UnitedHealthcare Patient-Centered Medical Home Program- Arizona

Program Location: 
Phoenix, AZ
Payer Type: 
Partner Organizations: 

Reported Outcomes


UnitedHealthcare and IBM launched the Patient-Centered Medical Home (PCMH) program in Arizona in 2009. Since then, more than 30 additional employers with operations in Arizona have opted to participate in the program, which offers each patient an ongoing relationship with a primary care physician who, in turn, leads a team that takes collective responsibility for each patient's care. The result is a greater level of proactive and personalized care, helping coordinate visits to specialists, mental health professional and health education. United Healthcare currently uses NCQA's PCMH recognition program or convener-defined equivalent as a basis for defining “medical home” capabilities.  It also reviews other alternative assessment and recognition programs as they become endorsed by the medical professional societies.

The  pilot program, open to UnitedHealthcare’s employer-sponsored, Medicare Advantage and Medicaid health plan customers, will include four to six primary-care practices from UnitedHealthcare’s physician network in Phoenix and Tucson.  UnitedHealthcare will provide the selected primary-care practices with technology, infrastructure support and care coordination, with the goal of leveraging improved information systems to enhance patient access to care, the quality and safety of the care experience, and patient satisfaction with health care providers.


Payment Model: 

The program's PCMH reimbursement model builds on the current Fee for Service (FFS) schedule with a PMPM Care Management Fee and in some cases a bonus / gain share option based on performance.

  • Care Management Fee: Prospective fixed-rate, PMPM payments for anticipated quality, efficiency and satisfaction improvements under the PCMH model.
  • Bonus: For some programs, practices are eligible for a periodic performance bonus or rate adjustment that aligns with clearly defined clinical quality, medical cost and operational measures.
  • Gain Share: For some programs, practices have lower Care Management Fee in consideration for sharing in the risk/benefit of realized cost reduction outcomes.
Cost Savings: 
  • On average, the commercial PCMH model in RI, OH, CO, and AZ have demonstrated 4-4.5% medical cost reduction
  • and a 2:1 Return on Investment (ROI)
Last updated January 2015
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