Table 1.

Selected Characteristics of AHR High Performers at Baseline, 2016

AHR High PerformerChange in AHR, %aProbability of Improving AHR, %aHospital/System OwnedNo. of PCPsNo. of BeneficiariesbPrior Transformation ExperiencecCounty LocationState
  1−1199Yes  3-5  798YesUrbanKentucky
  2  −999Yes  ≥62,674YesUrbanMissouri
  3  −691Yes  ≥62,991YesUrbanColorado
  4  −691Yes  ≥62,206YesUrbanPennsylvania
  5  −587Yes  ≥62,540YesRuralMontana
  6  −686Yes  ≥6  889YesUrbanColorado
  7  −683No  3-5  831YesUrbanNew Jersey
  8  −583No  3-51,028YesSuburbanMichigan
  9  −583No  3-5  929YesRuralArkansas
10  −582Yes  ≥61,802YesUrbanOregon
11  −577No  ≥6  574YesUrbanOhio
12  −477No  ≥61,090YesUrbanRhode Island
13  −476No  ≥61,256YesUrbanOhio
14  −475Yes  ≥61,055YesRuralColorado

  • AHR = acute hospitalization rate; PCP = primary care practitioner.

  • Sources: Mathematica’s analysis of data on the number, characteristics, and service use and spending of attributed Medicare beneficiaries based on Medicare Enrollment Database and claims data. Mathematica’s analysis of data on practice size and ownership from IQVIA’s SK&A Office-based Provider Database data; data on the number of attributed Medicare beneficiaries from Medicare Enrollment Database and claims data; data on participation in the Centers for Medicare & Medicaid Services’ (CMS’) Multipayer Advanced Primary Care Practice (MAPCP) and Comprehensive Primary Care Classic (CPC Classic); county data from the Area Resource File.

  • ↵a Risk-adjusted and denoised percentage changes from 2016 to 2018 (Supplemental Appendix 1).

  • ↵b Attributed Medicare fee-for-service beneficiaries in 2016.

  • ↵c Includes patient-centered medical home (PCMH) recognition, MAPCP, or CPC Classic. A practice was considered to have PCMH recognition if ≥1 of its PCPs had recognition at some point in 2014-2017 by the Accreditation Association for Ambulatory Health Care, The Joint Commission, the National Committee for Quality Assurance, or the Utilization Review Accreditation Commission. A practice was considered to be an MAPCP participant if it participated in any year during 2011-2014, as determined by a file from CMS. Participants include practices that stayed enrolled in CPC Classic for at least the first 5 months.