States make progress with medical homes

Exclusive of the health reform law, a majority of states have established delivery system qualifications and payment policies to promote Medicaid's medical homes program.

But even not depending on the Affordable Care Act, those proactive states have found the health reform law’s incentives are useful to push providers who were previously undecided to get on board with transforming their care delivery.

Twenty-six states over the past several years have adopted policies to make payments to healthcare providers that meet medical home standards, said Mary Takach, program director, National Academy for State Health Policy (NASHP).

To receive payments, providers meet the National Committee for Quality Assurance’s (NCQA) medical home standards, but some states also have their own qualifications and standards or a mix of both, she said. The NCQA sets conditions for recognition of medical homes that foster teamwork between patients and their physicians and the care team.

With a medical home, providers use electronic health records (EHRs), health information exchange and registries to make sure that patients get the appropriate care.

Providers typically receive a monthly Medicaid care coordination payment, while some states add a performance-based payment retrospectively.
“But there is a lot more interest now among states in evolving the performance-based payments to shared savings,” she said at the May 31 Medicaid Congress.
The Patient Protection and Affordable Care Act has driven the expansion of the medical home concept to a medical neighborhood with community services outside provider practices because the federal government will fund a 90 percent match for two years.