Medical Home & NH Medicaid Care Management Mary Vallier-Kaplan, - PowerPoint PPT Presentation

Medical Home & NH Medicaid Care Management Mary Vallier-Kaplan, Chair Governor’s Commission on Medicaid Care Management 1

Governor’s Commission on Medicaid Care Management “To review and advise on the implementation of New Hampshire’s Medicaid care management program.” “Seeks periodic review & recommendations of commission…to review program’s implementation, the status & integrity of the planning for each step, & program’s responsiveness to quality of care concerns including those raised by NH citizens.” 2

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 3

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 outlined by AHRQ: comprehensive care, patient centered care, coordinated care, accessible services & quality and safety. 4

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. 5

And the rest of the story….. 6

Commission Recommendation #3: Patient Centered Medical Home The Governor’s Commission on Medicaid Care Management hereby recommends ongoing 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. 7

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 8

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 9

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 10

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 11

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 12

Questions & Answers Discussion 13