State Medicaid Programs Drive PCMH Initiatives Forward

April 04, 2013 04:45 pm News Staff

State Medicaid programs continue to serve as a vanguard for the patient-centered medical home (PCMH) movement.

By the end of 2012, 26 state Medicaid programs had launched PCMH initiatives on a state, regional or local level, thereby providing impetus for the PCMH, as well as lessons for public and private payers on how to implement and sustain innovative payment and delivery models. That's according to Mary Takach, R.N., M.P.H., program director for the National Academy for State Health Policy and author of a Health Affairs article( published in November.

[Stock photo of physician examining a young girl's ear]

"Without Medicaid, there may not have been medical home initiatives at all in many states," said Takach in a recent interview with AAFP News Now.

In the Health Affairs article, Takach pointed out that "early Medicaid patient-centered medical home initiatives primarily served mothers and children."

"Because of budget pressures, compelling evidence about ability to improve the quality of care and lower costs with a focus on high-risk patients, and new opportunities through the (Patient Protection and) Affordable Care Act (ACA), states are now adapting early initiatives or developing new ones to service their most costly populations -- patients with chronic conditions," Takach said in the article.

Takach cited Minnesota's Medicaid program as an example, saying that the state was "an early innovator in efforts to focus on chronically ill populations." As part of that process, the state "designed a care management fee that was adjusted according to the number of a patient's chronic conditions and that was added to a practice's fee-for-service payments."

"The adjustment was designed to take into account the time and resources -- including staff and information technology -- that a primary care practice required to manage the care of patients with complex conditions," according to the article.

The ACA, meanwhile, also provided impetus for Medicaid PCMH initiatives to focus on the chronically ill. The law gives Medicaid agencies with an approved state plan amendment a 90 percent federal match for two years to provide health home services when specific criteria are met.

"Health homes described in section 2703 of the act share many features with patient-centered medical homes, but the law requires that states focus services on chronically ill populations," according to the article.

In the area of lessons learned, the initiatives have demonstrated that payers need to help practices with the transformation process and that the transformation process itself takes time, said Takach. "Payers need to come prepared knowing that they need to help practices with the transformation, or practices will not transform."

Moreover, said Takach, "the return on the (PCMH) investments are not going to be seen in a year and probably won't be seen in two years or maybe even three years."

Increasingly, Medicaid PCMH programs are using shared teams or networks for their PCMH initiatives, thus giving small practices access to ready-made infrastructures and allowing them to employ the services of a care coordinator or behavioral health specialist as part of the PCMH package, according to Takach.

"In 2012, Alabama, Maine, Michigan and Minnesota added shared, locally based teams or networks to help practices -- particularly small ones -- become medical homes and to provide resources to better address the need of Medicaid patients with complex conditions," said the Health Affairs article. "The shared teams may include registered nurses, behavioral health specialists, pharmacists, nutritionists and community health workers; teams are often based at a hospital or community health center."

Before 2012, four states -- New York, North Carolina, Oklahoma and Vermont -- had team or network care models, according to the article.