Texas

In 2011, S.B. 7, 82nd Legislature called for a study by the Health and Human Services Commission to submit a report to the Texas Legislature regarding the commission's work to ensure that Medicaid managed care organizations promote the development of patient-centered medical homes (PCMH) for recipients of medical assistance and provide payment incentives for clinicians that meet the requirements of a PCMH as required under Section 533.0029, Government Code. Beginning December 1, 2013, MCOs must develop and submit to HHSC an annual plan for expansion of alternative payment structures with its providers that encourage innovation, collaboration and increase quality and efficiency. The plans must include mechanisms by which the MCO will provide incentive payments to hospitals, physicians, and other providers for quality of care. Plans will include quality metrics required for incentives, recruitment strategies of providers, and a proposed structure for incentive payments, shared savings, or both.

 S.B. 58, 83rd Legislature, Regular Session, 2013  charges HHSC with integrating behavioral and physical health services within the Medicaid managed care program. Under this legislation, by September 1, 2014, HHSC shall establish two health home pilot programs in two health service areas, representing two distinct regions of the state for persons who are diagnosed with a serious mental illness and at least one other chronic condition.  

The Texas Department of State Health Services has an active Medical Home Learning Collaborative (MHLC), formerly the Medical Home Workgroup, which meets quarterly via conference call in order for members to share knowledge, implement strategies, and best practices on the philosophy and effectiveness of medical homes. Their mission is to enhance the development and promote the principles of the Patient-Centered Medical Home model within the state of Texas for all children and youth including those with special health care needs.

On May 23, 2014 the state of Texas signed a Memorandum of Understanding with the Centers for Medicare & Medicaid Services regarding a Federal-State partnership to test a capitated financial alignment model for the dual eligible population. 

CHIPRA: 
No
MAPCP: 
No
Dual Eligible: 
Yes
2703 Health Home: 
No
CPCi: 
No
SIM Awards: 
No
PCMH in QHP: 
No
Legislative PCMH Initiative: 
Yes
Private Payer Program: 
Yes
State Facts: 
Population:
26,422,500
Uninsured Population:
20%
Total Medicaid Spending FY 2013: 
$28.3 Billion 
Overweight/Obese Adults:
66.1%
Poor Mental Health among Adults: 
28.1%
Medicaid Expansion: 
No
CPC+: 

Coordinating All Resources Effectively (CARE) - Texas

Children’s National Health System has been named a recipient of a Center for Medicare & Medicaid Innovation (CMMI) award to improve health care delivery for children with complex medical needs.  The grant, aimed at advancing care coordination models, was awarded to the Children’s Hospital Association (CHA) and 10 pediatric hospital partners.

Cigna Collaborative Care Program - Austin Diagnostic Clinic

Cigna and The Austin Diagnostic Clinic launched a collaborative care initiative to improve patient access to health care, enhance care coordination, and achieve the goal of improved health,affordability and patient experience. 

Cigna Collaborative Care Program - St. Joseph Health System

Cigna and St. Joseph Health System  have a collaborative care initiative to improve patient access to health care, enhance care coordination, and achieve the goal of improved health,affordability and patient experience. The program became effective July 1 and is Cigna's first collaborative care initiative serving the Brazos Valley. Cigna currently has eleven collaborative care arrangements throughout Texas and 100 of them nationwide.

Humana medical home program - MHMD

This program is offered to practices that are either patient-centered medical home (PCMH) certified or in the certification process. These practices must meet HEDIS and clinical initiative targets and have made progress addressing some of the requirements necessary to transform their practice in order to become successful population health managers. For example PCMH program participants have implemented electronic medical records and likely use electronic prescribing systems. Additionally, they have made other infrastructure changes, including the use of a care coordinator in the practice.

Texas Dual Eligible Demonstration

CMS approved a Memorandum of Understanding with the state of Texas on 5/23/2014. The State of Texas Health and Human Services Commission is partnering with the Centers for Medicare & Medicaid Services to implement a

Focus on Sickest in Medical Homes Saves Costs in Pilot Test

on mer, 2014-04-23 00:00   staci

Consulting firm Mercer has just wrapped up what it terms an intensive primary-care pilot project with a large unidentified Dallas employer.

Dallas was the third test of a concept Mercer calls an ambulatory intensive care, or A-ICU. The employer sent its highest-risk patients to Plano-based Village Health Partners (VHP) and Baylor Scott & White’s physician subsidiary, HealthTexas Provider Network.

Story Date: 
April 23, 2014
News Author: 
Steve Jacob
Source Link: 
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Cigna Collaborative Accountable Care Program - Texas Health Resources/Texas Health Physicians Group

Cigna, Texas Health Resources  and Texas Health Physicians Group (THPG) have launched a collaborative accountable care  initiative to improve patient access to health care, enhance care coordination and achieve the “triple aim” of improved health, affordability and patient experience. The program, effective January 1, 2014 is Cigna's fifth accountable care initiative in North Texas. The ultimate goal of the collaboration is to enhance the overall well-being of the population through a coordinated approach to all aspects of health.

Cigna Collaborative Accountable Care Program - Patient Physician Network

Cigna and Patient Physician Network  (PPN) have launched a collaborative accountable care  initiative to improve patient access to health care, enhance care coordination, and achieve the “triple aim” of improved health, affordability and patient experience. The program became effective October 1, 2013 and is Cigna's fourth accountable care initiative in the Metroplex.

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