In April 2010, the U.S. Veterans Health Administration (VA) embarked on an ambitious three-year plan to build patient-centered medical homes in more than 900 primary care clinics across the nation. Its model organizes care around an interdisciplinary team of providers who work together to increase access and clinical effectiveness by identifying and removing barriers to high-quality care. To build the teams, the VA allocated more than $227 million to hire additional clinical staff and instituted a nationwide training program that is supplemented by provider participation in regional learning collaboratives. The program has in one clinic shortened the waiting time for appointments from as long as 90 days to same-day access, reduced the percentage of inappropriate emergency department visits from 52 percent to 12 percent, and in just three months reduced hemoglobin A1c scores by at least one point in 33 percent of patients with poorly controlled diabetes.

This study was based on publicly available information and self-reported data provided by the case study institution(s). The aim of Commonwealth Fund–sponsored case studies of this type is to identify institutions that have achieved results indicating high performance in a particular area of interest, have undertaken innovations designed to reach higher performance, or exemplify attributes that can foster high performance. The studies are intended to enable other institutions to draw lessons from the studied institutions' experience that will be helpful in their own efforts to become high performers. Even the best-performing organizations may fall short in some areas or make mistakes—emphasizing the need for systematic approaches to improve quality and prevent harm to patients and staff. The Commonwealth Fund is not an accreditor of health care organizations or systems, and the inclusion of an institution in the Fund's case study series is not an endorsement by the Fund for receipt of health care from the institution.