New york pcmh chartbook 2013

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New york pcmh chartbook 2013

  1. 1. Patient-Centered Medical Homes in New York: Updated Status and Trends as of July 2013 A C H A R T B O O K
  2. 2. OFFICERS DIRECTORS United Hospital Fund J. Barclay Collins II Chairman Richard A. Berman Jo Ivey Boufford, MD Rev. John E. Carrington Derrick D. Cephas Philip Chapman Dale C. Christensen, Jr. J. Barclay Collins II Richard Cotton Michael R. Golding, MD Josh N. Kuriloff Patricia S. Levinson David Levy, MD Howard P. Milstein Susana R. Morales, MD Robert C. Osborne Peter J. Powers Mary H. Schachne John C. Simons Michael A. Stocker, MD, MPH James R. Tallon, Jr. Frederick W. Telling, PhD Mary Beth C. Tully The United Hospital Fund is a health services research and philanthropic organization whose primary mission is to shape positive change in health care for the people of New York. We advance policies and support programs that promote high-quality, patient-centered health care services that are accessible to all. We undertake research and policy analysis to improve the financing and delivery of care in hospitals, health centers, nursing homes, and other care settings. We raise funds and give grants to examine emerging issues and stimulate innovative programs. And we work collaboratively with civic, professional, and volunteer leaders to identify and realize opportunities for change. James R. Tallon, Jr. President Patricia S. Levinson Frederick W. Telling, PhD Vice Chairmen Sheila M. Abrams Treasurer Sheila M. Abrams David A. Gould Sally J. Rogers Senior Vice Presidents Michael Birnbaum Deborah E. Halper Vice Presidents Stephanie L. Davis Corporate Secretary HONORARY DIRECTORS Howard Smith Chairman Emeritus Douglas T. Yates Honorary Chairman Herbert C. Bernard John K. Castle Timothy C. Forbes Barbara P. Gimbel Rosalie B. Greenberg Allan Weissglass
  3. 3. Patient-Centered Medical Homes in New York: Updated Status and Trends as of July 2013 Gregory Burke D I R E C T O R , I N N O VA T I O N S T R A T E G I E S UNITED HOSPITAL FUND UNITED HOSPITAL FUND
  4. 4. Copyright 2013 by United Hospital Fund ISBN 1-933881-38-0 Free electronic copies of this report are available at the United Hospital Fund’s website, www.uhfnyc.org.
  5. 5. Introduction This chartbook tracks the growth of patientcentered medical homes (PCMHs) in New York State. It builds on analyses of National Committee for Quality Assurance (NCQA) data presented in two prior United Hospital Fund reports: The Patient-Centered Medical Home: Taking a Model to Scale in New York State (2011) and The Evolution of Patient-Centered Medical Homes in New York State: Current Status and Trends as of September 2012 (2012). Like those earlier reports, this update describes trends in the number of providers in New York State working in NCQA-recognized PCMHs, provides insights into the adoption and spread of the PCMH model over the past three years, and identifies some issues for consideration by the provider community, payers, and the New York State Department of Health (NYSDOH) as the medical home movement matures. The following sections and the charts to which the narrative refers describe changes in the number of providers working at NCQArecognized PCMHs in New York from three perspectives: • Status of PCMH adoption in New York as of July 2013 (Figures 1-13) • Growth in PCMH adoption between July 2011 and July 2013 (Figures 14-22) • Year-by-year trends for each region, by practice type (Figures 23-34) Highlights New York State leads the nation in the adoption of the medical home model, as measured by the number of practices recognized by the NCQA as patient-centered medical homes and the number of PCMH providers—that is, providers working in those practices. Roughly half of all PCMH providers in the state are in New York City and half are in non-NYC regions. Those regions (and, within New York City, the boroughs) vary markedly from each other in terms of the penetration of the PCMH model and the type of practice in which the PCMH providers work. After a period of rapid growth, the adoption of the PCMH model in New York State has slowed. Between 2011 and 2013, the number of PCMH providers in New York grew by 44 percent, from roughly 3,500 to nearly 5,000. Most of that growth occurred between 2011 and 2012, much of it in upstate regions. Between 2012 and 2013, the number of PCMH providers in the state grew by only 5 percent. As of July 2013, 80 percent of the NCQArecognized PCMH providers in New York State were recognized under NCQA’s 2008 standards. To maintain NCQA recognition, those practices will need to meet the NCQA’s more rigorous 2011 standards over the next few years. A substantial portion of the cohort recognized under NCQA’s 2008 standards, received recognition as a Level 1 or Level 2 PCMH. These practices (which include a large number of small practices) may have more difficulty retaining NCQA recognition. Acknowledgments This analysis would not have been possible without the support of Kate Bliss from the Office of Quality and Patient Safety in the New York State Department of Health. Kate was of enormous assistance in acquiring, scrubbing, and formatting the NCQA data files for this set of reports. This report was supported in part by the Altman Foundation, TD Charitable Foundation, EmblemHealth, New York Community Trust, and Excellus BlueCross BlueShield. Patient-Centered Medical Home Update, 2013 1
  6. 6. Methods To produce this analysis, UHF received three data files from the New York State Department of Health (originally generated by the NCQA) listing all providers working in NCQArecognized PCMHs as of three specific dates: July 1, 2011; July 1, 2012; and July 1, 2013. These files included all providers in New York State working in practices recognized by the NCQA as patient-centered medical homes, along with basic demographics and descriptors, enabling us to assign them to geographic regions and practice type. For consistency, we have maintained the definitions of the metrics used in prior reports. PCMH Providers: This includes all providers listed as active in the NCQA reports: physicians (MD and DO) and mid-level providers (e.g., nurse practitioner and physician’s assistant).1 NCQA Standards and Level of NCQA Recognition: Practices have received three-year NCQA recognition under either the 2008 or the 2011 standards, along with level of recognition (Level 1, 2, or 3 PCMH).The original NCQA PPC-PCMH Standards, published in 2008 (referred to in this report as the 2008 standards), were used by the NCQA in its original recognition process for all PCMHs. In 2011, the NCQA published and began to use a revised set of standards for PCMH recognition. The 2011 standards include changes in the number of “must-pass” elements, and in the weighting and scoring of a number of measures that determine the different levels of recognition. Providers applying for PCMH recognition after January 1, 2011, were reviewed using the 2011 standards, as are those providers who were recognized under the 2008 standards applying for recertification. New York State Regions: In these reports, we have used a variant of New York State’s insurance regions as a way of grouping and analyzing PCMH Providers into seven regions: • New York City (also analyzed at a borough level, given its size and diversity) • Long Island • Hudson Valley • Albany/Northeast New York • Rochester Area • Syracuse/Central New York • Buffalo/Western New York Practice Type: Providers who work within different practice contexts (large group vs. solo practice, for example) often have access to different infrastructure and resources—e.g., electronic medical records and care managers— and they face different challenges in achieving and sustaining PCMH recognition. In order to distinguish among these different settings (which in some cases are also markers for populations served) we use six different practice types first established in the 2011 PCMH report: • Group Practice: Large and small groups, with five or more physicians listed on the NCQA roster • Health Center: Federally qualified health centers and state-licensed diagnostic and treatment centers • HHC: New York City’s Health and Hospitals Corporation • Hospital Clinic: On-site or communitybased clinics of hospitals • Hospital/AMC Practice: Private practices and faculty practice plans based in hospitals and academic medical centers (AMCs) • Practice: Small private practices, with fewer than five physicians listed on the NCQA roster 1 This report updates the PCMH data published in The Evolution of Patient-Centered Medical Homes in New York State: Current Status and Trends as of September 2012. That report was based on data received from the New York State Department of Health (NYSDOH), which inadvertently included a number of providers and practices whose NCQA recognition had expired, resulting in an overcount of providers working in NCQA-recognized PCMHs. In preparing this report we worked with NYSDOH staff to verify the “active” status of all practices and providers as of July of all three years (2011, 2012, and 2013) and verified these figures with NCQA staff. 2 United Hospital Fund
  7. 7. Status of PCMH Adoption in New York State as of July 2013 Total PCMH Providers New York State has led the nation in the adoption of the medical home model. Based on a recent review of NCQA data (which counts both NCQA-recognized practices and providers working in those practices), New York is home to one-sixth of the total number of NCQArecognized PCMHs in the nation (Figures 1 and 2). Examining only the number of PCMH providers (physicians and mid-level practitioners) who are working in practices that have achieved NCQA recognition as PCMHs is a more accurate measure of clinical capacity. As of July 2013, NCQA data showed that there were 4,908 providers working in practices that had received NCQA recognition as PCMHs in New York. As shown in Figure 3, roughly half of the total (2,533 PCMH providers, or 52 percent) were in New York City, and half (2,375, or 48 percent) were in other regions of the state. Distribution by Region The number of PCMH Providers in New York State varied widely both by region of the state and within New York City, as shown in Figures 4 and 5. Distribution by Practice Type The PCMH model is not evenly distributed across different types of practices. Figure 6 depicts the distribution of providers working in PCMH practices by practice type for the state as a whole. Statewide, large group practices and health centers—organizations with the scale and infrastructure to more readily support the PCMH model—accounted for the largest numbers of PCMH providers, followed by the New York City Health and Hospitals Corporation, hospital clinics, and hospital/AMC practices. Small practices (practices with fewer than five providers), which have the least scale and infrastructure, made up the smallest cohort. There were marked differences between New York City and the rest of the state in the composition of PCMH providers by practice type (Figures 7 and 8). • Outside New York City, half of the PCMH providers worked in large group practices. • In New York City, group practices were a far smaller proportion of the total (11 percent), while hospital clinics (including HHC) and hospital/AMC-based practices and faculty practice plans were the dominant practice type (78 percent, in aggregate). The NYSDOH Hospital Medical Home program will likely increase the number of providers in hospital teaching clinics achieving NCQA recognition under the 2011 standards over the next year. There is presently no equivalent program or initiative focused on providers working in other practice types. Distribution by practice site also varied significantly among regions in the state (Figures 9 and 10). Outside New York City, all regions showed a substantial proportion of PCMH providers in larger groups in 2013; Hudson Valley and Albany had the largest cohort within health centers; and Syracuse and Rochester had the largest concentrations within hospital clinics and hospital/AMC-affiliated practices, respectively. Patient-Centered Medical Home Update, 2013 3
  8. 8. Similar differences existed within New York City. The HHC and health centers were consistently strong across the four larger boroughs, but there were differences among the boroughs in the importance of groups, hospital clinics and small practices. Manhattan had by far the largest concentration of PCMH providers within hospital/AMC practices, largely a function of the adoption of the PCMH model by Manhattanbased medical school faculty practices. maintain recognition, these practices will need to reapply for NCQA recognition under NCQA’s more rigorous 2011 standards. Year and Level of NCQA Recognition As is shown in Figure 12, small practices face the most substantial challenge: many were recognized under the 2008 standards at Level 1 or Level 2. These practices represent over onethird (37 percent) of all small practices with NCQA recognition as PCMHs (Figure 13). As is shown in Figure 11, 3,905 (80 percent) of the state’s 4,908 NCQA-recognized PCMH providers worked in practices recognized at Level 1, 2, or 3 under NCQA’s 2008 standards. To 4 United Hospital Fund Of the PCMH providers recognized under NCQA’s 2008 standards, 588 (15 percent of the 2008 total) work in practices that were recognized at Level 1 or 2, and they may have greater difficulty meeting—or may be unwilling to meet—NCQA’s 2011 standards, resulting in some practices losing NCQA recognition.
  9. 9. Growth in PCMH Adoption, July 2011 to July 2013 Overall Growth The number of providers working in NCQArecognized PCMHs grew by 44 percent over the three-year period, increasing from a statewide total of 3,399 in July 2011 to 4,908 in July 2013 (Figure 14). As shown in Figure 15, however, that growth was not uniform; it was different in New York City than in other parts of the state. While New York City had 2,054 PCMH providers in 2011, its growth between 2011 and 2012 was only 15 percent, and between 2012 and 2013 the rate of growth fell to 7 percent. New York City accounted for 60 percent of the state’s total PCMH providers in 2011 but roughly 50 percent in 2012 and 2013. Regions outside New York City had a different trajectory. Non-NYC regions, which had 1,345 PCMH providers in 2011, grew to 2,298 in 2012, an increase of 71 percent. However, between 2012 and 2013 this rate of growth declined sharply, to only 3 percent. Non-NYC regions’ share of the state’s total PCMH providers grew from 40 percent in 2011 to roughly 50 percent in 2012, and remained at that level in 2013. Regional Differences in Growth Outside New York City, the number of PCMH providers grew substantially between 2011 and 2013 in all upstate regions, particularly in Syracuse (Figure 16). In New York City (Figure 17), there was less impressive growth, roughly equivalent across the boroughs, with the exception of Staten Island. Growth in the number of PCMH providers between 2011 and 2013 was evenly spread across all practice types (Figure 18), with the exception of the Health and Hospitals Corporation, which had already achieved NCQA recognition for essentially all of its primary care clinics by 2011. Looking at the growth in PCMH providers on a year-by-year basis shows a somewhat different picture. As is shown in Figure 19, there are indications that, after rapid expansion in the adoption of the PCMH model between 2011 and 2012 (when the number of PCMH providers in the state grew by 37 percent), the rate of growth in the PCMH model leveled off in 2013 to a rate of only 5 percent. That decline in the rate of growth was statewide: each of the non-NYC regions grew at roughly the statewide average between 2012 and 2013 (Figure 20) and—with the exceptions of Queens and Staten Island—in New York City (Figure 21). That phenomenon was evenly spread across practice types as well (Figure 22). Patient-Centered Medical Home Update, 2013 5
  10. 10. Year-by-Year Trends for Each Region Notwithstanding the modest rate of growth over the past year, essentially every region in New York showed a substantial increase in the number of PCMH providers between 2011 and 2013. As is shown in Figures 23-34, the regions varied considerably from one another in numbers of PCMH providers, the types of practices adopting the PCMH model, and patterns of growth. • In Albany/Northeast New York, where the PCMH census was evenly spread among practice types in 2011 (with groups the largest cohort), there was marked growth in groups and hospital clinics in 2012, which held in 2013 (Figure 23). • In Buffalo/Western New York, where the PCMH census was dominated by groups in 2011, there was further growth in groups, as well as in health centers and practices in 2012 and 2013 (Figure 24). • In the Hudson Valley, which was dominated by groups and health centers in 2011, there was further growth in both types in 2012, and in groups in 2013 (Figure 25). • Long Island—which had the lowest PCMH penetration of any region, largely composed of groups—there was slight growth in 2012, which leveled off in 2013 (Figure 26). • In Rochester, where the PCMH census was relatively evenly spread in 2011 among Groups, Health Centers, Hospital Clinics, and Hospital/AMC Practices, there was substantial growth in 2012, driven in large part by an increase in Hospital/AMC practices (Figure 27). • In 2011, Syracuse/Central New York had a comparatively low PCMH penetration; it increased considerably in 2012, driven by a major increase in hospital clinics and groups (Figure 28). Within New York City, the boroughs were 6 United Hospital Fund similarly diverse in the composition and growth trajectories by practice type between 2012 and 2013. • In 2011, New York City as a whole (Figure 29) had a PCMH profile that was quite broadly based, with HHC, hospital clinics, health centers, and hospital/AMC practices all accounting for substantial proportions of the total. In 2012 each showed overall growth, with the largest absolute growth in health centers, HHC, and practices. • The Bronx, whose PCMH profile was more institutionally based in 2011 (including health centers, HHC, hospital clinics, and hospital/AMC Practices), grew in both health centers and HHC (Figure 30). • Brooklyn, which in 2011 had the largest proportion of its PCMHs in HHC (and fewer in groups, health centers, hospital clinics, and practices), showed growth in health centers and hospital clinics (Figure 31). • Manhattan (Figure 32), which in 2011 had a relatively even spread of PCMHs across health centers, HHC, and hospital clinics (and the state’s largest cohort of hospital/AMC practices), grew slightly in all practice types. (Note: the number of PCMH providers shown for hospital clinics in 2011 was overstated as a result of some duplicate reporting; when corrected for that overcount, the net growth in hospital clinics between 2011 and 2013 was in line with that of the other boroughs.) • Queens (Figure 33), which has a stronger presence of groups and small practices than the other boroughs, experienced most of its growth between 2011 and 2013 in small practices. • Staten Island (Figure 34), which had the smallest number of PCMHs of any borough, was spread between groups and practices in 2011, both of which grew slightly in 2012 and 2013.
  11. 11. Conclusion While New York State continues to lead the nation in the adoption of the PCMH model of care, and the medical home model is continuing to grow in New York, that growth appears to be leveling off. In addition, while the statewide growth trajectory has been impressive, it masks substantial variation in the adoption of the PCMH model by practice type and region. To date, the model’s greatest penetration has been among larger practices that have the scale and infrastructure required to operate as a medical home. Considerable investment and effort—and better alignment between payers and providers—will be necessary to increase the adoption of the medical home model among smaller practices, which often lack the resources to mount and sustain the PCMH model. Similarly, the substantial variation across the state in the distribution and spread of the PCMH model reflects a series of region-specific factors, including (and perhaps especially) the underlying composition of the regions’ primary care systems. This argues for the use of regionspecific approaches to stimulating and supporting further growth in medical homes across the state. Further discussion of these issues is included in an accompanying issue brief, Advancing PatientCentered Medical Homes in New York, available on the United Hospital Fund’s website, www.uhfnyc.org. Patient-Centered Medical Home Update, 2013 7
  12. 12. Figures 1-13: PCMH Status as of July 2013 P 8 United Hospital Fund 1
  13. 13. Figure 1. NCQA-Recognized PCMHs, New York vs. Other States, 2013 Other States, 30,806 83% NYS PCMH, 6,276 17% Note: Includes both practices recognized as PCMH and providers working in those practices. Data as of October 2013; all other figures in this report show data current as of July 2013. Source: National Committee for Quality Assurance. Available at http://recognition.ncqa.org/index.aspx (accessed October 7, 2013). 1 Patient-Centered Medical Home Update, 2013 9
  14. 14. Figure 2. PCMHs (Practices and Providers) in New York, Other States, and the United States State California Florida Illinois Massachusetts Michigan New Jersey North Carolina Pennsylvania New York Texas Washington Other States U.S. Total 2008 Standards 218 515 686 711 556 421 2011 Standards Total in State 2,227 2,445 589 1,104 447 1,133 819 1,530 167 723 307 728 Pctg. of U.S. Total 7% 3% 3% 4% 2% 2% 1,882 605 2,487 7% 1,761 4,859 1,221 594 7,630 21,054 828 1,417 447 364 7,811 16,028 2,589 6,276 1,668 958 15,441 37,082 7% 17% 4% 3% 42% 100% Note: NCQA data include practices recognized as PCMHs and providers working in those practices. Source: NCQA Recognition Directory. Available at http://recognition.ncqa.org/index.aspx (accessed October 7, 2013). 10 United Hospital Fund P 1
  15. 15. Figure 3. New York State Providers in PCMHs, July 2013 NYC, 2533, 52% Non-NYC, 2375, 48% Patient-Centered Medical Home Update, 2013 1 11
  16. 16. Figure 4. Non-NYC Providers in PCMHs, by Region, July 2013 600 500 400 300 200 100 0 Albany/NE NY Buffalo Area Hudson Valley L.I. Rochester Area P 12 United Hospital Fund Syracuse/Cent NY 1
  17. 17. Figure 5. NYC Providers in PCMHs, by Borough, July 2013 1,200 1,000 800 600 400 200 0 Bronx Kings New York Queens Richmond 1 Patient-Centered Medical Home Update, 2013 13
  18. 18. Figure 6. New York State Providers in PCMHs, by Practice Type, July 2013 Practice, 472, 9% Group, 1459, 30% Hosp Px, 583, 12% Hosp Clinic, 875, 18% Health Ctr, 973, 20% HHC, 546 11% P 14 United Hospital Fund 1
  19. 19. Figure 7. Non-NYC Providers in PCMHs, by Practice Type, July 2013 Hosp Px 194 8% Practice 187 8% Hosp Clinic 389 16% Group 1,181 50% Health Ctr 424 18% 18 U d Hospital Fund Patient-Centered Medical Home Update, 2013 15
  20. 20. Figure 8. NYC Providers in PCMHs, by Practice Type, July 2013 Practice 285 11% Group 278 11% Hosp/AMC Px 389 15% Health Ctr 549 22% Hosp Clinic 486 19% HHC 546 22% P 16 United Hospital Fund 1
  21. 21. Figure 9. Non-NYC Providers in PCMHs, by Region and Practice Type, July 2013 600 500 400 300 200 100 0 Albany/NE NY Buffalo Area Group Health Ctr Hudson Valley HHC L.I. Hosp Clinic Rochester Area Syracuse/Cent NY Hosp Px Practice 2 Patient-Centered Medical Home Update, 2013 17
  22. 22. Figure 10. NYC Providers in PCMHs, by Borough and Practice Type, July 2013 1,200 1,000 800 600 400 200 0 Bronx Group Kings Health Ctr New York HHC Hosp Clinic Queens Hosp Px P 18 United Hospital Fund Richmond Practice 2
  23. 23. Figure 11. New York State Providers in PCMHs, by NCQA Program and Level, July 2013 Level 1: 10 (0%) Level 2: 57 (1%) Level 3: 936 (19%) Level 1: 405 (8%) Level 3: 3,317 (68%) Level 2: 183 (4%) 2 Patient-Centered Medical Home Update, 2013 19
  24. 24. Figure 12. New York State Providers in Practices Recognized Under NCQA’s 2008 Standards as Level 1 and Level 2 PCMHs (N=588 Providers) 180 160 140 120 100 80 60 40 20 0 Level-1 Level-2 Group 64 30 Health Ctr 65 39 Hosp Clinic 70 81 Hosp Px 47 16 P 20 United Hospital Fund Practice 159 17 2
  25. 25. Figure 13. Proportion of New York State Providers in Practices Recognized Under NCQA’s 2008 Standards as Level 1 and Level 2 PCMHs, July 2013 40% 35% 30% 25% 20% 15% 10% 5% 0% Group 2008 Levels 1 and 2 6% Health Ctr 11% HHC 0% Hosp Clinic 17% Hosp Px Practice 11% 37% 2 Patient-Centered Medical Home Update, 2013 21
  26. 26. Figures 14-22: Growth in PCMH Adoption, July 2011 to July 2013 2 22 United Hospital Fund
  27. 27. Figure 14. Number of New York State Providers in NCQA-Recognized PCMHs, 2011 and 2013 6,000 5,000 4,000 3,000 2,000 1,000 0 PCMH Providers in NYS % Growth 2011 3,399 2013 4,908 44% P 2 Patient-Centered Medical Home Update, 2013 23
  28. 28. Figure 15. Growth in PCMH Providers, NYC vs. Rest of State, 2011-2013 3,000 2,500 2,000 1,500 1,000 500 0 2011 2012 2013 2 24 United Hospital Fund NYC 2,054 2,366 2,533 Non-NYC 1,345 2,298 2,375
  29. 29. Figure 16. Changes in Non-NYC PCMH Providers by Region, 2011-2013 600 2011 2013 500 400 300 200 100 0 Albany/NE NY Buffalo Area Hudson Valley L.I. Rochester Area Syracuse Central NY P 2 Patient-Centered Medical Home Update, 2013 25
  30. 30. Figure 17. Changes in NYC PCMH Providers by Borough, 2011-2013 1,200 2011 2013 1,000 800 600 400 200 0 Bronx 3 26 United Hospital Fund Brooklyn Manhattan Queens Staten Island
  31. 31. Figure 18. Changes in New York State PCMH Providers by Practice Type, 2011-2013 1,600 2011 2013 1,400 1,200 1,000 800 600 400 200 0 Group Health Ctr HHC Hosp Clinic Hosp Px P Practice 3 Patient-Centered Medical Home Update, 2013 27
  32. 32. Figure 19. Number of New York State Providers in NCQA-Recognized PCMHs, 2011-2013 6,000 5,000 4,000 3,000 2,000 1,000 0 PCMH Providers in NYS % Growth vs Prior Year 3 28 United Hospital Fund 2011 3,399 2012 4,664 37% 2013 4,908 5%
  33. 33. Figure 20. Changes in Non-NYC PCMH Providers by Region, 2012-2013 500 2012 2013 400 300 200 100 0 Albany/NE NY Buffalo Area Hudson Valley L.I. Rochester Area P Syracuse Central NY 3 Patient-Centered Medical Home Update, 2013 29
  34. 34. Figure 21. Changes in NYC PCMH Providers by Borough, 2012-2013 1200 2012 2013 1000 800 600 400 200 0 Bronx 3 30 United Hospital Fund Brooklyn Manhattan Queens Staten Island
  35. 35. Figure 22. Changes in New York State PCMH Providers by Practice Type, 2012-2013 1,600 2012 1,400 2013 1,200 1,000 800 600 400 200 0 Group Health Ctr HHC Hosp Clinic Hosp Px P Practice 3 Patient-Centered Medical Home Update, 2013 31
  36. 36. Figures 23-34: Year-by-Year Trends by Region, 2011-2013 P 32 United Hospital Fund 3
  37. 37. Figure 23. Albany/Northeast New York 250 200 150 100 50 0 Group Health Ctr 2011 Hosp Clinic 2012 Practice 2013 3 Patient-Centered Medical Home Update, 2013 33
  38. 38. Figure 24. Buffalo Area 300 250 200 150 100 50 0 Group Health Ctr Hosp Clinic 2011 2012 Hosp Px 2013 P 34 United Hospital Fund Practice 3
  39. 39. Figure 25. Hudson Valley 350 300 250 200 150 100 50 0 Group Health Ctr 2011 Hosp Px 2012 Practice 2013 4 Patient-Centered Medical Home Update, 2013 35
  40. 40. Figure 26. Long Island 140 120 100 80 60 40 20 0 Group Health Ctr 2011 Hosp Px 2012 Practice 2013 4 36 United Hospital Fund
  41. 41. Figure 27. Rochester Area 140 120 100 80 60 40 20 0 Group Health Ctr Hosp Clinic 2011 2012 Hosp Px Practice 2013 4 Patient-Centered Medical Home Update, 2013 37
  42. 42. Figure 28. Syracuse/Central New York 250 200 150 100 50 0 Group Health Ctr Hosp Clinic 2011 38 2012 Hosp Px Practice 2013 United Hospital Fund P 4
  43. 43. Figure 29. New York City 700 600 500 400 300 200 100 0 Group Health Ctr HHC 2011 Hosp Clinic 2012 Hosp Px Practice 2013 Patient-Centered Medical Home Update, 2013 4 39
  44. 44. Figure 30. Bronx 200 150 100 50 0 Group Health Ctr HHC 2011 40 Hosp Clinic 2012 Hosp Px Practice 2013 United Hospital Fund P 4
  45. 45. Figure 31. Brooklyn 180 160 140 120 100 80 60 40 20 0 Group Health Ctr HHC 2011 Hosp Clinic 2012 Hosp Px Practice 2013 Patient-Centered Medical Home Update, 2013 4 41
  46. 46. Figure 32. Manhattan 350 300 250 200 150 100 50 0 Group Health Ctr HHC 2011 Hosp Clinic 2012 Hosp Px Practice 2013 Note: The number of PCMH providers shown for hospital clinics in 2011 was overstated as a result of some duplicate reporting; when corrected for that overcount, the net growth in hospital clinics between 2011 and 2013 was in line with that of the other boroughs. 42 United Hospital Fund P 4
  47. 47. Figure 33. Queens 120 100 80 60 40 20 0 Group HHC Health Ctr 2011 2012 Hosp Clinic Practice 2013 Patient-Centered Medical Home Update, 2013 43
  48. 48. Figure 34. Staten Island 16 12 8 4 0 Group Practice 2011 44 2012 2013 United Hospital Fund P 4
  49. 49. Shaping New York’s Health Care: Information, Philanthropy, Policy. 1411 Broadway 12th Floor New York, NY 10018 (212) 494-0700 http://www.uhfnyc.org ISBN 1-933881-38-0

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