Wednesday, June 16, 2010

Expanding Heathcare Efforts

In April, Maryland’s Governor O’Malley signed legislation to require the Maryland Health Care Commission (MHCC) to establish a Patient Centered Medical Home (PCMH) pilot program. Insurers, HMOs, managed care organizations and nonprofit health service providers are now authorized to pay a PCMH for providing care and for managing chronic conditions.

This PCMH pilot will test whether this new form of primary care centered on the patient and founded on team-oriented care can improve healthcare quality and lower costs. At the same time, the pilot will assess whether the PCMH model can face and improve the current primary care model and challenges.

Primary care practices including physician and nurse practitioner led pediatrics, family practices, internal and geriatric practices will be eligible to participate. The program hopes to cover 200,000 patients which could translate to about 50 practices and 200 providers. Practices must apply for NCQA PPC-PCMH Level 1 recognition within 6 months of acceptance plus Level II within 18 months.

The Maryland PCMH Program is currently evaluating whether to participate in the CMS Multi-Payer Advanced Primary Care Practice Demonstration Grant. The demo is open to states that are developing and or have implemented a PCMH or will be ready to implement a medical home in 2010 or in 2011. The CMS grant requires that the selected state do an evaluation to determine how the PCMH affects access to care, quality of care, and patterns of use.

The MHCC is also intends to select a contractor to complete a Feasibility Assessment of the Maryland Medical Assistance (Medicaid) program to see how the program can align with existing external health IT and HIE efforts. Specifically, the state is going to assess whether to expand EHR adoption among Medicaid providers, how to ensure provider connectivity to the HIE, and how to administer and oversee certified EHR incentive payments to providers.