VOL. 19, NO. 7 n THE AMERICAN JOURNAL OF MANAGED CARE n e263 n clinical n © Managed Care &

T he patient-centered medical home (PCMH) model is being implemented by a growing number of health organizations, with the goal of providing more comprehensive, coordinated, and patient-centered care. The major primary care medical societies have endorsed the PCMH as the desired model for primary care.1 Large health systems and primary care practice collaboratives are imple-menting the PCMH model, and the Centers for Medicare & Medicaid Services is funding PCMH demonstration and innovation projects in diverse clinical sites.2-5 Nonetheless, published evaluations of PCMH initiatives to date have been limited to single-practice or smaller groups of practices, and often focus on limited clinical conditions.3,6-11 In 2010, the Veterans Health Administration (VHA) became the largest integrated US health system to begin implementing the PCMH model at all primary care clinics throughout its nationwide system. The VHA delivers primary care to more than 5 million veterans in 16.4 mil-lion encounters annually—either at 160 large hospital-based primary care facilities, most of which are in urban areas, or 783 Community