Maryland Multi-payer Patient Centered Medical Home Program
Program Location:
Annapolis, MD
Number of Practices:
52
Payer Type:
Multi-Payer
Payers:
Medicaid
Medicare
Aetna
CareFirst
Cigna
Coventry
UnitedHealthcare
The Federal Employee Health Benefit Plan (FEHBP)
the Maryland state employee health benefits plan
TRICARE
Reported Outcomes
Description:
The Maryland Multi-payer Patient-Centered Medical Home Program (MMPP) began a three‐three year pilot study in 2011 to test the PCMH model of care, including 52 primary and multi-specialty practices. The practices are comprised of both private and all of the federally‐qualified health centers located across the State. Maryland law requires the State’s five major carriers of fully insured health benefit products (Aetna, CareFirst, CIGNA, Coventry, and UnitedHealthcare) to participate in the MMPP. The Federal Employees Health Benefit Plan, Maryland State Employees Health Benefit Plan, TRICARE, the health care program serving Uniformed Service members, and plans provided by private employers, such as Maryland hospital systems, have voluntarily elected to offer this program as well. Program participants are collaborating with the University of Maryland Department of Family Medicine, Johns Hopkins Community Physicians, Kaiser Health Plan of the Mid‐Atlantic, and program management staff at the Maryland Health Care Commission, Community Health Resources Commission, and Department of Health and Mental Hygiene, to encourage more than 300 primary care clinicians throughout Maryland to adopt these advanced principles of primary medical care.
PCMH Model for Maryland Patients
- Integrated care plans for ongoing medical care partnering with patients and their families
- Chronic disease management with the assistance of specialized care coordinators
- Medication reconciliation for every visit
- Increased access to a primary care provider via telephone and available 24 hours daily
- Same day appointments for urgent care
- Enhanced modes of care communication (e.g.,e‐mail)
PCMH model for Maryland Employers
- A strong emphasis on primary care services
- Focus on lowering the costs of care
- Improving the health of their workforce through:
- Expanded access to primary care clinicians
- Reduced health care disparities
- Better coordination of care
Additional Resources:
- An Assessment of Practices that Achieved Pilot Goals, October 2014
- An Overviewof the First Annual Report, October 2014
Related News & Resources
Payment Model:
The program incentives for practices include a Fixed Transformation Payment (FTP) and Shared Savings eligibility. The FTP gives primary care practices a per-patient per-month fee paid semi-annually if practices are able to achieve National Committee for Quality Assurance recognition and invest a portion of their fixed payment in care coordination. In addition, primary care practices participating in the MMPP can earn a percentage of the savings they generate through improved care and better patient outcomes. The first of these payments was made in the fall of 2012, and payments were based on performance during 2010 and 2011. Shared savings calculations comprise all patient costs including approximately 94 percent of costs that occur outside the primary care practice (e.g. in hospitals, specialist physicians, laboratories, etc.). This recognizes the comprehensive impact of PCMH.
Fewer ED / Hospital Visits:
Maryland Health Care Commission (December 2013)
- Larger decrease in the proportion of young adults with a hospital admission due to asthma
Improved Patient/Clinician Satisfaction:
Maryland Health Care Commission (December 2013)
Patient Satisfaction
- Patients are generally pleased with the care they received from MMPP participating providers.
- Although there were few statistically significant differences, generally the more vulnerable populations (African-American, Medicaid, and patients with chronic conditions) rated their provider or practice more highly.
- For patients with chronic conditions, providers pay attention to their mental health, discuss medication decisions with them, how well providers communicate with patients, and the overall rating of the provider.
Provider Satisfaction
- MMPP providers expressed greater satisfaction in their current job than the comparison group of PCMH providers.
- At MMPP practices, medical assistants and administrative staff are more likely to take responsibility for some duties that clinicians perform in the comparison practices.
- Providers in the MMPP group, however, were more likely to feel that their compensation plans rewarded hard workers and that the business office and administration are valued by the practice.
Improved Access:
Journal of Health Care for the Poor and Underserved (February 2014)
- statistically significant improvement in patient access to care (based on survey data)
Maryland Health Care Commission (December 2013)
- a relative increase in the annual rates of well-care visits among adolescent
- an increase in the proportion of patients with one or more office visits to th attributed primary care physician
Cost Savings:
Maryland Health Care Commission (December 2013)
- a relative decrease in total other payments (excluding inpatient, outpatient, emergency department, office visits, home health, nursing home, hospice, radiology, and lab).
- only one respondent (a PCMH lead) reported shared savings. The practice recently received $13,000 from the MMPP, which it plans to use to recoup administrative expenses and to develop programs that incentivize staff to meet targeted quality metrics
Other Outcomes:
Journal of Health Care for the Poor and Underserved (February 2014)
- improved care coordination
- improved provider understanding of the PCMH initiative
- increased HIT optimization
Maryland Health Care Commission (December 2013)
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Respondents across all practices stated that they have not seen any cost savings as a result of the MMPP. Many respondents noted, however, that this is most likely because the program is new, and they are optimistic that they will see cost savings in the next year or two.
Last updated March 2019
