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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.

Table of Contents

  • Chapter One


  • 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


The research described in this report was sponsored by the Centers for Medicare and Medicaid Services (CMS) and conducted by RAND Health.

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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