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.

National Demonstration Projects & State Initiatives

State Innovation Models (SIM) Awards for Health Care System Improvements
US Department of Health and Human Services
These SIM initiative awards help 25 states design and implement improvements to their health care systems focused on people enrolled in Medicare, Medicaid and the Children’s Health Insurance Program. Model Testing awards will fund 6 states (Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont) in implementing their plans for health care delivery transformation; the National Academy for State Health Policy launched an online resource on these 6 Models that includes a crosswalk of each state's payment methods, medical home requirements, performance metrics, and more. The remaining 19 states will develop their State Health Care Innovation Plans to guide comprehensive health care transformation.

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State Implementation Grants for Systems of Services for Children and Youth with Special Health Care Needs (CYSHCN)
US Department of Health and Human Services, Health Resources Administration, Maternal and Child Health Bureau
This grant program improves access to a quality, compreshensive, coordinated community-based systems of services for CYSHCN and their families that is family-centered and culturally competent. Nine states were provided 3-year awards (2012-2015) to focus on statewide improvements: Alabama, Alaska, Arkansas, Delaware, Kentucky, Louisiana, Ohio, Washington.

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Innovative Evidence Based Models for Children and Youth with Special Health Care Needs (CYSHCN)
US Department of Health and Human Services, Health Resources Administration, Maternal and Child Health Bureau
This 3-year initiative (2011-2014) funds models of care that are evidence based and can be spread to other communities. Innovative programs are in one of four key areas: outreach, care coordination, blended or braided funding, and access to medical home. The following 11 states were provided awards: Illinois, Iowa, Michigan, Minnesota, Missouri, New Jersey, North Carolina, Oregen, Pennsylvania, Texas, and Vermont.

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Assuring Better Child Health and Development (ABCD)
The ABCD program is funded by The Commonwealth Fund, administered by the National Academy for State Health Policy (NASHP), and designed to assist states in improving identification of and care coordination for very young children, age 0-3, with or at risk for developmental delay. Since 2000, ABCD has helped 27 states create models of service delivery and financing through a laboratory for program development and innovation.

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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. 

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Centers for Primary Care Practice-Based Research and Learning
Agency for Healthcare Research and Quality (AHRQ)
The Agency for Health Care Research and Quality (AHRQ) announced grant awards to 8 institutions to support collaborative centers for primary care practice-based research.  The goals of this new initiative are to learn more about the delivery and organization of primary care and to create communities of learning among primary care practices, in which they may improve health care quality, patient safety, and effectiveness of care.  One of the 8 awarded centers is the American Academy of Pediatrics (AAP) Center for Pediatric Practice Research & Learning, comprised of practice-based research networks including AAP Pediatric Research in Office Settings (PROS), AAP Quality Improvement Innovation Network (QuIIN), and Pediatric Research Consortium of the Children's Hospital of Philadelphia (PeRC).

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Children’s Health Insurance Program Reauthorization Act (CHIPRA) Grants
US Department of Health and Human Services
In February 2010, 10 states, representing single-state projects and multi-state collaborations, were awarded 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.

  • 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.
  • Evaluation of CHIPRA Quality Demonstration Grant Program
    An AHRQ Web page provides information about the national evaluation of a Quality Demonstration Grant Program to identify effective strategies for enhancing quality and delivery of care for children. The grant program, which funds efforts in 18 states, was funded by CHIPRA, and AHRQ is overseeing its national evaluation. The AHRQ Web page includes descriptions of the 51 projects being implemented. The second Evaluation Highlight of the CHIPRA Quality Demonstration Grant Program is available on the national evaluation Web site under Reports and Resources. This Highlight describes the development of the Medical Home Index-Revised Short Form (MHI-RSF), an adaptation of the Medical Home Index (MHI), for use in evaluating the demonstration projects.

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Consortium to Advance Medical Homes for Medicaid and CHIP Participants PDF
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 the NASHP 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.

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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

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Medicaid-Safety Net Learning Collaborative (2012-2013) PDF
Tthrough a cooperative agreement with the Health Resources and Services Administration (HRSA), NASHP has launched the Medicaid-Safety Net Learning Collaborative to support innovative delivery system models to support vulnerable populations. This initiative provides a structured opportunity to integrate safety net providers into evolving health systems through statewide partnerships with the Medicaid agency, safety net providers and other stakeholders. Medicaid-Safety Net Learning Collaborative states will have access to expert consultation, implementation resources, and networking opportunities for peer-to-peer learning over the course of 13-months to develop strategies to achieve value and high performance.

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Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration PDF
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.

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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.

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Patient-Centered Outcomes Research Institute (PCOI) Pilot Projects Program
PCOI has approved 50 Pilot Projects Program awards, totaling $30 million over two years. The awarded projects include programs working to develop tools and techniques for improving patient-centered care and decision-making; create new patient-centered care measures; and improve delivery of patient-centered counseling and care in various health care settings. A few funded pilot projects that relate to providing medical home services for all children and youth include:

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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.

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Reports and Briefs

Partnership for Sustainable Health Care
Five major health care groups have formed the Partnership for Sustainable Health Care, including America’s Health Insurance Plans (AHIP), Ascension Health, Families USA, the National Coalition on Health Care, and the Pacific Business Group on Health. The Partnership has outlined recommendations to fast-track efforts that will improve health care quality and costs, including transitioning away from a fee-for-service payment model, incentivizing and educating consumers, and promoting partnerships between states and other stakeholders.

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About Half of the States Are Implementing Patient-Centered Medical Homes for their Medicaid Populations
This November 2012 Health Affairs article focuses on trends in patient-centered medical home payment that can inform public and private payment strategies more broadly. The article also discusses the wide variety of approaches that Medicaid programs are taking to implement payment reform.

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The Commonwealth Fund

  • Building Medical Homes: Lessons from Eight States with Emerging Programs (December 2012)
    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 (December 2012)
    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.
  • A Nationwide Survey of Patient-Centered Medical Home Demonstration Projects (May 2012)
    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.

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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. 

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Initial Lessons from the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home.
Nutting PA, Miller WL, Crabtree BF, Jaen CR, Stewart EE, Stange KC. Annals of Family Medicine. 2009 May‐Jun; 7(3): 254‐60.
This article discusses how medical home demonstration projects are beginning in nearly every state, with a broad base of support from employers, insurers, state and federal agencies, and professional organizations. In June 2006, the American Academy of Family Physicians launched the first National Demonstration Project (NDP) to test a model of the PCMH in a diverse national sample of 36 family practices. The authors make up an independent evaluation team for the NDP that used a multimethod evaluation strategy, including direct observation, in-depth interviews, chart audit, and patient and practice surveys.

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National Academy for State Health Policy (NASHP)

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New Opportunities for Integrating Care for Women, Children and Their Families
Association of Maternal and Child Health Programs and The Commonwealth Fund
This issue brief highlights the efforts of Colorado, Florida, Ohio, and Vermont to integrate health care services for low-income women and children, especially through state Title V maternal and child health programs.

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Patient-Centered Primary Care Collaborative (PCPCC)

  • Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the United States PDF
    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 PDF
    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.

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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 PDF to access a brief published in May 2011.

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Side-by-Side Summary of State Medical Home Programs PDF
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.

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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.

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