As the U.S. health care system places a growing emphasis on improving the value of health care, many states and the federal government have increasingly invested in primary care to improve health outcomes and lower health care costs. Unlike “traditional” primary care settings, newer primary care models strengthen primary care providers’ role in expanding access to care and providing comprehensive, coordinated services to help improve patients’ experiences. In recent years, states have used federal funding to test new approaches to primary care through Patient-Centered Medical Home (PCMH) and other such initiatives.
Many of these efforts were originally funded through time-limited Centers for Medicare and Medicaid Services (CMS) demonstration projects that encouraged or required commitments from commercial payers and/or state Medicaid programs. As these initial demonstration grant periods end, public-private partnerships and other creative funding approaches are emerging to continue and/or expand PCMH efforts. New leadership at CMS appears poised to move the focus toward local solutions and governance that leverage private sector partnerships.
This brief, developed with support from the Commonwealth Fund, describes the major elements of PCMH initiatives and sustainability efforts in four states—Michigan, Vermont, Colorado, and Arkansas. The efforts undertaken by these four states provide valuable learnings for all states considering the future of their own initiatives.