Primary Care

Grantee Name

Excellus Health Plan, Inc.

Funding Area

Primary Care

Publication Date

May 2016

Grant Amount


Grant Date:

May 2009 – September 2013

Numerous studies have demonstrated that comprehensive and integrated primary care is a cost-effective means to reduce health care fragmentation and its associated costs.

The patient-centered medical home (PCMH) is a promising model in which highly connected, coordinated, and inclusive patient care is overseen by a team of care providers, including physicians, nurses, pharmacists, social workers, and other care coordinators. Excellus BlueCross BlueShield (Excellus), MVP Health Care, and physicians in upstate New York partnered to create the Rochester Medical Home Initiative (RMHI) to test the viability of the PCMH model. Excellus and MVP Health Care provided $8 million to fully fund the demonstration. Excellus also compensated participating primary care physicians for providing additional case management and trained them to implement PCMH principles into their practices. In 2009, NYHealth awarded Excellus a grant to support an independent research evaluation of RMHI’s demonstration of the PCMH model.

Outcomes and Lessons Learned

Goal: Conduct an outside evaluation of RMHI to determine whether the PCMH model decreased costs, improved patient satisfaction and quality of care, and benefited providers.


  • Contracted with a researcher from Harvard School of Public Health;
  • Supported the aggregation of claims data, as well as data analysis for the evaluation; and
  • Found reductions in emergency department visits and imaging tests and an increase in certain prevention screenings, but no significant differences in inpatient admissions or primary care visits. Average cost savings for patients participating in RMHI was $59 less compared with nonparticipating patients

Lessons & Opportunities:

RMHI was renewed for two more years in collaboration with Excellus, but MVP Health Care decided to pursue other provider program opportunities. The local community was able to leverage the RMHI experience to help secure a 3-year, $27 million Centers for Medicare & Medicaid Services Health Care Innovation Award. This award supported the training and embedding of care managers in 65 practices, involving 300 primary care physicians in the Rochester region, and acted as a catalyst for driving broad delivery system reform in the region.