Pennsylvania is asking the federal government to experiment with a range of healthcare delivery and payment reforms, and Medicaid is being eyed as a good fit for the patient-centered medical home.
As Gov. Tom Corbett seeks federal grant funding for new demonstrations and, separately, approval for the Medicaid expansion "private option," one lawmaker wants to ask the private sector to contribute new ideas for improving the $20 billion program, loosely based on the principles of the patient-centered medical home.
A bill sponsored by state representative Matt Baker would create a Patient-Centered Medical Home Advisory Council, charged with helping the Department of Welfare craft policies to "increase the quality of care while containing costs" for some 2.4 million beneficiaries (possibly more than 3 million if the state expands Medicaid).
In the bill, Baker, a Republican from the northcentral Pennsylvania town of Wellsboro, outlines nine broad principles that the physicians, mental health providers, nurse practitioners, hospitals and others on the council would follow, among them "patient and provider accountability," "comprehensive care management," and "sharing information and organizing care to avoid duplication."
Baker also offers a few suggestions for the model: expanded telemedicine options, "venues more accessible to patients" and "hours of operation that are conducive to the population served."
But perhaps the biggest issue for Pennsylvania to crack will be reimbursement, in Medicaid as well as Medicare and the commercial market.
If CMS approves funding for the PA Innovation Plan, the state is going to experiment with accountable care organizations, patient-centered medical homes, episodes of care budgeting and community-based care management teams, in both commercial and public payer reimbursement.
In the announcement of the innovation planning grant in May, Corbett said his goals were to find "ways to increase access to vital services for all Pennsylvanians" and "identify measurable methods to control healthcare costs." He also noted that Pennsylvania, the sixth largest state, has the fourth highest healthcare expenditures in the nation.
The PCMH Advisory Council bill would add weight to the PCMH strategy in the mix, and also give a voice to providers interested in expanding primary care in Medicaid (and those interested in figuring out sustainable reimbursement methodologies). The bill asks the committee to recommend a methodology that ensures "providers enter and remain participating in the system" while also improving wellness, prevention and chronic care management, based on the feasibility of several ideas that Baker outlines.
One idea Baker proposes in the bill is increasing Medicaid reimbursement to bring them in line with Medicare for "certain wellness and prevention services, chronic care management and immunizations." The bill also suggests reducing "disparities between reimbursement for specialty services and primary care services," linking "provider reimbursement rates to healthcare quality improvement measures established by the department" and offering funds for health information exchange technology.
Those and other strategies are being tested in various combinations in the 25 states with Medicaid patient-centered medical home and accountable care models -- many of them, like Pennsylvania, casting a wide net in their search to try to figure out what works.
After public comment on the 213 page draft document, the Corbett administration had to submit the Innovation Plan application by the end of December, with CMS expected to decide whether to fund that and other plans sometime in 2014.
The Corbett administration may also have fresh data to guide the designs, if the grant is awarded, based on the outcomes of the ACOs and PCMHs that have sprung up in the state already, such as the 400 physician practices offering patient-centered medical homes certified by National Committee for Quality Assurance.