Patient-Centered Medical Home: NYSDOH Office of Health Insurance Programs
Chapter 58 of the Laws of 2009 authorized the New York State
Department of Health to implement an initiative to incentivize the
development of patient-centered medical homes to improve health outcomes
through better coordination and integration of patient care.
Incentive payments have commenced for visits performed on or after July
1, 2010 to office-based physicians' and registered nurse practitioners' practices, Federally Qualified Health Centers (FQHCs), and Diagnostic and Treatment Centers (D&TCs) recognized by New York State Medicaid and the National Committee for Quality Assurance (NCQA) as patient-centered medical homes. Medicaid incentive payments for Article 28 hospital outpatient departments (OPDs) currently are available only for Medicaid managed care. Providers will be notified in a later edition of the Medicaid Update when further information is available. An index of all Medicaid Update medical home articles is available at the NYSDOH Web site.
The New York State Department of Health's Office of Health Insurance Programs is sponsoring a project where IPRO assists primary care practices to achieve National Committee for Quality Assurance (NCQA) medical home recognition at either a Level 1, 2, or 3 (http://www.ncqa.org/tabid/631/Default.aspx)
We are currently not recruiting for this project.
The patient-centered medical home (PCMH) is an approach to providing comprehensive care. PCMH facilitates partnerships between individual patients, their personal physicians, and when appropriate, the patient's family.
IPRO will be able to assist a limited number of practices. Participants must commit to applying to NCQA for PCMH recognition within 6-12 months of joining the project. Article 28 hospital clinics, diagnostic treatment centers, community health centers and other office-based practitioners are eligible to participate in this project. Participating practices must have at least thirty per cent of their active patients covered by Medicaid (fee-for service or managed care), Child Health Plus, Family Health Plus insurance or be uninsured (total aggregated across all these categories is at least 30%). There is no financial charge to participants.
Project Objectives:
- Recruit and assist eligible ambulatory care practices to achieve National Committee for Quality Assurance (NCQA) medical home recognition (either levels 1,2,3) [Enhanced Medicaid payments for Level 1 will only be available through December 2012.]
- Promote a preferred set of monitored clinical conditions such as asthma and diabetes, that must be part of the medical home recognition process and assist practices in quality improvement in those conditions
- Promote and facilitate both short and longer term adoption of electronic health records (EHRs) as to be defined by the National Coordinator for Health Information Technology Health Information Technology Policy Committee
NCQA recognizes practices that meet specific criteria. A practice is defined as an individual clinician or a group of clinicians practicing together at a single geographic location.
NCQA PCMH 2011 has six standards, they are:
- Enhance access and continuity
- Identify and manage patient populations
- Plan and manage care
- Provide self-care support and community resources
- Track and coordinate care
- Measure and improve performance
In March 2007, the American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), and American Osteopathic Association (AOA) developed a set of joint principles to describe the characteristics of the PCMH.
- Personal physician - each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
- Physician directed medical practice - the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
- Whole person orientation - the personal physician is responsible for providing for all the patient's health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life including acute care, chronic care, preventive services, and end of life care.
- Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient's community (e.g., family, public and private community based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
- Quality and safety are hallmarks of the medical home:
- Practices advocate for their patients to support the attainment of optimal, patient-centered outcomes that are defined by a care planning process driven by a compassionate, robust partnership between physicians, patients, and the patient's family.
- Evidence-based medicine and clinical decision-support tools guide decision making physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement.
- Patients actively participate in decision-making and feedback is sought to ensure patients' expectations are being met.
- Information technology is utilized appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication
- Practices go through a voluntary recognition process by an appropriate non-governmental entity to demonstrate that they have the capabilities to provide patient centered services consistent with the medical home model.
- Patients and families participate in quality improvement activities at the practice level.
- Enhanced access to care is available through systems such as open scheduling, expanded hours and new options for communication between patients, their personal physician, and practice staff.
- Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home. The payment structure should be based on the following framework:
- It should reflect the value of physician and non-physician staff patient-centered care management work that falls outside of the face-to-face visit.
- It should pay for services associated with coordination of care both within a given practice and between consultants, ancillary providers, and community resources.
- It should support adoption and use of health information technology for quality improvement;
- It should support provision of enhanced communication access such as secure e-mail and telephone consultation;
- It should recognize the value of physician work associated with remote monitoring of clinical data using technology.
A medical home is not a physical building but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective (AAP).
Project contacts:
Thomas Lemme, PA-C, MBA, AE-C
Performance Improvement Coordinator
tlemme@ipro.org
516 326-7767, ext 635
Veronica Pryor, RN, MPA, AE-C
Project Manager
vpryor@ipro.org
516 326-7767, ext. 631
Alan Silver, MD, MPH
Medical Director
asilver@ipro.org
516 326-7767, ext 509
The Patient-Centered Medical Home™(PCMH™) Recognition Program is developed, owned and managed by the National Committee for Quality Assurance (NCQA). To learn more about PCMH 2011, refer to the program's Web site at http://www.ncqa.org/tabid/631/Default.aspx. NCQA is not involved in any determination of clinician incentive payments under the New York State Medicaid Medical Home Program.