Chapter 10 Real-World Case Assignment The patient-centered medical home (PCMH) i

Question

Chapter 10 Real-World Case Assignment

The patient-centered medical home (PCMH) is a model of VBP and P4P systems. As stated in the textbook, PCMH initiatives are often organized by health plans, states, payers, providers, or multi-stakeholder groups. PCMHs are being widely implemented with a four-fold increase in the number of PCMH initiatives between 2009 and 2013 (Edwards et al. 2014, 1829). This trend is expected to continue because the PCMH model of care is endorsed by federal and state health agencies.

This Real-World Case focuses on the organization of PCMHs by states. Many states have adopted policies and programs to advance PCMHs. Go to the website of the National Academy for State Health Policy (NASHP) to learn about PCMHs in the states:

http://www.nashp.org/med-home-map

Questions and Application Activity

1. Click on the Medical Home tab, then click on “About medical homes”, look over the map. How many states have Multi-Payer programs?

2. Click on the link in the above paragraph titled “Patient-Centered Primary Care Collaborative”, change from State View to List View, enter Oregon in the State field and choose Multi-Payer in the Payer Type field, click “Apply”. Multi-payer medical homes, PCMH initiatives may involve patients that have multiple, different insurance companies and public payers; such as federal Blue Cross Blue Shield, TRICARE, Medicaid, and other payers; and multiple providers. These multi-stakeholder groups may develop payment methods through collaborative processes. Click on “Oregon Comprehensive Primary Care Initiative” and give the Number of Practices, a list of payers and what is the payment model?

3. Click on the “About health homes” on the home page, then click on the CMS website link and click on the link “Map of State Health Home Activity” . Section 2703 of the Affordable Care Act gives state Medicaid programs the option of establishing health homes. Health homes provide a comprehensive system of care coordination for Medicaid beneficiaries with chronic conditions. In health homes, providers treat the “whole-person” across the lifespan by integrating and coordinating all primary care, acute inpatient care, behavioral health, and long-term services and supports. Review the map on the CMS website and answer the following; How many states have approved Medicaid Health Home plans and Does Oregon have any Medicaid Health Home plans?

4. Now go to the following website - http://www.oregon.gov/oha/HPA/CSI-PCPCH/Pages/Standards.aspx, find the article titled; National Committee for Quality Assurance and Oregon PCPCH Recognition. As an example of national standards, the National Commission for Quality Assurance (NCQA) has standards for PCMHs (2014). The standards are in the areas of patient-centered access, team-based care, population health management, care management and support, care coordination and care transitions, and performance measurement and quality improvement. Is the NCQA model identical to the Oregon model and will Oregon accept the NCQA recognition?

5. On the Oregon Health Authority site click on the tab for Payment Incentives. Read “Primary Care Payment Reform Collaborative”, What is the objective of the Collaborative?

Click on the Recognized Clinics tab and name 2 Patient Centered Primary Care Homes (PCPCH) practices in Eugene or Springfield.

Explanation / Answer

National Academy for State health Policy is an policy makers. They are helping states excellence in health policy and practices.
1, According to NASHP, as of April 2013, 43 states have adopted policies and programes to advance Medical homes. Importantly for behavioral health organization, the NASHP map also includes information about section 2703 health homes, established under the Affordable Care Act.
2, Oregon: Statewide.
   Number of providers: 70/517
   Medicare Benificiaries served: 49,000
Payment Model:
Monthly care management fees for Medicare Fee-for-service Beneficiaries:
--- CMS will pay participating practices a risk adjusted,monthly care management fee for their medicare Fee- for-service beneficiaries. For the first two years of the initiative, the per-beneficiary,per-month (PBPM) amount will average out to $20, for years 3 and 4, the PBPM will be reduced to an average of $15.
Shared savings in medicare Fee-for -service:
   ----This is to provide health care to patients who receive from primary care practices.
3, Medicaid health Homes: 15 states have atleast one health home program in place.This update profile health home programs in the nine states that have taken up the option in the intervening two years.
   Oregon was far ahead of the pack on medicaid expansion and reform. Medicaid to cover people with incomes up to 100percent of poverty two decades ago, in1994. Federal goverment is paying the full cost of expansion through 2016,and will always pay atleast 90percent of the cost of covering the newly-insured people.
4, Both models require continuous access to clinical advice,PCMH has an additional requirement that clinical advice care provided after,hours does not conflict with patient'ss medical record.
Oregon largest physician group comprising more than 2,800 primary care and specially physicians,announced that three clinics,the first in oregon have been officially recognized by NCQA in its new recognition program for specialists who work with primay care.
5, understand the role behavioral health integration for effectively addressing NCQA PCMA recognition standards and responding to the complex health care.
   In october 2011 we wre among the first clinics in the state to be certified by the state of oregon as a tier 3 patients certered primary care home. In August 2012 we were one of 75primary care clinics in oregon....

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