Maryland's Patient Centered Medical Home Program

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

Last April, the Maryland legislature created the Maryland Medical Home Program. The program's objectives are to provide incentives for the provision of high quality primary care and expand access to primary care across the state. In early 2011, practices will begin enrolling in the program, which aims to ?elevate the role of the primary care provider? in the state?s health care system and engender overall improvements in patient health.

Purpose of health policy or idea

Maryland's House Bill 929, introduced early this year by a large coalition of sponsors and signed into law by Governor Martin O'Malley last April, requires the Maryland Health Care Commission (MHCC) to establish the Maryland Patient Centered Medical Home Program.

The five-year Program is designed to encourage the adoption of the medical home model of care across the state; it is also designed to standardize the definition and practices of medical homes, and to quantify the benefits to be accrued from their adoption.

The program began in summer of 2010, when MHCC began a series of education and outreach efforts targeting practices. Fifty practices will begin enrolling in the Program in early 2011; ultimately, the state expects the Program will reach 200,000 patients.  

The Patient Centered Medical Home Program (PCMHP) is, according to the state's literature, "a model of practice in which a team of health professionals, guided by a primary care provider, provides continuous, comprehensive, and coordinated care in a culturally and linguistically sensitive manner to patients throughout their lives." In addition to practices that apply to participate in the program, a "prominent carrier," chosen by the MHCC, is required by law to participate in the program. Earlier this fall, the MHCC announced that CareFirst BlueCross BlueShield's plan was the first prominent insurer to participate in the program. The state's Department of Health and Mental Hygiene may also require public programs and managed care organizations to participate in the program.

Main points

Main objectives

The primary objectives of the Act are to "help slow the continuing escalation of health care costs," and  improve both the quality of health care as well as health outcomes in the state of Maryland.

Type of incentives

The law authorizes (but does not require) insurers that participate in the program to pay medical home providers "a bonus, fee-based incentive, bundled fee, or other incentives"; the expectation is that such payments will be made possible by savings realized through reduced costs expected to follow from the adoption of coordinated, high quality care.

Groups affected

Patients, Primary Care Providers, Insurers

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Maryland is not the first or only state to take legislative or other steps to promote or evaluate the medical home model; the state joins Rhode Island, Pennsylvania, Washington, and Massachusetts, among others, that have adopted medical home or medical-home-like initiatives.

Political and economic background

The text of HB 929 indicates that the Act was designed, first and foremost, to address rising health care costs, as such costs are at least partially attributable to poorly coordinated care, challenges accessing needed care, variable quality of care, and "a lack of engagement between patients and their primary care providers."

The coalition of Maryland legislators sponsoring the bill recognized the medical home concept as offering a potential solution to this trio of shortcomings in the health care system; but they also recognized that medical homes are likely to be of greatest benefit if they conform to a uniform, tested set of standards. Medical homes have been adopted on a piecemeal basis across the state and across the country, especially in recent years, but qualifying standards, quality measures, and methods of payment have differed from one medical home to the next and best practices are only beginning to be established.

The Patient Centered Medical Home Program was thus created not only to encourage uptake of the medical home model across the state, but to enable Maryland to develop a set of best practices in implementing the medical home model. To these ends, the law authorizes the MHCC to institute a state definition of the medical home; adopt a set of standards and practices for the program, including payment methodologies and performance measures; and evaluate the program over a three year term so that best practices can be identified.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The idea of the medical home was first introduced by the American Academy of Pediatrics (AAP) in the 1960s. It initially referred to the site or practice in which a child's medical records resided. In the last decade, the concept has been increasingly revisited as a model for improving the provision of health care in the U.S. while cutting costs in the long run by emphasizing preventive, coordinated care. In 2002, the AAP revised its definition of the concept to be more expansive and to include "accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care." Professional associations representing other categories of primary care providers have followed the AAP's lead and adopted their own working definitions of the medical home concept.

In 2007, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians and American Osteopathic Association released a joint statement outlining fundamental principles of the patient-centered medical home. According to these principles, each patient is cared for by a team of practitioners, led by a personal physician who oversees the continuous care of that patient in his/her entirety, for the duration of his/her life. All care is coordinated through the patient's medical home; the principles also outline the elements of quality, safe care, payment specifications, and a credo to enhance access to care by embracing easy scheduling and alternative forms of communications between patients and providers. The statement of principles is the guiding definition that MHCC has adopted as it begins rolling out its new Program.

Initiators of idea/main actors

• Regierung

• Leistungserbringer

• Privatwirtschaft, privater Sektor

Approach of idea

The approach of the idea is described as:
renewed:

Stakeholder positions

The Act establishing the Patient Centered Medical Home Program was sponsored by a large coalition of over 40 house delegates, including Democrats and several Republicans. Provider associations, notably the American Academy of Pediatrics, have been active in lobbying for legislative measures supporting the expansion of medical homes.

Actors and positions

Regierung
Governor Martin O-Malley	sehr unterstützend		stark dagegen
General Assembly Legislators	sehr unterstützend		stark dagegen
Lt. Governor Anthony Brown	sehr unterstützend		stark dagegen
Leistungserbringer
AAP - Maryland chapter	sehr unterstützend		stark dagegen
AAFP - Maryland chapter	sehr unterstützend		stark dagegen
Privatwirtschaft, privater Sektor
Insurers	sehr unterstützend		stark dagegen

Influences in policy making and legislation

The Act establishing the Patient Centered Medical Home Program was sponsored by a large coalition of over 40 house delegates, including Democrats and several Republicans. Provider associations, notably the American Academy of Pediatrics, have been active in lobbying for legislative measures supporting the expansion of medical homes.

Legislative outcome

success

Actors and influence

Regierung
Governor Martin O-Malley	sehr groß		kein
General Assembly Legislators	sehr groß		kein
Lt. Governor Anthony Brown	sehr groß		kein
Leistungserbringer
AAP - Maryland chapter	sehr groß		kein
AAFP - Maryland chapter	sehr groß		kein
Privatwirtschaft, privater Sektor
Insurers	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

In the months following enactment of law, MHCC began outreach to providers to draw participants into the pilot program. MHCC also released program specifications, including its reward structure and performance requirements.

During summer and early fall 2010, practices submitted statements expressing their interest in participating in the pilot program. In late October, MHCC announced the 50 practices selected to participate; the practices will officially begin the program in January 2011.

Participating providers will be held to quality standards for patient centered medical homes as outlined by the non-profit National Committee on Quality Assurance (NCQA). The NCQA employs a three-tiered ranking system; practices must attain a level 1 (the lowest level) ranking within their first six months in the program and must increase to at least level 2 by the end of the first 18 months.

Monitoring and evaluation

The law requires the MHCC to contract with an outside consultant to conduct an evaluation of the program and report the results of the evaluation to the Senate Finance Committee and House Health and Government Operations Committee by December 1, 2014. The law specifies that the evaluation must measure the program's impact on health care costs and outcomes, by investigating, specifically:

• Improvements in health care delivery
• Improvements in clinical care processes
• Increased access to coordinated care
• Sufficiency of payments in covering enhanced and added services
• Increased patient satisfaction
• Lower total costs of care; and
• Reduced health disparities.

The evaluation will likely determine the ultimate fate of the medical home program - that is, whether it will be expanded, modified, or terminated - as the current Act becomes ineffective at the end of 2015.

Expected outcome

Supporters of the Act expect it to result in more efficient and effective health care. They, and MHCC, point to several studies in the literature indicating a positive return on investment, and less reliance on costly forms of care, notably emergency room care, in practices that have adopted the medical home model. A Seattle-based clinic reported in Health Affairs last May, for example, that its medical home model resulted in a 29% drop in emergency room visits and a 6% drop in hospitalizations, and yielded a $1.50 return for every dollar invested in implementing the model. Other studies report perceptions of improved care, as well; a 2009 study published in the Journal of General Internal Medicine reported that patients in "guided care" practices were twice as likely to say they were receiving high quality care compared to patients in standard practices. Such findings suggest that Maryland's Program is likely to result in increased perception of quality care as well as measurable cost savings. Its findings will undoubtedly prove useful to other states, regions, or health systems interested in pursuing the medical home model as well.  

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

Analysts predict that Maryland's program will cost approximately $150,000 per year to operate, and no net savings are expected for the first year; the savings in subsequent years remain to be determined. Experts expect, however, that patients will quickly notice an improvement in the quality of care they receive within a medical home; whether this translates into improved outcomes as well will become evident with time.

References

Sources of Information

American Academy of Family Physicians. Joint Principles of the Patient-centered medical Home, February 2007. www.aafp.org/online/etc/medialib/aafp_org/documents/policy/fed/jointprinciples
pcmh0207.Par.0001.File.dat/022107medicalhome.pdf.

House Bill 929, Maryland General Assembly, February 12, 2010. http://mlis.state.md.us/2010rs/bills/hb/hb0929t.pdf

Patient Centered Medical Home. http://mhcc.maryland.gov/pcmh/index.aspx

Author/s and/or contributors to this survey

Elena Conis

Empfohlene Zitierweise für diesen Online-Artikel:

Elena Conis. "Maryland's Patient Centered Medical Home Program". Health Policy Monitor, October 2010. Available at http://www.hpm.org/survey/us/a16/2