Table 1

Data Inputs to the Model

Population demographics within each state population
 Age, yCohorts of <5, 5–13, 14–17, 18–24, 25–44, 45–64, 65–84, and >84 yUS Census Bureau24
 SexCohorts of male or female
 Race/ethnicityCohorts of non-Hispanic white, non-Hispanic black, Hispanic, and other
 IncomeHousing income relative to household size, expressed relative to federal poverty level
 Insurance statusCohorts of private, Medicare, Medicaid/CHIP, or self-pay
Patient features
 Diagnoses among each demographic groupInternational Classification of Disease, Ninth RevisionAgency for Healthcare Research and Quality25
 Per-person utilization of primary care clinicsVisits per person per year, conditional on demographics, diagnoses, and state of residence
Practice features
 Reimbursement for each primary care visitSpecific to diagnoses and payerAgency for Healthcare Research and Quality25
 Productivity of primary care physicians and midlevel cliniciansEncounters and empanelment per clinician per year, by clinician type (physician, NP, PA)Medical Group Management Association26
 Utilization changes associated with changes in staffChanges in encounters and empanelment given levels of support staffa
 Staffing ratios of midlevel clinicians and support staff per full-time physicianIncluding NPs, PAs, RNs, LPNs, and MAs
 Overhead costsIncluding 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 clinicianSalary per full-time physician or midlevel clinician per yearBureau of Labor Statistics27
 Compensation costs for support staffSalary per full-time worker per year, by worker typeIBM Kenexa Compensation Analysis28
New financing approaches
 Increased FFS payment ratesMedian increase of 12% above current CPT codes (95% CI, 10%–14%)bCareFirst BlueCross BlueShield29
 PMPM payment ratesMedian of $4.90 per empaneled patient per month (95% CI, $3.00–$8.00)Survey of patient-centered medical home initiatives4
 P4P payment ratesMedian receipt rate of $2.63 per empaneled patient per annum (95% CI, $1.08–$4.17)cNational 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 membersMedical Group Management Association26
Reimbursement codes for electronic and telephone visits99444 for electronic, 99441 for telephone, varied by state and payerCenter 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 hourRegression model of utilization per extended hourdAgency 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,

  • a See the Supplemental Appendix Figure 1,

  • 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,