical home program.
Building Medical Homes: Lessons from Eight States with Emerging Programs
The Commonwealth Fund—December 2011
This report discusses the progress and experiences of eight states (Alabama, Iowa, Kansas, Maryland, Montana, Nebraska, Texas, and Virginia) that are at various stages of implementing a medical home program.
The Commonwealth Fund: A Nationwide Survey of Patient-Centered Medical Home Demonstration Projects
The medical home has been promoted by many experts as a model for delivering comprehensive, coordinated, patient-centered health care. This survey has been derived from interviews with leaders at 26 demonstration sites around the country where the patient-centered medical home is being pilot-tested about payment structure, practice transformation, practice requirements, and other characteristics, researchers found substantial diversity in terms of size, scope, and design. Most of the projects use a payment approach that combines fee-for-service payments with a fixed, monthly case management fee and bonuses based on clinical performance. Future research should focus on evaluation plans, as interest in the model grows.
Evaluating the Patient-Centered Medical Home—Potential and Limitations of Claims-Based
Data
National Academy for State Health Policy (NASHP)—September 2010
This brief summarizes the advantages and disadvantages of using claims-based data to evaluate patient-centered medical home initiatives. A Medicaid-based medical home initiative in Oklahoma and a multi-payer medical home pilot in Rhode Island are highlighted. Both states are using a mixture of claims-based data and supplementary resources like patient or provider surveys and data collected from electronic medical records to evaluate their medical home programs. Understanding the potential uses and limitations of both claims data and other data sources that can aid evaluators will help states to design appropriate evaluative criteria for their medical home programs.
Fast Facts on Primary Care Practice Support Systems In Select States
National Academy for State Health Policy (NASHP), 2012
This matrix provides an overview of six state projects that help providers deliver high-powered primary care and discusses how the teams, pods, and networks support practices, draw on federal health reform resources, and much more.
Making Connections: Medicaid, CHIP, and Title V Working Together on State Medical Home Initiatives
National Academy for State Health Policy (NASHP)—September 2010
Several of the most promising state medical home initiatives have entailed interagency collaboration. This report details productive practices and policy considerations for collaborative medical home building in four areas: laying foundations for partnership, and then working together to engage patients and families, engage health care providers and practices, and build strong systems of care.
State Multi-Payer Medical Home Initiatives and Medicare’s Advanced Primary Care Demonstration
National Academy of State Health Policy (NASHP)—February 2010
This report builds from a December 2009 research scan and webcast that looks at a broad range of state multi-payer initiatives and compares some of these criteria against the proposed APC criteria.
Implementing Patient-Centered Medical Home Pilot Projects, Lessons from AF4Q Communities
Robert Wood Johnson Foundation
This brief is the first in a series of updates from the Aligning Forces for Quality (AF4Q) Ambulatory Quality Network, a peer learning network designed help communities build the infrastructure for ongoing improvement in primary care. Launched in early 2010, the Network consists of peer-to-peer learning groups, online resources, and direct technical assistance from local and national experts.
Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the United States 
Patient-Centered Primary Care Collaborative (PCPCC)
This brief documents the evidence in support of the patient-centered medical home concept and outlines that the primary care patient-centered medical home results in improved quality of care and patient experiences. The report highlights 14 state medical home projects, including Community Care of North Carolina and the Colorado Department of Health Care Policy and Financing, which resulted in positive outcomes in pediatric care. Overall, the brief shows that improvements in preventive, coordinated care yield reduced cost from hospital and emergency department utilization, as well as stronger evidence that investments in primary care can bend the cost curve.
Proof in Practice
Patient-Centered Primary Care Collaborative (PCPCC)
A compilation of patient-centered medical home pilot and demonstration projects, providing descriptions and details of how they are structured and what they are achieving. Additionally, PCPCC tracks medical home demonstration projects by state.
Reducing Disparities at the Practice Site
Center for Health Care Strategies, Inc. 2008-2011
Small provider practices play a critical role in caring for Medicaid beneficiaries, particularly those who are racially and ethnically diverse. Funded by Robert Wood Johnson Foundation, this initiative was developed by CHCS to support quality improvement in small practices serving this population. The three-year project is helping Medicaid agencies and health plans partner with small practices to reduce racial and ethnic disparities and improve overall outcomes. State-led teams in Michigan, North Carolina, Oklahoma and Pennsylvania are helping practice sites implement interventions focused on tracking patients and outcomes using an electronic data management tool; adopting evidence-based guidelines for targeted chronic conditions; and incorporating team-based care into ongoing practice operations. Click here to access a brief published in May 2011.
Side-by-Side Summary of State Medical Home Programs
National Partnership for Women & Families
This chart describes and compares state efforts, including the population covered, provider requirements, payment policies, performance measurement and public reporting, the status of the efforts, and additional relevant notes. Please note that this chart is not exhaustive, and currently only includes public and public/private initiatives.
State Initiatives in Patient-Centered Medical Homes
The Council of State Governments
The majority of state Medicaid programs are testing models of coordinated medical care to improve quality and reduce costs, particularly for patients wit h multiple chronic illnesses. This brief includes descriptions of eleven states' pilot programs or authorizing legislation.
