Adirondack Medical Home Pilot
Program Location:
Mineville, NY
Number of Practices:
39
Payer Type:
Multi-Payer
Parent Program:
Payers:
CDPHP
Empire Blue Cross
Excellus
Fidelis Care
MVP Healthcare
Medicare
Medicaid
Reported Outcomes
Description:
The Adirondack Region Medical Home Demonstration Pilot is a joint initiative of medical providers and public and private insurers to transform health care delivery in this rural, upstate New York Region. Its goals are to improve care, expand access and contain costs. It accomplishes these goals by emphasizing preventive care, enhanced management of chronic conditions, and by assuring a close relationship between patients and their primary care providers.The Commissioner of Health has the authority to continue the Adirondack program until March 31, 2014. A recent budget request will extend the statewide program until March 31, 2016.
New York requires all participating practices to obtain Level 2 or Level 3 NCQA PPC® PCMH™ recognition within 12 months of joining the initiative, although this was extended to 18 months for some practices. Every participating practice met this requirement under the 2008 NCQA PCMH standards; as of December 31, 2012, all but one has achieved Level 3 recognition. Participating practices are required to:
- use an electronic prescribing system within 7 months of the program’s start;
- participate in a disease registry and develop data reporting capabilities to enable reporting on access to care, clinical processes, clinical outcomes, and patient experience of care using common metrics and methods;
- offer expanded access requirements, including 24/7 telephonic access; and
- provide same-day scheduling for urgent care.
In 2011, the Adirondack Medical Home Demonstration added Medicare as a payer to implement the MAPCP Demonstration.
Payment Model:
Under the terms of the pilot, primary care providers receive increased payment for services in exchange for expanded responsibility for coordinating care, providing preventive care and managing chronic diseases. The pilot’s reimbursement model includes a fee-for-service component, a care coordination fee, and a performance-based payment that reflects improved clinical outcomes. The incentive payments will be a total of $84 per-member per-year to support practice transformation and new care coordination services.
Payment frequency was left to each payer (i.e., some paid $7 monthly, some $21 quarterly). Providers must reach NCQA Patient-Centered Medical Home Level 2 or 3 recognition within 12-18 months to continue receiving these enhanced payments. Providers receiving Adirondack Demonstration payments are not eligible for additional payments under the Statewide Patient-Centered Medical Home Program.
Fewer ED / Hospital Visits:
- 8% reduction in inpatient admissions (from 2010-2011)
- 9% reduction in ED Visits (from 2010-2011)
Improved Patient/Clinician Satisfaction:
- Over 61% of patients said they had the best possible provider (10 of 10)
Data Source(s):
Last updated Febbraio 2015
