In the fall of 2009 the Montana Department of Health and Human Services (DPHHS) received a technical assistance grant from the National Academy on State Health Policy (NASHP) to advance a multi-payer Patient-Centered Medical Home Initiative that included Medicaid and CHIP patients. In August of 2011, Commissioner Lindeen reformed the working group as an official state advisory council. The council includes insurance companies, medical providers, public agencies, and consumer advocates working together to lay the groundwork for patient-centered medical homes in Montana. On April 30, 2013 the project was codifed into law.
The Montana Patient-Centered Medical Home Act sets clear expectations for the Montana PCMH program to help payors, providers, and patients achieve better health outcomes and lower costs. A primary care practice participating in the Montana PCMH program must obtain accreditation from one of the following nationally recognized accrediting organizations: The National Committee for Quality Assurance [NCQA], The Joint Commission [JCo], and The Accreditation Association for Ambulatory Health Care [AAAHC].
In August of 2015, the Office of the Montana State Auditor released the first year of program data in a 2015 public report. The report notes that while the program is still in its infancy "the baseline data is encouraging and supports the proposition that the PCMH program advances comprehensive primary care and will keep Montanans healthier."
Blue Cross Blue Shield of Montana pays a PMPM particiaption fee for each attributed member and a PMPM fee for chronic disease management.
PacificSource Health Plans compensates providers with:
Allegiance Benefit Plan Management compensates providers through care coordination CPT codes:
Montana Medicaid compensates providers with traditional FFS payment and one of 3 PMPM fees for each enrolled PCMH member: