This journal article presents findings from CMS’s Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration – through which Medicare, Medicaid, and private payers offered supplemental payments to 849 primary care practices. Since there was variation in the eight participating states’ demonstration designs, experiences, and outcomes, we used a case-ordered predictor-outcome matrix to identify the factors that differentiated states that generated net savings for Medicare from the states that did not. A majority of the states that generated savings: required practices to be recognized patient-centered medical homes to enter the demonstration; did not allow late entrants into the demonstration; used a consistent demonstration payment model across payers; and offered practices opportunities to earn performance bonuses. Practices in states that generated savings also reported receiving demonstration payments and bonuses as expected, without any issues. Designers of future medical home initiatives may increase their likelihood of generating savings by incorporating the initiative features we identified.

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