Medicare to join state medical home projects

Medicare will participate in state-based “medical home” programs designed to improve the care of individual patients by tightening the coordination of tests, consultations and treatments they typically receive from assorted caregivers, Health & Human Services Secretary Kathleen Sebelius said today.

Medicare will join a demonstration built on a model now being tested in Vermont, Sebelius said, in which private insurers are working with Medicaid to set standards for “Advanced Primary Care” models. The patient-centered approach provides doctors incentives for coordinating care and monitoring patients' health from in or outside the office or hospital. 

Maine, Massachusetts and Colorado and other states have similar medical home programs, Sebelius said.

Because of the coordination of providers and services involved, medical home projects normally rely on health IT to make records instantly available at the point of care or inquiry.

“Duplicative, unnecessary and costly tests are eliminated, and dangerous medication interactions are flagged,” said Vermont Gov. Jim Douglas, who joined Sebelius in making the announcement.

For example, in Rutland, Vt., doctors in the local hospital’s emergency department now have electronic access to a patient’s medication history. They are able to diagnose more quickly an adverse drug reaction and avoid the need for costly tests, which can save time, money and lives.

“The primary care providers are being paid for better care, not more care through incentive payments. In our Vermont pilots, which cover about 10 percent of our population, participating providers receive a larger fee for higher performance,” Douglas said.

Under the model, physicians are paid a per member per month fee for intensive primary care interventions such as coaching chronically ill patients on effective self-care, working with patients to develop an individual care plan and using technology to track patient care and manage the transition from a hospital stay, according to the HHS plan.

States that want to conduct similar demonstrations must ensure that their projects will produce savings for the Medicare program. The Centers for Medicare and Medicaid Services will develop applications for states later this fall and start the programs next year, Sebelius said.

When Medicare, Medicaid and private insurance companies coordinate their efforts, it means better quality of care. “Improved efficiencies in the system mean doctors can spend more time with their patients, provide high quality care and better coordinate that care with other medical professionals," Sebelius said.

Under the advanced practice model, all insurers initially would align their compensation to primary care physicians instead of each using different approaches, different ways of measuring performance and different payment incentives.

More information about the project is online.