State Medicaid Programs Drive PCMH Initiatives Forward

State Medicaid programs continue to serve as a vanguard for the patient-centered medical home (PCMH) movement.

By the end of 2012, 26 state Medicaid programs had launched PCMH initiatives on a state, regional or local level, thereby providing impetus for the PCMH, as well as lessons for public and private payers on how to implement and sustain innovative payment and delivery models. That's according to Mary Takach, R.N., M.P.H., program director for the National Academy for State Health Policy and author of a Health Affairs article(www.commonwealthfund.org) published in November.

"Without Medicaid, there may not have been medical home initiatives at all in many states," said Takach in a recent interview with AAFP News Now.

In the Health Affairs article, Takach pointed out that "early Medicaid patient-centered medical home initiatives primarily served mothers and children."

"Because of budget pressures, compelling evidence about ability to improve the quality of care and lower costs with a focus on high-risk patients, and new opportunities through the (Patient Protection and) Affordable Care Act (ACA), states are now adapting early initiatives or developing new ones to service their most costly populations -- patients with chronic conditions," Takach said in the article.

Takach cited Minnesota's Medicaid program as an example, saying that the state was "an early innovator in efforts to focus on chronically ill populations." As part of that process, the state "designed a care management fee that was adjusted according to the number of a patient's chronic conditions and that was added to a practice's fee-for-service payments."