This project will evaluate a unique demonstration of a patient-centered medical home model being launched in Colorado and Ohio by five of the nation's leading insurers. A key component of the demonstration is a new payment system featuring a monthly, per-member care management fee and performance-based bonuses. Because the study will be led by the same Fund-supported research team currently assessing a multipayer demonstration in Rhode Island, data from three very different states will be available to see how contextual factors affect medical home adoption. Project staff will examine the implementation of the model and its impact on clinical quality, process outcomes, health care spending, patients' experiences, and satisfaction of practice staff.