全球智库信息集成服务系统

The medical home model, whose principles have recently been refined by the American Association of Family Physicians (AAFP), American Academy of Pediatricians (AAP), American College of Physicians (ACP), and American Osteopathic Association (AOA) (2007), are expected to achieve these goals largely through integration and coordination of health care by primary care physicians. Integrated health care is expected to enhance patient adherence to recommended treatment and avoid (1) hospitalizations, unnecessary office visits, tests, and procedures; (2) use of expensive technology or biologicals when less expensive tests or treatments are equally effective; and (3) patient safety risks inherent in inconsistent treatment decisions. Eighty-six percent of beneficiaries of fee-for-service (FFS) Medicare have one or more chronic conditions (Peikes et al. 2008), and many of these individuals suffer from five or more chronic conditions (Anderson 2005). Most FFS Medicare beneficiaries with chronic conditions receive care from several physicians—often 10 or more in a given year. The fragmentation of care for Medicare beneficiaries (MedPAC 2006; Pham et al. 2007; Starfield et al. 1976) and its relationship to rapidly rising health care costs (Parchman et al. 2005; Kripalani et al. 2007) are well documented.

This report summarizes the design of the CMS Medical Home Demonstration, hereafter referred to as the demonstration. Chapter II covers the basics of the demonstration design—how medical homes are defined, which physicians and patients are eligible to participate in the demonstration, and how practices will be paid for providing medical home services. Chapter III covers the operational procedures of the demonstration—the demonstration timeline, site selection, recruitment and enrollment procedures, assignment of beneficiaries to practices, how transitions such as patients who move out of the demonstration site or practices who drop out of the demonstration during the demonstration will be handled, and finally how the demonstration will be evaluated.