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In December 2009, President Barack Obama directed the Department of Health and Human Services to implement a three-year demonstration to support federally qualified health centers (FQHCs) in becoming advanced primary care practices (APCPs) for Medicare beneficiaries. Under this demonstration, FQHCs are expected to obtain Level 3 recognition as patient-centered medical homes (PCMHs) from the National Committee for Quality Assurance by the end of the demonstration, with the ultimate goals of better health outcomes and management of chronic conditions, decreased use of certain health care services (e.g., hospitalizations, emergency department visits, duplicative/unnecessary tests and procedures), increased use of other services (e.g., preventive services), and reductions in health care expenditures. RAND was asked by the Centers for Medicare and Medicaid Services to study the processes and challenges involved in transforming FQHCs into APCPs and assess the effects of the APCP model on access, quality, and cost of care provided to Medicare and Medicaid beneficiaries served by FQHCs. This first report in a series of three is an introduction to the evaluation and a statement of the evaluation team's approaches to important methodological challenges that we have identified.

Table of Contents

  • Chapter One


  • Chapter Two

    Selection of the Demonstration and Comparison Sites and of the Study Population

  • Chapter Three

    Assessing the Structure of FQHCs

  • Chapter Four

    Experiences of Demonstration and Comparison FQHC Site Leaders with CMS' and Other APCP Transformation Activities

  • Chapter Five

    Experiences of Primary Care Associations with CMS' and Other APCP Transformation Activities

  • Chapter Six

    Interventions to Motivate Transformation to PCMH Attributes

  • Chapter Seven

    Claims-Based Quantitative Measures Reported

  • Chapter Eight

    Medicaid Claims Analyses

  • Chapter Nine

    Beneficiary Survey

  • Appendix A

    FQHC Site Interviews

  • Appendix B

    PCA Interviews

  • Appendix C

    Medicare Claims Analyses

  • Appendix D

    Medicaid Claims Analyses

This work was prepared for the Centers for Medicare and Medicaid Services and conducted in RAND Health, a division of the RAND Corporation.

This report is part of the RAND Corporation Research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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