# Primary Care Transformation in Puerto Rico's Physician Organizations Following Hurricane Maria

> **NIH NIH R01** · RAND CORPORATION · 2022 · $775,772

## Abstract

Project Summary/Abstract
 In September 2017, Hurricane Maria brought unprecedented devastation to Puerto Rico. The Hurricane’s
impact was disproportionately borne by elderly patients and residents of remote areas of Puerto Rico who were
vulnerable to disruptions in health care services. Providers and policymakers are currently seeking to make
major investments in Puerto Rico’s primary care delivery system that were outlined in Puerto Rico’s recovery
plan. However, the ability of Puerto Rico’s physician organizations (POs) to undertake large-scale primary care
transformation remains unclear. In particular, POs might differ widely in both their existing primary care
infrastructure as well as the level of technical or financial support they typically receive to implement new
infrastructure from the health systems or independent physicians associations with which they are affiliated,
from the Medicare Advantage plans and Medicaid managed care organizations with which they contract, or
from the federal government. The proposed study, which builds on an existing collaboration between RAND
and the University of Puerto Rico, will examine four models of physician organization in Puerto Rico: federally
qualified health centers, small independent medical groups, large independent medical groups, and vertically-
integrated medical groups. We will use Medicare fee-for-service claims and Medicare Advantage encounter
data to assess trends in the physician workforce providing care through these four delivery models, the
Medicare beneficiaries who receive care through each model, and changes in both trends following Hurricane
Maria. We will then assess changes in access, quality of care, and care coordination before and after
Hurricane Maria to measure differences in performance across PO models and to identify high-performing POs
and low-performing POs in each model. We will conduct interviews with leaders of 32 of the highest-performing
POs and lowest-performing POs in each model to identify the advanced primary care infrastructure they have
sought to implement as well as implementation barriers. Finally, we will interview Medicare beneficiaries living
with Alzheimer’s disease (or Alzheimer’s disease related dementias) and their caregivers to better understand
their unmet care needs and how these needs differ across the four PO models. The research will be guided
and supported by an Advisory Committee comprising representatives of two local provider associations and
two local patient advocacy groups that represent older adults and people living with Alzheimer’s disease and
Alzheimer’s disease related dementias. The study will help to identify specific models of physician organization
that are associated with higher performance that could help guide Puerto Rico’s Hurricane Maria recovery
effort. Our findings could also help stakeholders prioritize the expansion of specific services that could most
directly improve the lives of patients with Alzheimer’s disease o...

## Key facts

- **NIH application ID:** 10345390
- **Project number:** 1R01AG075508-01
- **Recipient organization:** RAND CORPORATION
- **Principal Investigator:** Justin W. Timbie
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $775,772
- **Award type:** 1
- **Project period:** 2022-03-15 → 2025-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10345390

## Citation

> US National Institutes of Health, RePORTER application 10345390, Primary Care Transformation in Puerto Rico's Physician Organizations Following Hurricane Maria (1R01AG075508-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10345390. Licensed CC0.

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