Data Inputs to the Model
| Parameter | Details | Source |
|---|---|---|
| Population demographics within each state population | ||
| Age, y | Cohorts of <5, 5–13, 14–17, 18–24, 25–44, 45–64, 65–84, and >84 y | US Census Bureau24 |
| Sex | Cohorts of male or female | |
| Race/ethnicity | Cohorts of non-Hispanic white, non-Hispanic black, Hispanic, and other | |
| Income | Housing income relative to household size, expressed relative to federal poverty level | |
| Insurance status | Cohorts of private, Medicare, Medicaid/CHIP, or self-pay | |
| Patient features | ||
| Diagnoses among each demographic group | International Classification of Disease, Ninth Revision | Agency for Healthcare Research and Quality25 |
| Per-person utilization of primary care clinics | Visits per person per year, conditional on demographics, diagnoses, and state of residence | |
| Practice features | ||
| Reimbursement for each primary care visit | Specific to diagnoses and payer | Agency for Healthcare Research and Quality25 |
| Productivity of primary care physicians and midlevel clinicians | Encounters and empanelment per clinician per year, by clinician type (physician, NP, PA) | Medical Group Management Association26 |
| Utilization changes associated with changes in staff | Changes in encounters and empanelment given levels of support staffa | |
| Staffing ratios of midlevel clinicians and support staff per full-time physician | Including NPs, PAs, RNs, LPNs, and MAs | |
| Overhead costs | Including staff benefits, building and occupancy, information technology, drug and medical supply, equipment and administrative supplies, liability insurance and fees, laboratory and imaging fees, and other ancillary service costs | |
| Compensation costs for clinician | Salary per full-time physician or midlevel clinician per year | Bureau of Labor Statistics27 |
| Compensation costs for support staff | Salary per full-time worker per year, by worker type | IBM Kenexa Compensation Analysis28 |
| New financing approaches | ||
| Increased FFS payment rates | Median increase of 12% above current CPT codes (95% CI, 10%–14%)b | CareFirst BlueCross BlueShield29 |
| PMPM payment rates | Median of $4.90 per empaneled patient per month (95% CI, $3.00–$8.00) | Survey of patient-centered medical home initiatives4 |
| P4P payment rates | Median receipt rate of $2.63 per empaneled patient per annum (95% CI, $1.08–$4.17)c | National Academy for State Health Policy1 |
| Empanelment rate among new patient encounters (to charge new PMPM fees during panel expansion) | Median of 53% of new encounters (95% CI, 42%–64%) who become additional panel members | Medical Group Management Association26 |
| Reimbursement codes for electronic and telephone visits | 99444 for electronic, 99441 for telephone, varied by state and payer | Center for Connected Health Policy30 |
| Additional infrastructure costs for electronic visits | $240 per year (95% CI, $0–$360) | Telehealth Resource Center31 |
| Encounter rate per extended business hour | Regression model of utilization per extended hourd | Agency for Healthcare Research and Quality25 |
CHIP = Children’s Health Insurance Program; CPT = Current Procedural Terminology; FFS = fee for service; IBM =International Business Machines; LPN = licensed practical nurse; MA = medical assistant; NP = nurse practitioner; PA = physician assistant; P4P = pay for performance; PMPM = per-member-per-month; RN = registered nurse.
Note: See Supplemental Appendix Tables 1 and 2 and Supplemental Appendix Figure 1 for full parameter values, http://www.annfammed.org/content/14/5/404/suppl/DC1.
↵a See the Supplemental Appendix Figure 1, http://www.annfammed.org/content/14/5/404/suppl/DC1.
↵b Confidence intervals are estimates of the distribution of input data, not the results of a model of population data estimates, and are used to construct normal probability distributions from which to perform repeated sampling in our probabilistic uncertainty analyses.
↵c Receipt rate incorporates the observed rate of performance target achievement, which we varied in sensitivity analyses from a baseline estimate of 10% to a lower and upper bound of 0% to 100%.32
↵d See the Supplemental Appendix, http://www.annfammed.org/content/14/5/404/suppl/DC1.