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At today’s Council of State Governments/Eastern Region Annual Meeting in Portland ME, we heard a fascinating panel on patient centered medical homes. We heard from Lisa Letourneau of Maine Quality Counts about their multi-payer PCMH pilot, including Medicaid – they have included community health centers, private practices and hospital-owned practices serving adults and children across the state. They are requiring NCQA accreditation plus ten other “core expectations” including population risk stratification and management, connection to community health and wellness programs, and a commitment to waste reduction. The pilot includes a learning collaborative, quality improvement practice coaches, technical assistance experts, including how to work with consumers effectively, and ongoing feedback, both clinical and claims-based, from an all-payer state database. PCMH providers are paid their regular fee-for-service rates, plus a per-member-per-month care management payment (about $3 pmpm) and the P4P bonuses they are getting now from the payers. Ten percent of all primary care practices in the state applied to participate in the program, reflecting broad support from providers across Maine. The 3 year pilot started operating in January. Lisa outlined the challenges encountered so far and lessons learned – change starts with effective leadership (physician leadership skills need ongoing support), change happens through effective teams, NCQA credentialing is not sufficient, the value of outside coaching and “it’s all about relationships” – with patients and within teams.

Then Ron Preston, from the University of New Hampshire, former CMS Boston office director, spoke about the current Medicare PCMH demonstration applications due tomorrow. This demonstration is different for Medicare in that only states can apply, they expect other payers to be engaged, they expect the project to be scalable – there needs to be an indication that other providers are interested in joining the effort in the future, they expect standards for PCMHs (such as NCQA), the pilot must engage the rest of the health care system, and must, of course, be cost neutral. CT is expected to submit an application along with other states for this competitive opportunity; Ron worked with the Comptroller’s Office and DSS to develop CT’s application. Ron also talked about the new cooperative arrangement forming among the New England states to support PCMHs including learning collaborative and evaluation activities.
Ellen Andrews