Pennsylvania's medical home program is just one of at least 22 commercial health insurer sponsored patient-centered medical home demonstration programs around the country, but is unique for the number of participating health plans, according to a report released late last year by the Patient-Centered Primary Care Collaborative, a Washington, D.C.-based advocacy group of employers, consumer groups, health plans, labor unions, hospitals, and clinicians.

Here's where several others are taking place:

Arizona

UnitedHealthcare kicked-off a two-year medical home pilot program in February with six primary care practices in Phoenix and Tucson. The insurer collaborated with IBM, which has nearly 11,000 UnitedHealthcare beneficiaries in the state, and its employees to seek primary care services from the physicians participating in the pilot program.

UnitedHealthcare provides technical assistance with upgrades such as e-prescribing and patient registries (which are required); practices need to submit for NCQA medical home qualification in order to receive as much as a 20 percent increase over their normal fee-for-service revenue from the insurer.

"You really need to have an electronic medical record. It would be unimaginable to do without it," says Jim Stape, practice manager at Gilbert Center for Family Medicine near Phoenix, a pilot practice that adopted an EHR five years ago. "Just having a portion of our patients being reimbursed for this extra work isn't enough to do it. I'm hoping UnitedHealthcare is opening the eyes of the payers."

Michigan

In May, Blue Cross Blue Shield of Michigan launched what it claims is the largest medical home program in the country. The state's largest health plan, Blue Cross hopes to enroll 300 practices in the three-year program, which is based NCQA model and has dedicated $30 million. Practices can earn as much as a 10 percent increases on common E&M codes.

Mary Durfee, MD, an internist and primary care president for IHA, a 150-physician group practice in Ann Arbor, says the medical home workflow changes require more than just switching to open access and team-based care, but a careful analysis of your entire staff's job duties.

"What are your nurses trained to do?" Durfee asks. "How about that MA? What are they getting ready for you before you walk in the room, so you're not in and out of the room six times?"

New Hampshire

Dartmouth-Hitchcock Medical Center in Lebanon launched a medical home pilot with Cigna in June 2008 with 391 primary care doctors statewide. Physicians receive an undisclosed reimbursement for enhanced services, such as care management, and a pay-for-performance bonus for achieving health benchmarks with chronically ill patients.

Already a highly-integrated system, Dartmouth Hitchcock expanded its preventive test notification for the Cigna program, such as notifying patients about screenings such as mammograms prior to their next visit, so the physician had the most recent results while in the exam room with the patient.

"Our doctors believe it's the right way to organize from a clinical perspective and the best way to take care of patients, regardless of the commercial revenue stream," says Barbara Walters, MD, senior medical director for the medical center.

North Dakota

Participating physicians in Blue Cross Blue Shield of North Dakota's MediQHome program receive a care-management fee for health plan members with pediatric asthma, adult or pediatric high blood pressure, attention deficit hyperactivity disorder, diabetes, coronary heart disease, or chronic heart failure.

Physicians are also able to access an information technology tool created by MDdatacor of Atlanta to track patients' treatment information. The system, similar to an EHR, offers evidence-based alerts for diabetics, as well as reminders for pediatric and adult immunizations, and screenings for colon, cervical, and breast cancer.

The program is an expansion of a smaller medical home demonstration at four integrated clinics in the state, which saved the insurer more than $390,000 in one year on only 1,286 plan members, according to the company.