In 2014, the Nebraska State Legislature issued a voluntary Participation Agreement to recognize and reform payment structures to support the PCMH. Through this agreement, commercial insurance companies and health care providers agree to support the PCMH by using "consistent requirements and measurements to promote the efficient transformation of primary care practices into PCMH." The goals set forth are that insurers have active PCMH contracts with 10 clinics by the end of 2014 and 20 clinics by the end of 2015.
Insurers are asked to recognize the same set of standards for PCMH including PCMH recognition programs offered by NCQA, Joint Commission, URAC, and the Nebraska Medicaid PCMH Pilot Program Tier I and II standards. Insurers are asked to use agreed upon metrics to determine clinical outcomes for both adult and pediatric populations. Payments to PCMH practices are left up to each insurer to determine but should be linked to clinical, financial and/or patient satisfaction measures.
Each insurer in the pilot is asked to support PCMH practices through payment tied to clinical outcomes, cost savings and patient satisfaction.
Insurers offering a medical home program must utilize payment mechanisms that recognize value beyond the fee-for-service payment. Payments should be linked to clinical, financial and/or patient satisfaction measures in accordance with the goals of the Patient Centered Medical Home. Payments shall be directed toward the clinic's full covered panel of patients and not confined to a subset of diseases. The design and details of the payment mechanism will be left up to each individual health plan to determine through an agreement with the provider or provider group to be negotiated in accordance with the PCMH program cycle.
