Patient Centered Medical Home Demonstration in New York
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Patient Centered Medical Home Demonstration in New York
The patient care medical home was modeled in 2006, and since then, states have been working on trials while some are adopting the program to primary care structures. Both public and private players are shifting resources while improving sustainability to boost primary care while improving quality and cost effectiveness in the general care delivery system (Berenson, Gans, Merrell, Underwood, Williams & Zuckerman, 2009). States are adopting new payment systems while optionally improving on the available methods to enable the primary care functions fit the medical home model. Different states have varied focus and approaches of adopting the model basing on their primary health focus and the needs of the population. The reforms undertaken in the general health care delivery systems align the payment methodologies to the proposed model and performance metrics focusing on patient centeredness. States and stakeholders keep the focus of aligning existing structures to the proposed models to improve their focus on healthcare needs and ensure patient satisfaction in the episode of care.
New York State has several physicians enrolled in the Medicaid program, and this is a greater opportunity for the state to adopt the medical home model incorporating primary care physicians. The state has developed incentives and legislations that support multi layer payment methods to ensure that the medical practices fit into the proposed model. The expected ultimate achievement of the approach is cost effectiveness since the focus is on primary cares that encourage the population to stay healthy (Berenson et al., 2009). New York has focused on programs that ensure enhanced payment for the providers within the patient-centered medical home. Several programs under the method are in place in different regions of the state to benefit the target cohorts within the populations. The number of the PCMH providers has increased in the state over the years with more citizens being enrolled in the program.
Which Populations
The New York PCMH program focuses on different groups of the population with different programs. Under the Children Health Plus (CH Plus), the focus is on improving the health of the children within the state. Other than the children population, the program is also rolled out for patients under the Medicaid managed care for integrated and coordinated primary care services (Andrews, King, & Wexler, 2012). The focus on this population is to ensure that patients stay healthy with appropriate information on their health and embracing preventive measures. Communities of low income are also a target of the program within the state, in providing care that is culturally and linguistically acceptable to the patients.
Conditions and Diseases Targeted
Other than promoting health and ensuring patients stay healthy and improve their health, the medical home approach focus on management of chronic diseases and behavioral health services. PCMH ensures patient is empowered on self-management of diseases and their interaction with providers improved. Care for chronically ill is improved, and the related costs reduced while attending to their complex needs that are primary drivers of healthcare costs (Larson, & Reid, 2012). There are federal policies that allow states to offer medical home health services to persons with multiple chronic conditions that support the services to beneficiaries.
The expectation is that the PCMH providers can provide best services in different domains of care radically improving the quality of care while containing costs (Bitton, Landon, & Martin, 2010). Under the medical home program, management of chronic conditions will mainly include comprehensive preventive and acute primary care that ensures routine check-up and attention for patients. The concept is capable of preventing consequences of episodic and fragmented care in the event one suffers from multiple conditions.
Participating Payers
In New York State, the first patients to be enrolled under PCMH are those that are under the CHplus and Medicaid. The methods of systems adopted, and the legislations in place ensure a multi-layer payment approach that supports both public and private payers under the program (Bitton, Landon, & Martin, 2010). State offers incentives to those providing services under the concept paying 20% for the services. Payment reforms have been undertaken by the state to ensure that the current payment systems are improved while other payment methodologies are incorporated to enable proper reimbursement for the services under the concept.
The payment reforms under medical home restructures provide reimbursement to put in line the available incentives with the quality of care and health outcomes (Bitton, Landon, & Martin, 2010). Provider of better coordination of care services and improving general patient health through prevention and preventive mechanisms is rewarded. The standard payment approach for services under the medical home is fee-for-service and restructured to cover comprehensively the services offered. Overall, the payment system under the model may take the form of other payment forms as another system pays the providers per person per month. The multilayer payment forms comprehensively cover for medical home activities such as coordination and achieving quality targets and cost containments (Berenson et al., 2009).
There are over ten payers in New York under the medical home focused on transforming primary care. Medicare, Medicaid, WellPoint, and Adirondack are the major payers in New York State (Larson, & Reid, 2012). The providers under the program are members of the BlueCross BlueShield Association, Humana, Capital District Physicians Health Plan, Aetna and United Healthcare (Bitton, Landon, & Martin, 2010). Adirondack was the model for the pilot of patient-centered medical home, and now different payers and providers are embracing the system.
Participating Providers and Reimbursement
The participating providers under the PCMH are health institutions that initially offered other plans of care to the patient population. The providers having met set criteria and gaining approval, the institutions provide services to service seekers (Andrews, King, & Wexler, 2012). The service providers are compensated in a multilayer approach where first, they are reimbursed for the actual services provided (Berenson et al., 2009). The payments also cover coordination of services for individual patients, the achievement of quality measures met and improving patient health status and promoting self-care. Provider compensations are direct for their services from the managed care plans for their services provided. The services are paid for as per the set codes and policies within the state that support the program.
The Progress of Patient Centered Medical Home in New York
The PCMH have achieved greater acceptance in New York with State and Federal policies giving a boost to its implementation. The year 2010 and 2011 saw a major adoption of the medical home in the State, and to date, the majority of people under Medicare and Medicaid programs have been enrolled under the primary care. The method is adopted across states majorly because of the burden and increase expenditure on healthcare services per individual. There is a high level of satisfaction among the patient population about the PCMH with provider-seeker communication rating great (Andrews, King, & Wexler, 2012). The groups offering services to the medical home are reported to be providing significantly better services than those who are not in the model. In as much as this model has been increasingly adopted, access to care in New York has not seen any significant increment (Larson, & Reid, 2012). The medical home approach to primary care is evidently of significant importance to the state in achieving the desired health outcomes to its population.