Idaho Embraces Medical Home Model

Some physician practices may consider the transition to becoming a patient-centered medical home (PCMH) to be a rough one, but thanks to the support of both public and private insurers, physicians in one state are moving aggressively to make the model work. 

In Idaho, two state initiatives are underway: the Idaho Health Home Program(healthandwelfare.idaho.gov) and the Idaho Medical Home Collaborative(imhc.idaho.gov). Although some overlap exists between the programs because Medicaid participates in both of them, they are intended to work in tandem.

But getting them off the ground required a combination of high-level political support from the governor, acceptance of risk by primary care physicians and the willingness of the state's largest private insurers to participate.

Health Home Program

Introduced as a two-year pilot, the Idaho Health Home Program began in 2013 with Medicaid and private insurers. Medicaid pays practices that participate in the initiative a per-member, per-month fee, with a focus on patients with multiple chronic conditions.

Initially created to encourage physicians to continue to accept Medicaid patients -- as well as to entice those in practices already considering medical home transformation to move forward -- payments vary based on the complexity of patients' care needs but average between $2.50 and $3.50 per patient. An enhanced monthly payment of $3 or $3.50 is available for clinics that maintain extended hours.

In addition, practices can receive an enhanced payment of $15.50 per month for select patients -- namely, those who are receiving chronic care treatment for asthma, diabetes or hypertension.

A total of 9,100 patients now are enrolled in the program, and 25 primary care organizations offer the medical home model at 51 sites. Currently, more than 90 percent of primary care physicians in the state accept Medicaid patients, and CMS has made a commitment to keeping the medical home program operating indefinitely.

Scott Dunn, M.D., past president of the Idaho AFP, is co-chair of the Idaho Medical Home Collaborative, an initiative that is assisting physician practices as they transform to a medical home. He told AAFP News that he is tracking the progress of both initiatives.