Table 1.

The Impact of Diffuse Improvement Initiatives

	Panel Size	Access	Burnout	Primary Care Spending
PCMH	Studies are limited.³ PCMH practices have a broader scope of practice than non-PCMH practices, meaning they do more work to care for their panels.⁴	Waiting times for new patient appointments are similar for PCMH vs non-PCMH practices.³	In VHA, burnout was slightly lower with greater PCMH implementation.⁵ Clinician burnout in safety-net clinics increased with greater PCMH adoption, though staff morale improved.⁶	While some insurers paid small incentive payments to PCMH practices, many did not.
ACO	No data was found on panel size in ACO vs non-ACO primary care practices.⁷	Patient satisfaction (including timely access) was similar between ACO and non-ACO care except 1 study showing better access in ACOs.⁸ Timely access was not different between commercial ACOs and non-ACO providers.⁹	A 2020 review found little evidence on ACOs and clinician experience.⁸	Shared savings coming to an ACO may go to hospitals, specialists, and ancillary services, rather than to primary care. ACO savings are unlikely to improve primary care spend.
CPC+	Many CPC+ practice leaders could not accurately report panel size.¹⁰	90% of CPC+ physicians reported that their patients enjoyed after-hours access and electronic access compared with 80% of non-CPC+ physicians. Patients’ experience of access was not reported.¹¹	No difference was found between CPC+ and non-CPC+ practices on physician-reported burnout.¹¹	Medicare made enhanced payments to CPC+ practices, which added to those practices’ revenues and increased Medicare expenditures.¹¹

ACO = accountable care organizations; CPC+ = Comprehensive Primary Care Plus; PCMH = patient-centered medical homes; VHA = Veterans Health Administration.