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Objective Analysis. Effective Solutions.

RAND conducted an independent evaluation of the Federally Qualified Health Center (FQHC) Advanced Primary Care Practice (APCP) Demonstration for the Centers for Medicare and Medicaid (CMS). The evaluation studied the processes and challenges involved in transforming FQHCs into patient-centered medical homes (PCMHs) and assessed the effects of the FQHC APCP Demonstration model on access, quality, and cost of care provided to Medicare and Medicaid beneficiaries served by FQHCs.

The evaluation sought to answer three key policy questions: How does the demonstration affect practice structure and medical home recognition? Do demonstration sites deliver better beneficiary processes and outcomes than comparison sites? How does medical home recognition affect beneficiary processes and outcomes?

RAND used a mixed-methods approach to address these questions. This report presents the final results of RAND's analyses.

• Chapter One

  Introduction

• Chapter Two

  Medical Home Recognition

• Chapter Three

  FQHC Use of Demonstration Funding and Other Financial Resources to Support PCMH Recognition

• Chapter Four

  FQHC Use of Technical Assistance and Feedback Reports to Support PCMH Recognition

• Chapter Five

  Demonstration Effect on Medical Home Recognition

• Chapter Six

  Pathways to Medical Home Recognition

• Chapter Seven

  Change Management: Challenges and Facilitators

• Chapter Eight

  Provider and Staff Experience of Change

• Chapter Nine

  Effects of the Demonstration on Utilization, Care Processes, and Spending

• Chapter Ten

  Effect of the Demonstration on Patient Experience

• Chapter Eleven

  The Relationship Between Medical Home Recognition and Changes in Beneficiary Processes and Outcomes

• Chapter Twelve

  The Effects of Medical Home Recognition on Beneficiary Utilization, Processes, and Spending

• Chapter Thirteen

  The Effects of Medical Home Recognition on Beneficiary-Reported Experiences

• Chapter Fourteen

  The Effect of Alternative PCMH Recognition Types on Claims-Based Outcomes

• Chapter Fifteen

  Intensity of Change and Remaining Transformation

• Chapter Sixteen

  Conclusion