CareOregon: Transforming the Role of a Medicaid Health Plan from Payer to Partner - The Commonwealth Fund

CareOregon, a Portland, Oregon-based nonprofit Medicaid health plan, developed two innovative programs to help optimize care for its enrollees: a patient-centered medical home initiative in safety-net clinics and a multidisciplinary case management program for members at high risk of poor health outcomes. To implement these programs, the health plan emphasizes the use of learning communities through which independent providers can acquire, share, and practice techniques to achieve three goals: improve population health, enhance the patient experience of care, and reduce the rate of increase in the per capita cost of care. These goals are the focus of the Triple Aim, an Institute for Healthcare Improvement initiative that is helping CareOregon define and reach its goals. By partnering with health care providers to create and pursue a common vision for improving primary care delivery, CareOregon is transforming its role from payer to integrator of care on behalf of its members.

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Specialist Physician Practices as Patient-Centered Medical Homes | Health Care Reform Center

by awrence P. Casalino, M.D., Ph.D., Diane R. Rittenhouse, M.D., M.P.H., Robin R. Gillies, Ph.D., and Stephen M. Shortell, Ph.D., M.P.H.

During the past few years, widespread support has emerged for the patient-centered medical home (PCMH) model of health care delivery. The PCMH combines traditional concepts of primary care (a personal physician providing first-contact, continuous, and comprehensive care) with newer responsibilities to systematically improve the health of the medical home’s patient population (e.g., through the use of chronic disease registries, information technology, and new options for communication between patients and the practice). The framework for the model was created by the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and the American Osteopathic Association (AOA)1 and has been endorsed by the American Medical Association (AMA) and several medical specialty associations, including the American College of Cardiology, the American College of Chest Physicians, and the American Academy of Neurology. This model is a prominent component of the health care reform bill recently signed by President Barack Obama and is being tested in dozens of pilot projects around the country; it has been promoted by the Patient-Centered Primary Care Collaborative, a coalition of more than 500 large employers, consumer groups, health plans, labor unions, and physician and hospital organizations.

Some specialist physicians are raising concerns about the medical home’s implications for their practices. Proponents of the model advocate reforms that would increase payments to practices that qualify as medical homes; these payments might well come, directly or indirectly, from funds that would otherwise have been used to pay specialists. In addition, some specialists who see patients frequently for a chronic disease believe that their practice should be able to serve as the medical home for those patients.2 For example, in recent testimony before a Senate committee, a representative of the Alliance of Specialty Medicine criticized the planned medical home demonstration project of the Centers for Medicare and Medicaid Services (CMS) for excluding surgeons and argued that a urology practice may be the most appropriate PCMH for patients with prostate cancer or bladder-control problems.3 The AMA House of Delegates recently passed a resolution in support of permitting specialist practices to serve as medical homes.
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Incremental Cost Estimates for the Patient-Centered Medical Home - The Commonwealth Fund

Despite wide and growing interest in the medical home approach, little is known about the costs it entails. This analysis uses data from some three dozen practices to analyze the relationship, if any, between costs and medical home activities. The cost data are from the Medical Group Management Association Cost Survey and from the American College of Physicians Practice Management Check Up Tool for 2006; the medical home data are from the National Committee for Quality Assurance's Physician Practice Connections–Patient-Centered Medical Home recognition tool. The study does not find evidence of additional costs associated with higher levels of "medical homeness," with the exception of information technology costs, which show a modest but statistically significant increase with medical home intensity. The researchers acknowledge that the general lack of an association between costs and medical home intensity may be due to limitations of the data or to the definition of medical home.
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LOUISIANA’S MEDICAID WAIVER PROPOSAL- Is it the Right Fit for Louisiana?

By January Angeles and Judith Solomon in the Center on Budget and Policy Priorities blog

The Department of Health and Hospitals is seeking approval from the legislature to submit a proposal for a section 1115 Medicaid waiver to the U.S. Department of Health and Human Services (HHS). The state claims that the proposal would establish a medical home system like that described in the Health Care Reform Act. However, there are serious questions about whether the design of the Department's plan is appropriate or even possible for Louisiana, because Louisiana lacks the type of managed care organizations on which the plan primarily depends.
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In considering how to move the state forward toward its goal of a medical home system of care, the Louisiana legislature and other policy makers should give careful consideration to alternative approaches, which may be a better fit for Louisiana. In particular, Louisiana's current CommunityCARE program could be enhanced in ways that have been shown to improve outcomes and save money in other states. This alternative approach would be more suited to the state’s current health care environment and infrastructure, and have a higher likelihood of success.

AMA meeting: Delegates back medical home, want pay issues resolved

The American Medical Association united with four other physician organizations on principles for how a patient-centered medical home system should work. But it resolved to study further the contentious issue of doctor payment under such a system.

Medical homes get boost in Louisiana Medicaid reform effort

By Doug Trapp, AMNews staff. Dec. 15, 2008 -- The feasibility of the plan hinges on federal approval of a waiver and the release of hurricane disaster funds. Physician organizations and Louisiana Gov. Bobby Jindal agree that a medical-home model could help Medicaid provide better value to patients with low incomes or disabilities. But they disagree on whether managed care organizations should be the ones overseeing those homes. On Nov. 14, Jindal released a concept paper for Louisiana Health First, his proposal to transform the state's Medicaid program from a disjointed fee-for-service system largely dependent on hospital charity care to a program in which enrollees have their care coordinated by a primary care physician. The proposal also would expand Medicaid to cover approximately 85,000 additional children, parents and caregivers and calls for the construction of a new academic medical center in New Orleans. The Louisiana Chapter of the American Academy of Pediatrics opposes an option in the plan to allow private, for-profit managed care organizations to run the Coordinated Care Networks that would contract with physicians to provide medical homes. Managed care organizations have no track record using the medical-home model for Medicaid enrollees, said Steven B. Spedale, MD, chair of the chapter's Medicaid policy committee.

Building a Medical Neighborhood for the Medical Home

Elliott S. Fisher, M.D., M.P.H. in New England Journal of Medicine Volume 359:1202-1205 September 18, 2008 Number 12 Recent efforts to improve primary care in the United States have focused largely on the development and implementation of practice models and payment reforms intended to create a "medical home" for patients. The notion of a medical home makes intuitive sense and indeed has great promise. But unrealistic expectations about this approach abound, and insufficient attention is being paid to several important barriers to the clinical and financial success of the medical-home model.

No Place Like Home — Testing a New Model of Care Delivery

John J. Inglehart in the New England Journal of Medicine Seeking ways to slow the growth of Medicare spending and to better coordinate the health care it finances, the federal government is preparing to test the concept of the "medical home" in the Medicare program. In response to a mandate in the Tax Relief and Health Care Act of 2006, the staff at the Centers for Medicare and Medicaid Services (CMS) is developing a demonstration program that will operate for 3 years in rural, urban, and underserved areas in up to eight states. Congress has directed the agency to use the program to "redesign the health care delivery system to provide targeted, accessible, continuous and coordinated, family-centered care to high-need populations." Reluctant to constrain the freedom of beneficiaries currently covered under the traditional fee-for-service model, however, Congress placed no limits on patients' freedom to seek treatment, without a referral, from physicians not affiliated with their medical home and made virtually all practices eligible to participate in the demonstration program.

Wonks' Medical Dream Home: Easy to Design, Tough to Build

By John Reichard, CQ HealthBeat Editor Panelists at a Washington, D.C., forum Wednesday offered a sober assessment of the prospects for redesigning the health care system around the concept of a "medical home," but at the same time offered some evidence of its tantalizing potential.

Continuous Innovation in Health Care: Implications of the Geisinger Experience

Through innovations like patient-centered medical homes, chronic disease management, and bundled payment of acute-care episodes, Geisinger Health System in Pennsylvania is improving its quality of care and achieving better outcomes for patients, while at the same time lowering costs and increasing value.

Transforming Safety Net Clinics into Medical Homes: Call for Proposals

The Commonwealth Fund, together with Qualis Health and the MacColl Institute for Healthcare Innovation, have launched a new initiative to transform 50 primary care safety net clinics into patient-centered medical homes. The goal of the Safety Net Medical Home Initiative is to develop and demonstrate a replicable and sustainable implementation model for medical home transformation. Through a request for proposal process, four regional coordinating centers will be selected to help transform 12 to 15 safety net clinics per region--for a total of 50 clinics--into high-performing medical homes. These regional coordinating centers--which could include professional affiliations of safety net providers/practices, state primary care associations, and state Medicaid agencies, among other entities--will receive expert technical assistance and up to $500,000 over four years to support a Medical Home Facilitator, who will lead the clinics through practice transformation and quality improvement exercises. In addition, regional coordinating centers will partner with both the safety net providers and community stakeholders to advance the medical home in Medicaid and pursue other policy reform efforts in their states. Regional Coordinating Center applications are due on November 3, 2008, and can be downloaded at http://qhmedicalhome.org/safety-net/index.cfm. For more information, please contact RFP@qhmedicalhome.org or Kathryn Phillips, M.P.H., Project Manager, at 206-364-9700 ext. 2007.