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Medical Home & NH Medicaid Care Management Mary Vallier-Kaplan, - - PowerPoint PPT Presentation
Medical Home & NH Medicaid Care Management Mary Vallier-Kaplan, - - PowerPoint PPT Presentation
Medical Home & NH Medicaid Care Management Mary Vallier-Kaplan, Chair Governors Commission on Medicaid Care Management 1 Governors Commission on Medicaid Care Management To review and advise on the implementation of New
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Medical Home & MCM
- Commission’s Workplan is based on CMS
MMC Implementation Recommendations- Benefit Design & Specialized Services: Medical Home
- Section 10: NH MCM Contract, Care
Management Program
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10.2 Care Coordination: Role of the Primary Care Provider
10.2.2 The MCO shall develop programs to assess & support, wherever possible, primary care providers to act as a patient centered medical home. A PCMH shall included all of the five key domains
- utlined by AHRQ:
comprehensive care, patient centered care, coordinated care, accessible services & quality and safety.
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10.2 Care Coordination
10.2.3 DHHS recognizes that there is a variety of ways in which these domains can be addressed in clinical practices. External accreditation is not required by providers acting as a PCMH. The MCO’s support to primary care providers acting as PCMH shall include, but is not limited to, the development of systems, processes & information that promotes coordination of the services to the member outside of that provider’s primary care practice.
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And the rest of the story…..
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Commission Recommendation #3: Patient Centered Medical Home
The Governor’s Commission on Medicaid Care Management hereby recommends
- ngoing system transformation that
embraces the Patient Centered Medical Home (PCMH) practice model as a principal primary care service delivery model of the New Hampshire Medicaid Care Management Program.
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- Gov. requests DHHS to develop &
deploy a plan for enhancing PCMH capacity across State that:
- Defines PCMH according to AHRQ
- Inventories capacity & variation
- ID opportunities to enhance capacity &
develop in areas of need
- Encourage all payers to embrace &
collaborate to develop to build system
- ID opportunities to enhance provider
compensation or instituting other payment reform options that promote development of PCMHs
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- Gov. requests DHHS to develop &
deploy a plan for enhancing PCMH capacity across State that:
- Addresses how implementation
progresses
- Discuss how DHHS will work with MCOs
to implement the plan, assuring that efforts for Medicaid patients are equivalent to efforts on behalf of privately insure patients
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Aspirations
- Use of best practice protocols
- Strengthen commitment in next in
upcoming MCO contract
- Build off successes of other states
- Incorporate & align with MCM Quality
Plan
- Build off current NH successes
- Acknowledge that to date variation
brings challenges
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Aspirations
- Collaborate with current private payers
who already are reimbursing PCMH providers
- Robust PCMHs are fundamental to Step
2 implementation
- Seen as a tool to support health of
vulnerable populations by impacting health care conditions, thereby keeping costs low
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What to watch for…What to think about…
- Universal PCMH definition with variation in
implementation
- Adequate PCMH capacity
- State wide PCMH “system”
- Multi-payer system: need to align to all payer
standard
- PCMH quality metrics required
- Reimbursement incentives enhancement
- Introduction of true health home model
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