Adoption and Impacts of Innovations in Primary Care Transformation - Lessons from Initiatives Tested by the Center for Medicare & Medicaid Innovation

The shifting focus of health care from volume to value and the resources dedicated to testing new health care payment and delivery models call for an understanding of the conditions or mechanisms that drive successful implementation and achievement of improved cost, quality and health. This two brief series, funded by the Laura and John Arnold Foundation, presents findings related to implementation, context, and impacts of five initiatives designed to transform primary care and tested under the auspices of the Centers for Medicare & Medicaid Services (CMS) Center for Medicare & Medicaid Innovation (Innovation Center).

Based on a systematic review of final evaluation reports, we synthesized findings on how innovations are adopted and potential drivers of outcomes. The first brief explores the relationship between features of innovation, their implementation and outcomes. We further provide a cross-initiative summary of cost and utilization outcomes to demonstrate the relative success of initiatives. The second brief explores selected organizational and environmental factors that influenced initiative implementation and their prospects for sustainability.

Initiatives in this analysis include: (1) the Comprehensive Primary Care Initiative, (2) Frontier Extended Stay Clinic Demonstration, (3) Medicare Coordinated Care Demonstration, (4) Multi-Payer Advanced Primary Care Practice Demonstration, and (5) six Health Care Innovation Award portfolios. These initiatives ran for 3-12 years over a period spanning 2002 to 2016.

This analysis was conducted in five phases that entailed:

  1. selecting and refining an analytic framework for innovation adoption;
  2. developing a codebook based on analytic framework domains
  3. coding evaluation reports publicly available on the Innovation Center website;
  4. conducting qualitative content analysis of coded data; and
  5. synthesizing key findings across initiatives.

This study advances an understanding of implementation and outcomes across primary care transformation initiatives by considering external and internal context, the implementation and adoption of various innovations, and their outcomes. While limitations such as the level of detail available in evaluation reports, different units of qualitative and quantitative analysis, and constraints of evaluation designs themselves qualify our findings, these analyses shed light on common implementation conditions, challenges, and lessons learned that may be applicable to future models.

This research was supported by the Laura and John Arnold Foundation. The views expressed are those of the authors and do not necessarily reflect the views of the funder.