The Patient-Centered Medical Home Initiative in New York State Medicaid

Since 2010, the number of PCMH providers in NYS has increased from 633 to 4,461. As of mid-2012, over 1.4 million Medicaid managed care (MMC) and CHPlus enrollees are assigned to PCMH providers. In 2011, about 75,000 Medicaid fee-for-service (FFS) members had a visit with a PCMH provider. For the first six months of 2012, this number increased to 84,000. As this number represents unique recipients and not visits, there is no expectation that the number for the full year will double or increase substantially. Since January 2010, NYS Medicaid has provided over $148 million in enhanced reimbursement to providers.

An evaluation of quality of care, as defined by nationally recognized measures of care, indicates that PCMH providers have outperformed non-PCMH providers in several domains of care, in particular, management of chronic disease which is essential to improving outcomes, quality of life and lowering costs. For example, the management of cholesterol for those treated in PCMHs is twelve percentage points higher than those who are not in PCMHs (59% vs. 47%). PCMHs also provided superior care to diabetics with a higher rate of preventive care and testing, as well as, better outcomes such as control of blood sugar and cholesterol. PCMH practices also provided better preventive care and counseling such as measurement of BMI and nutrition counseling. Children in PCMHs are less likely to have an inpatient hospitalization.