Table 2.

Factors Present in States that Did or Did Not Generate Net Savings for Medicare

	Net savings for Medicare?
	Yes				No
	MI	VT	PA	NY	RI	NC	ME	MN
Factors associated with generating net savings*
No late entrants allowed after the demonstration start date	●		●	●		●
Practices had to be recognized PCMHs when they entered the demonstration (no grace period to obtain PCMH recognition)	●	●	●				○	●
All payers’ demonstration payment models incentivized consistent activities within a state		●	●	●	●
Payers’ demonstration payment models included opportunities for practices to earn performance bonuses	●		●	●	●
Demonstration participants received the demonstration payments and bonuses they expected to receive	●	●		●	●
Factors that may be necessary but not sufficient to generate net savings†
A precursor PCMH initiative offered payments to practices	●	●	●	●	●	●	●	●
Payers participated voluntarily in the MAPCP Demonstration	●		●	●	●	●	●
Leaders of state government supported the demonstration	●	●		●	●	●	●	●
Stakeholders and physicians supported the demonstration	●	●	○	●	●	○	●	●
Complementary payment and care delivery reforms underway	●	●	●	●	●	●	●	●
Most practices met NCQA’s PCMH recognition standards (as opposed to another entity's PCMH recognition standards)		●	●	●	●	●	●
Care coordinators focused on high-risk patients	●	●	●	●	○	●	●	●
Factors not associated with net savings‡
A large number of practices participated (> 100 practices)	●	●						●
Practices were only required to recertify as PCMHs every 3 years (instead of more frequently—e.g., every 12–18 months)		●	●	●	●		●
Practices were required to offer round-the-clock access to care	●			●				●
Other organizations received demonstration payments to support/supplement practices’ activities (e.g., Physician Organizations in MI, Community Health Teams in VT)§	●	●		●		●	●
Technical assistance was viewed positively by practices	○	●	○	●	○	●	●	●
Technical assistance targeted to care coordinators was offered	●	●			●	○	●	○
Care coordinators tended to be employed by practices (as opposed to a health system or outside entity)			●	○	●		●	○
Care coordinators tended to be nurses (as opposed to individuals with less clinical training)	●		●	●	●	●	○
Practices regularly received hospital discharge data or alerts	●	○		○	○	○	○	○

● = factor is present in state; ○ = factor is partially present in state; empty cell = factor is not present in state; MAPCP = Multi-Payer Advanced Primary Care Practice; PCMH = patient-centered medical home

*These factors were present in ≥ 3 of the 4 states that generated net savings and absent from ≥ 3 of the 4 states that did not generate savings

† These factors were present in ≥ 3 of the 4 states that generated net savings and ≥ 3 of the 4 states that did not generate savings

‡ These factors did not meet either of the prior two criteria, suggesting that they may not have a relationship with net savings

§ The payment methodologies used in these five states are described in our online appendix