Evaluation of CMS FQHC APCP Demonstration

Executive Summary

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. FQHCs serve an important function nationally as organizations funded by Section 330 of the Public Health Services Act to offer primary health care to underserved populations. APCPs are designed to encourage doctors, hospitals, and other health care providers to work together to better coordinate care for patients. The demonstration supported the transformation of FQHCs through the use of APCP principles that are designed to support continuous, comprehensive, patient-centered medical care.

For the demonstration, CMS recognizes as advanced primary care (APC) the type of care that is offered by FQHCs that have achieved Level 3 recognition as a patient-centered medical home (PCMH) from the National Committee for Quality Assurance (NCQA). PCMH recognition is based on scoring according to six standards (enhancing access and continuity, identifying and managing patient populations, planning and managing care, providing self-care support and community resources, tracking and coordinating care, and measuring and improving performance), each of which comprises multiple elements. Sites achieve Level 1, 2, or 3 recognition based on their total number of points scored across elements. An expectation of the demonstration is that all FQHCs receiving the demonstration’s interventions would attain Level 3 within three years.

The goals of the demonstration are to improve the safety, effectiveness, efficiency, timeliness, and quality of care; patient access to care; adherence to evidence-based guidelines; care coordination and care management; and patient experiences with care. These improvements, in turn, may lead to better health outcomes and management of chronic conditions, decreased use of certain health care services (e.g., hospitalizations, emergency department [ED] visits, duplicative/unnecessary tests and procedures), increased use of other services (e.g., preventive services), and reductions in health care expenditures. 

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