Obama Says New Medical Home Demonstration Project Will Focus on CHCs

The Obama administration has approved a patient-centered medical home, or PCMH, demonstration project for Medicare beneficiaries who rely on community health centers, or CHCs, as one of their main sources of care.

President Obama announced the creation of the PCMH demonstration project during a Dec. 9 White House press conference. The purpose of the project is to "evaluate the benefits of the medical home model of care that many of our health centers aspire to," said Obama.

According to a White House press release, Obama directed HHS to implement a demonstration project that would evaluate the effect of the medical home practice model on access, quality and the cost of care.

"Because community health centers already provide comprehensive health care to people who face the greatest barriers to accessing care, these demonstration projects have the potential to support and improve the care delivered not only to Medicare beneficiaries, but also to others who rely on community health centers for primary care," said HHS Secretary Kathleen Sebelius in the press release.

CHCs deliver care to more than 20 million patients at about 7,500 sites throughout the country, but only about 8 percent of health center patients are Medicare recipients, according to Dan Hawkins, senior vice president for public policy and research for the National Association of Community Health Centers, or NACHC.

The CHC medical home demonstration will be a separate and distinct project from a three-year Medicare medical home demonstration project created as part of the Tax Relief and Health Care Act of 2006 and involving about 400 practices, 2,000 physicians and 400,000 Medicare beneficiaries. CMS still is waiting to receive final approval to conduct that medical home demonstration project.

CMS plans to start soliciting applications for the CHC demonstration project in the spring with the goal of implementing the three-year project in 2011, according to the White House press release. The agency will pay participating health centers a monthly care management fee for each Medicare beneficiary they enroll into the demonstration. The agency also will provide a payment for any other covered Medicare services the centers furnish. The White House has not said how many centers will participate or how much they will be paid for serving as medical homes.

To participate, CHCs will need to demonstrate that their clinic sites have the capacity to deliver continuous and coordinated care across providers and settings, including improving access to care by expanding service hours, facilitating and following up on referrals, and managing medications provided by different physicians, according to the press release.

During the Dec. 9 press conference, Obama said the idea behind the medical home is "very simple -- that in order for care to be effective, it needs to be coordinated."

"It's a model where the center that serves as your medical home might help you keep track of your prescriptions or get the referrals you need or work with you to develop a plan of care that ensures your providers are working together to keep you healthy," Obama said.

AAFP President Lori Heim, M.D., of Vass, N. C., who attended the press conference, said, "There is no doubt in my mind the president understands the value of the medical home. The president can articulate the value of primary care, and he can articulate the value of the medical home because he understands it and he believes in it."

Hawkins, of NACHC, said most CHCs already serve as PCMHs by their inherent role. "We believe the vast majority of CHCs already exhibit many or most of the features of a medical home," said Hawkins. "The centers provide continuous care even through changes in health or insurance coverage status, and they take steps to make sure care is accessible."

The real question is whether the centers make a difference in the health of their patients, Hawkins said. Numerous studies have documented the effectiveness of the centers in improving quality and reducing costs, findings acknowledged by the president, he noted.

"Studies show that people living near a health center are less likely to go to the emergency room and less likely to have unmet critical medical needs," said Obama during the press conference. "CHCs are proven to reduce ethnic and racial disparities in care. And the medical expenses of regular CHC patients are nearly 25 percent lower than those folks who get their care elsewhere."