Nebraska Patient-Centered Medical Home Pilot
Program Location:
Lexington, NE
Number of Practices:
2
Payer Type:
Medicaid
Payers:
Medicaid
Reported Outcomes
Description:
In 2009, the Nebraska Legislature, through enabling legislation initiated the Nebraska Medical Home Pilot Program Act to be designed and implemented by the Division of Medicaid and Long-Term Care (DHHS). The two-year pilot began in February, 2011, with two rural practices and 7000 Medicaid patients. The focus for the pilot was to transform the two practices into recognized patient-centered medical homes (PCMH) in order to improve health care access and health outcomes for patients and contain costs of the medical assistance program.
A goal of the pilot program was to transform primary practices into fully recognized and operating medical homes that met the criteria of a patientcentered medical home. DHHS reviewed standards utilized in other states along with the national credentialing organization, NCQA, standards. The final standards for Nebraska’s pilot were a hybrid of several models.
**The pilot concluded February, 2013.
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Payment Model:
A PMPM was established for patient care coordination and administration expenses. Initially the pilot practices received $2 PMPM and once they achieved the Tier 1 minimum standards, the PMPM was increased to $4. One practice met the minimum standards six months after the start of the pilot and the other practice at nine months. A practice meeting the optional Tier 2 standards received a 5% enhanced fee-for-service payment on office visits. One practice achieved Tier 2 six months prior to the end of the pilot.
Fewer ED / Hospital Visits:
- significant decrease in the rate of overall Emergency Room (ER) visits per 1,000
- no significant difference in revisits to the ER for the same complaint
- a slight increase in hospital readmissions, yet noticeable reduction in proportion of all admissions that were caused by ambulatory care sensitive conditions tracked in this pilot
Improved Health:
- distinct improvement in patient health outcomes
Improved Patient/Clinician Satisfaction:
- patient indicators suggested an increase in satisfaction with the services provided
- provider and employee satisfaction fluctuated over the course of the pilot and did not reflect overall significant improvement by the end
Cost Savings:
- small decrease in costs for high-tech radiology
- significant decrease in the rate of prescriptions written and spending per 1,000
- the increase in rate of spending on specialist visits per 1,000 clients was not statistically significant
- total expenditures per client per month reflected a slight decrease
Data Source(s):
Last updated March 2019
