In 2010, the Maryland legislature passed a bill requiring the Maryland Health Care Commission (MHCC) to establish and conduct a three year pilot implemented in 2011 to promote Patient-Centered Medical Homes (PCMH) in a limited number of practices. Fifty two physician practices are participating in the program that employs 335 physicians and nurse practitioners and cares for 243,000 patients.
The law requires the state’s five largest commercial insurers as Aetna, Carefirst BlueCross BlueShield, CIGNA, Coventry, and United Healthcare to participate in the program. The law also requires the Commission to establish a mechanism to assess the program’s impact on quality, costs, and patient and provider satisfaction. Participating payers also include the Maryland Medicaid program and six Medicaid management care organizations.
Overall the MHCC provides oversight and management of the program. To do this, experts at the Commission’s Center for Health Information Technology and the Center for Analysis and Information Services help practices with data mining, provide advice on data-related issues, and manage analysis and reporting for the program.
Specifically, participating practices must:
- Hold extended office hours, provide same-day appointments to urgent care patients and offer 24/7 telephone access
- Develop and use EHRs to manage patients with chronic conditions and post laboratory results electronically for patient review
- Form a team to coordinate patient care, including tracking referrals to specialists, updates on medications, and must assign care coordinators to patients
- Conduct medication reconciliation at every visit, track reports from specialists, follow up with patients and hospital discharges, and develop individualized care plans
Participating payers provide funding to practices in addition to standard fee-for-service payments to support the infrastructure necessary to transform into a PCMH. These payments include a fixed transformation payment designed to cover the costs of investments made by participating practices. Plus separate incentive payments where the savings generated by the program are shared.
Other support is provided by the Maryland Learning Collaborative, a separate venture funded by MHCC, the Maryland Community Health Resources Commission, and various pharmaceutical firms. The venture is being led by clinicians from the University of Maryland School of Medicine and Johns Hopkins School of Medicine.
Results have been positive and show:
- All participating practices as of September 2012 have achieved Level 1, 2, or 3 designation by the NCQA-PCMH program
- Feedback from patients and physicians suggests that the program has improved access and the quality of care and services within these practices, including the ability to coordinate care
- A significant potential for cost savings even though most pilot programs do not realize savings in the first year of operation
To sustain this program, team based culture change must be cultivated, requires individuals with training and/or experience in process improvement and other quality improvement methods to play an important role, physicians and other providers must recognize the value of medical homes to improve care for patients and improve their own efficiency, and lastly, the program must ensure adequate reimbursement to medical homes.
Go to www.innovations.ahrq.go/content.aspx?id=3696 for more information available from the AHRQ Health Care Innovations Exchange.