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Patient-centered home projects

Patient-centered home projects

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Published by Teresa Buckley

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Published by: Teresa Buckley on Feb 04, 2011
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By Courtney Burke and Wendy Weller 
Part I. An Overview of Patient-Centered Medical HomesIntroduction
atient-centered medical homes (PCMHs) are receiving alot of attention lately. PCMHs are an approach to primarycare that is organized around the core relationship be-tween patients and their primary care provider.
Althoughthere is no standard definition of a medical home, there isagreement on many of the principles behind the medical homeconcept. Many of these principles are reflected in the 2007 JointPrinciples of the Patient- Centered Medical Home, a collabora-tive effort of four major primary care specialties.
These princi-ples include an ongoing relationship with a personal physician;enhanced access to care; whole-person-oriented care; safe andhigh quality care that is coordinated across the health care sys-
Patient-CenteredMedicalHomePilotDemonstrationsinNew York
No Longer a Leap of Faith
Rockefeller Institute Page 1 www.rockinst.or WWW.ROCKINST.ORG JANUARY 2011
This brief was written by Courtney Burke, director of the Health Policy Re-search Center at the Nelson A. Rockefeller Institute of Government, with as-sistance from Wendy Weller, associate professor at the School of PublicHealth, State University of New York at Albany, and with research supportprovided by Barbara Stubblebine of the Rockefeller Institute. The authorswish to thank Linda Lambert from the American College of Physicians, NewYork Chapter; Ronda Kotelchuck from the Primary Care Development Corpo-ration; and Dr. Foster Gesten from the New York State Department of Health,for their helpful comments on earlier drafts.
ThePublicPolicyResearch ArmoftheStateUniversityofNewYork
tem; and payment systems that recognize the value of thePCMH. Although not explicitly stated in these principles,PCMHs are expected to lower costs of care and improve pro-vider and patient satisfaction.The joint principles provide an important descriptive andwidely used guide to PCMHs. However, they do not providean operational definition of PCMHs or specify the key elementsrequired to identify a medical home. Many practices and dem-onstration projects rely on an operational definition of PCMHsdeveloped by the National Committee on Quality Assurance(NCQA).
NCQA has developed a set of standards that areused to determine if primary care practices have met the defini-tion of a medical home. NCQA recognizes three levels ofPCMHs using 30 elements, 10 of which are mandatory for prac-tices to be designated as a certified medical home.
By August2010, some 5,000 physicians had received NCQA PCMH recog-nition. Other operational definitions have been developed bystates, purchasers, and professional organizations.Because there is no operational definition of a medicalhome, PCMHs can vary considerably according to how theyare organized and structured, how they are reimbursed, andtypes of provider incentives. However, many medical homesdo share some common elements, such as close patient contactwith a primary care provider and the use of electronic healthrecords. Nationally, at least 14,000 physicians caring for nearly5 million patients were participating in PCMH pilots bymid-2010.
The majority are single payer and utilize athree-component payment model, including traditional fee forservice, per member per month (PMPM) fixed payments, andbonus performance payments.
Although multiyear rigorousevaluations of the PCMH model are still largely underway,PCMHs are taking hold in policy circles as a way to transformhealth care delivery in part because they are included and en-couraged under the new federal health reform law known asthe Patient Protection and Affordable Care Act (PPACA).
Who Is Participating in PCMH in New York?
There are at least eight PCMH pilot demonstrations in NewYork State. Organizations involved in the demonstrations wererecently convened by the New York State Department ofHealth, the American College of Physicians, the Primary CareDevelopment Corporation, and the Rockefeller Institute ofGovernment in an effort to understand the operation, chal-lenges, and opportunities of using PCMHs. This paper de-scribes what was learned about New York’s PCMH pilotsduring the discussion and examines some of the policy implica-tions of PCMHs.The large majority of PCMH demonstrations in New Yorkwere initiated by insurance companies to test whether the useof PCMH could lower costs while improving health outcomes
Rockefeller Institute Page 2 www.rockinst.orHealth Policy Patient-Centered Medical Home Pilot Demonstrations in New York: No Longer a Leap of Faith
for plan enrollees. In one instance, a pilot demonstration wasinitiated by a physician group, and in another, a federally qual-ified health center (FQHC) was a major driver in getting the pi-lot started. Most of the pilots are governed by multiplestakeholders including insurers, the New York State Depart-ment of Health, physician groups, and, in at least one instance,a private corporation.The smallest PCMH pilot began with three physician prac-tices, while the largest involves 50 practices and more than 500physicians. Table 1 outlines the pilots, the timeframe for oper-ating the pilot, the number of sites, and the number of partici-pating practices and physicians.
Quality Metrics
In order for a PCMH to qualify under the NCQA definition,the applicant must meet certain criteria related to access, qual-ity, and care delivery. There are basic elements that practicesmust first pass and three levels of recognition are given. Mostinsurers aim to have a certain number of their sites reach LevelII or Level III NCQA recognition. Most pilots have added qual-ity metrics to their PCMH. Some of these metrics deal with pa-tient satisfaction, while others deal with team vitality ormedical chart data. A summary of some of the primary metricsused by the PCMH demonstrations in New York are summa-rized in Table 2.
The majority of pilots in New York use a per member permonth payment for the number of persons enrolled in a partici-pating practice. The payments range from about $2.50 to $7 permember per month. Most pilots also provide additional
Rockefeller Institute Page 3 www.rockinst.orHealth Policy Patient-Centered Medical Home Pilot Demonstrations in New York: No Longer a Leap of Faith
Pilot Number of Practices Number of Physicians
 Adirondack Region Medical Home Pilot2010-2014 (5 years)40+ (3 geographic pods) 120 MDs, 96 PAs and NPsCDPHP: Enhanced Primary Care(2008-2010)24 87.75 MD FTEsCatholic IPA WNY, Inc.(5+ years)12 (20 by the end of 2010) 50Emblem Health Medical HomeHigh Value Network Project(2008-2010)38 159Independent Health(2008-2011)18 130Excellus and Preferred Care/MVP:Rochester Medical Home Initiative(2009-2012)7 21MVP: Onondaga County(began in 2008)21 50+THINC: Hudson Valley P4PMedical Home Project(3+ years)50 500+
Table 1. An Overview of PCMH Pilots and Participants

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