Preliminary data does not yet provide a clear picture of the results of an “enormous undertaking” by a CMS demonstration project that provided support for federally qualified health centers (FQHCs) to transform into advanced primary care practices (APCPs). According to an independent evaluation performed by the RAND Corporation, the demonstration FQHCs achieved advanced primary care practice status earlier than those not participating in the program, but final data is needed to consider the demonstration’s impact on transformation timing as well as on cost savings and patient outcomes.
In 2009, the President Obama directed HHS and CMS to implement a three-year demonstration to support the conversion of FQHCs into APCPs in order to provide care for Medicare beneficiaries. FQHCs provide primary care to underserved populations and are intended to encourage health care providers to coordinate patient care. FQHCs that have achieved Level 3 recognition by the National Committee for Quality Assurance (NCQA) as a patient-centered medical home (PCMH) are considered to be providing advanced primary care (APC). The demonstration was intended to improve care coordination, management, patient experiences, and overall access to quality care.
The demonstration provided four intervention components to 500 sites through November 2011 through October 2014. These included quarterly care management payments of $18 for each Medicare beneficiary, technical assistance and training for achieving the Level 3 PCMH recognition, and feedback reports.
The RAND Corporation conducted an independent evaluation of the FQHC APCP demonstration. The evaluation examined the challenges faced in transforming the FQHCs to APCPs and assessed the APCP model’s effects on the access, quality, and cost of medical care provided to Medicare and Medicaid beneficiaries as compared to FQHCs that did not participate in the demonstration. The evaluation examined the demonstration’s effects on NCQA recognition and patient outcomes. It also considered the impacts of practice-site and beneficiary characteristics.
The evaluation concluded that 69 percent of demonstration FQHCs were able to achieve NCQA Level 3 recognition by October of 2014 versus just 11 percent of non-demonstration FQHCs.
Processes and outcomes
The evaluation showed significant differences between the demonstration and non-demonstration FQHCs for claims-based metrics, but did not show any difference for beneficiary survey-based metrics. The analysis of claims showed more utilization and costs associated with demonstration FQHCs versus non-demonstration FQHCs in such areas as Medicare payments, hospital admissions, readmissions, and emergency department visits. Therefore, the report concluded that the demonstration will likely not result in cost savings as compared to non-demonstration FQHC sites, but also cautioned that the evaluators are still awaiting longitudinal beneficiary analysis information, which will be contained in the final report that will evaluate the demonstration.
The evaluators could not report on the impact of practice-site and beneficiary characteristics on structures, processes or outcomes because they are awaiting additional data from the demonstration’s final quarters. However, the demonstration is ending soon and the data should be available in the coming months.