Strategies States Can Use to Support the Infrastructure of a Medical Home

Introduction

Recognizing High Performing Medical Homes: In order to support medical homes, payers must define what they expect practices to do and how they will know when practices are meeting those expectations. According to the PCPCC, a medical home is “a physician-directed medical practice that provides point-of-entry, enhanced primary care in a continuous fashion, across the health care spectrum, and is comprehensive, coordinated and delivered in the context of family and community." The PCPCC recommends that practices go through a “voluntary recognition process by an appropriate non-governmental entity to demonstrate that they have the capabilities to provide” PCMH services. It  should be noted that most of the initiatives fostered by the PCPCC are using the National Physician Practice Connections® - Patient Centered Medical Home (PPC-PCMH™) tool developed by National Committee for Quality Assurance (NCQA).

During the project that the National Academy for State Health Policy (NASHP) is conducting on advancing patient centered medical homes in Medicaid and SCHIP, we are seeking to identify strategies that can be used by state Medicaid and SCHIP agencies to support medical homes. We are searching out strategies that can be used within each of the major types of systems states use to deliver primary care: capitated systems in which states contract with MCOs, Primary Care Case Management (PCCM) programs in which states contract directly with primary care providers (PCPs), and fee-for-service. While we have already identified a wide variety of strategies, they can be placed into three broad categories, and those categories are addressed in this brief.