The Adirondack medical home demonstration: A case study

With the passage of the Affordable Care Act (ACA), the next phase of health reform is now under way. The focus is shifting from laying a new foundation for national policy to actually building it at the local and regional level. Evidence indicates that most successful models occur within integrated delivery systems. One promising integrated effort in New York is the Adirondack Medical Home Demonstration (AMHD). In the northeast corner of the state, providers, payers, and the state government have been working together for four years to improve the way primary care is delivered in the region by implementing the principles of the patient-centered medical home in roughly 40 primary care practices. This pilot project is testing the effect of implementing advanced patient-centered medical homes in an entire region that is rural and underserved. The purpose of this case study is to describe the Adirondack initiative, and to draw from it some lessons that may be useful to other regions in New York State and the entire nation.