The Department of Health and Human Services, acting through the Centers for Medicare and Medicaid Services, implemented a three-year project intended to support the transformation of federally qualified health centers (FQHCs) into advanced primary care practices (APCPs) in support of Medicare beneficiaries. RAND is assessing the effects on access, quality, and cost of care provided to Medicare and Medicaid beneficiaries.

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Evaluation of CMS's Federally Qualified Health Center (FQHC) Advanced Primary Care Practice (APCP) Demonstration

Final Second Annual Report

by Katherine L. Kahn, Justin W. Timbie, Mark W. Friedberg, Tara Lavelle, Peter Mendel, J. Scott Ashwood, Liisa Hiatt, Ian Brantley, Beverly A. Weidmer, Afshin Rastegar, et al.

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Research Questions

  1. What are the effects of interventions designed to stimulate advanced primary care principles on changes in practice structure and on recognition status from the National Committee for Quality Assurance (NCQA)?
  2. Do demonstration sites deliver better beneficiary processes and outcomes than comparison sites?
  3. Which practice-site and beneficiary characteristics are associated with observed changes in structures, processes, and outcomes?

In December 2009, President Barack Obama directed the Department of Health and Human Services, acting through the Centers for Medicare and Medicaid Services (CMS), to implement a three-year demonstration intended to support the transformation of federally qualified health centers (FQHCs) into advanced primary care practices (APCPs) in support of Medicare beneficiaries. RAND is conducting an independent evaluation of the FQHC APCP demonstration for CMS. The evaluation includes studying the processes and challenges involved in transforming FQHCs into APCPs and assessing the effects of the APCP model on access, quality, and cost of care provided to Medicare and Medicaid beneficiaries currently served by FQHCs. This is the second of three annual reports on this project.

Key Findings

Interim Findings Show More Sites Achieving NCQA Recognition

  • Though sites had a slow start in achieving NCQA Level 3 recognition, significantly more demonstration than comparison FQHCs (69 percent versus 11 percent) achieved NCQA Level 3 recognition by October 2014.
  • Preliminary analyses show significant differences between demonstration and comparison FQHCs for most measured claims-based metrics, but no differences for most beneficiary survey--based metrics.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Key Policy Question 1: What Are the Effects of Interventions Designed to Stimulate APC Principles on Changes in Practice Structure and on NCQA Recognition Status?

  • Chapter Three

    Key Policy Question 2: Do Demonstration Sites Deliver Better Beneficiary Processes and Outcomes Than Comparison Sites?

  • Chapter Four

    Key Policy Question 3: Which Practice-Site Characteristics Are Associated with Observed Changes in Structures, Including NCQA Recognition Status, and with Patient-Level Processes and Outcomes?

  • Chapter Five

    Conclusion

  • Appendix A

    Data Sources

  • Appendix B

    Medicare Claims Methods

  • Appendix C

    Baseline Beneficiary Survey

  • Appendix D

    RAS/NCQA Data

  • Appendix E

    CASE Methods

  • Appendix F

    Qualitative Methods

  • Appendix G

    Site Leader Report of How Site Payments Are Used

  • Appendix H

    NCQA Webinar Participation by Cluster

  • Appendix I

    Predictors of NCQA Webinar Participation

  • Appendix J

    PCA Delivery of TA

The research described in this report was conducted by RAND Health.

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