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Case Study of a Primary Care–Based Accountable Care System Approach to Medical Home Transformation

Phillips, Robert L. Jr, MD, MSPH; Bronnikov, Svetlana MS; Petterson, Stephen PhD; Cifuentes, Maribel RN; Teevan, Bridget MS; Dodoo, Martey PhD; Pace, Wilson D. MD; West, David R. PhD

Journal of Ambulatory Care Management: January/March 2011 - Volume 34 - Issue 1 - p 67–77
doi: 10.1097/JAC.0b013e3181ffc342
Issue on the Medical Home: Original Article

We report a case study of a mature primary care–based accountable care organization that is both a health plan and a network of medical homes. Over 20 years, WellMed Inc (San Antonio, Texas) implemented many patient-centered services, experimenting to find which belong within clinics and which operate best as system functions. The adjusted mortality rate is half that of the state for people older than 65 years. Hospitalization and readmission rates and emergency department visits have not changed over time, but preventive services have improved. Phased implementation across the network makes it difficult to link improvements to specific processes but they seem to have improved outcomes collectively.

The Robert Graham Center, Washington, District of Columbia (Drs Phillips and Petterson and Mss Bronnikov and Teevan); Department of Family Medicine, University of Colorado-Denver, Aurora, Colorado (Ms Cifuentes and Drs Pace and West); and Economist, Washington, District of Columbia (Dr Dodoo).

Correspondence: Robert L. Phillips Jr, MD, MSPH, The Robert Graham Center, 1350 Connecticut Ave, NW Ste 201, Washington, DC 20036 (

Funded by US Agency for Healthcare Research and Quality, contract number HHSA290200710008, Task Order No. 6.

The information and opinions contained in research from the Robert Graham Center do not necessarily reflect the views or policy of the American Academy of Family Physicians.

© 2011 Lippincott Williams & Wilkins, Inc.