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

1) There are currently 18 states with Multi-payer programmes in the USA.

2) a) The number of practices in the state of Oregon are 70 in number.

b) There are 7 payers and the list of payers is as follows,

i)Medicare,

ii) care oregon,

iii)Oregon Health Authority (Medicaid FFS),

iv)Providence Health Plans,

v)Regence BlueCross BlueShield,

vi)Teamsters Multi-Employer Taft Hartley Funds and

vii) Tuality Health Alliance

c) The selected practices are payed by medicare in PBPM model i:e per-beneficiary per-month, with risk adjusted care management fee ranging for $8 to 40$. With an average of $20 PBPM for care management fees for intial 2 years( as per Comprehensive primary care initiative), and From the year 3 to 4 care management fees will average $15 PBPM.Medicare will also introduce shared savings component beginning in Year 2(calculated at the market level)

The non-medicare participating payers are expected to follow paying per-member per-month (PMPM) care management fees model, to participating practices. Which is similar to the medicare payment framework.

3)a) As on December, 2017, 21 states had approved 'Medicaid Health Home plans'.

b) The state of Oregon does not have the 'Medicaid Health Home plans'.

4) NCQA model is not identical to the Oregon primary care model ( barring a few similarities) . And
The state of oregon will accept the NCQA recognised patient centered medical homes.

5)
a) The objective of the collaborative are as follows
i) Sharing best practices which support primary care and improve it, among the participants.
ii) Working together for seeking alignment and agreement around primary care reimbursement.
iii)To improve health and patient care for the population of Oregon. And also to control the health care costs across oregon

b) 2 Patient Centered Primary Care Homes (PCPCH) practices in Eugene are,

i) 4J Wellness Clinic
ii) CHCLC - Brookside Clinic

2 Patient Centered Primary Care Homes (PCPCH) practices in Springfield are,
i) CHCLC - RiverStone Clinic
ii) Springfield Family Physicians

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