Maryland Multi-Payor Patient Centered Medical Home Program

Overview

The Patient Centered Medical Home (PCMH) is a model of primary care delivery designed to strengthen the patient-clinician relationship by replacing episodic care with coordinated care and a long‐term healing relationship. It can lower costs of care through its focus on patient self-management and engagement, rather than only disease treatment.

PCMH encourages teamwork and coordination among clinicians and support staff to give patients' better access to care and to take a greater role in making care decisions. Key PCMH components include understanding patients’ preferences and culture, shared decision making between patient and clinician, and patients’ willingness to establish and work toward personal health goals. These concepts, endorsed in the Joint Principles of PCMH, have been adopted by national organizations such as the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians, and many other business and consumer organizations across the United States.

The Joint Principles of the PCMH was published in February 2007 and represents over 333,000 physicians. Additional information on the Joint Principles is located at the following link:

http://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf

PCMH Model for Maryland Patients

  • Integrated care plans for ongoing medical care partnering with patients and their families;
  • Chronic disease management with the assistance of specialized care coordinators;
  • Medication reconciliation for every visit;
  • Increased access to a primary care provider via telephone and available 24 hours daily;
  • Same day appointments for urgent care;
  • Enhanced modes of care communication (e.g.,e‐mail).

Maryland PCMH Pilot Study:

The Maryland Multi-Payor Patient Centered Medical Home Program

The MMPP began a three year pilot study in 2011 to test the PCMH model of care, including 52 primary and multi-specialty practices. The practices are comprised of both private and federally‐qualified health centers located across the State. Maryland law requires the State's four major carriers of fully insured health benefit products (Aetna, CareFirst, CIGNA, Coventry (merged with Aetna) and UnitedHealthcare) to participate in the Maryland Multi-Payor Patient Centered Medical Home Program (MMPP). The Federal Employees Health Benefit Plan, Maryland State Employees Health Benefit Plan, TRICARE, the health care program serving Uniformed Service members.  Plans provided by private employers, such as Maryland hospital systems, have also voluntarily elected to offer this program. Program participants have collaborated with the University of Maryland Department of Family Medicine, Johns Hopkins Community Physicians, and program management staff at the Maryland Health Care Commission, Community Health Resources Commission, and Department of Health and Mental Hygiene, to encourage more than 300 primary care clinicians throughout Maryland to adopt these advanced principles of primary medical care.

Program Incentives: Fixed Transformation Payments and Shared Savings Overview

The program incentives for practices include a fixed transformation payment (FTP) and shared savings eligibility. The FTP gives primary care practices a per-patient per-month fee paid semi-annually if practices are able to achieve National Committee for Quality Assurance (NCQA) recognition and invest a portion of their FTP in care coordination. In addition, primary care practices participating in the MMPP can earn a percentage of the savings they generate through improved care and better patient outcomes. The first of these payments was made in the fall of 2012, and payments were based on performance during 2010 and 2011. Shared savings calculations comprise all patient costs including approximately 94 percent of costs that occur outside the primary care practice (e.g., in hospitals, specialist physicians, laboratories, etc.).

Benefits for implementing a PCMH

The Patient-Centered Primary Care Collaborative developed the following chart, linked below, to help medical home supporters and advocates explain the benefits and strategies associated with delivering patient centered primary care. The chart is organized according to the five key features of the medical home model: patient centered, comprehensive, coordinated, accessible, and committed to quality and safety. It includes definitions for each of these features, sample strategies used by health professionals, employers, and payers, and their collective impact on the health system.

  Why Medical Homes Work

The Maryland Health Care Innovations Collaborative

The Commission contracted with the University of Maryland, Department of Family and Community Medicine at the University of Maryland School of Medicine, to operate the Maryland Health Care Innovations Collaborative (MHCIC). The MHCIC partnership uses resources from education and research communities, and plays a primary role in supporting NCQA staff to expedite the review process. The MHCIC assists with practice transformation and quality improvement in the MMPP, and is committed to the advancement of primary care. It is led by Niharika Khanna, M.D., Kathy Montgomery, Ph.D., RN of the University of Maryland, and Scott Feeser, M.D. of Johns Hopkins University. The MHCIC provided practice transformation coaches and conducted four quarterly meetings in the past year.

  Visit the Maryland Health Care Innovations Collaborative Website