Half of U.S. states have moved ahead with patient-centered medical homes in the last six years, following the passage of the Children’s Health Insurance Program and other Medicaid reforms, a new report published this week in Health Affairs finds. The report, based in part on a Commonwealth Fund project funding the development of medical home initatives, found that in participating states, providers receive a mix of up-front payments for startup costs, monthly per patient care management fees and performance-based payments. Meanwhile, the medical homes themselves vary widely in approach and strategy, from a focus on chronic disease in Minnesota to a Missouri initiative to integrate primary and behavioral health care.
The Minnesota effort stratifies patients by risk, with provider reimbursements beginning at $10 per patient per month for patients with one to three chronic conditions and rising to $60 for patients with 10 or more conditions. In Missouri, monthly care management fees were used to fund nurse care managers, primary care physician consultants, health home directors and administrative support, leading to a reduction in cost of $300 per patient per month. Meanwhile, Alabama's 2011 medical home initiative created new community care team networks that share global payments.
Among the other findings:
- Of the 25 states with significant payment changes, 19 are paying providers a monthly care management fee per patient.
- Fourteen states give providers performance-based payments, while four states use a shared savings model based on participation by multiple payers.
- Eight states focus their medical home efforts on team-based care.