Montana has convened a large group of diverse stakeholders to plan a multi-payer statewide medical home pilot. Initially, Medicaid convened the project, but Montana’s Commissioner of Securities & Insurance took the leadership role in September 2010 in order to more effectively engage commercial payers. The Montana Medical Home Working Group, which includes all commercial payers, is now carrying out a workplan for implementing a multi-payer initiative. The plan includes seeking legislative approval when the Montana legislature reconvenes in 2013.
In August 2011, the Commissioner announced the creation of an official advisory council that will build on the efforts of the Working Group. The advisory council is charged with, “mak[ing] recommendations about a patient-centered medical home pilot project and provid[ing] advice about how to administer it efficiently and encourage its success and expansion.” The goal is to have processes and procedures in place to facilitate a rapid roll-out once legislative approval is obtained. In November 2011, the Commissioner announced that her office will survey Montana providers to best, “determine how the Medical Home model can be molded to fit Montana’s unique needs.”
In seeking to participate in a multipayer initiative, Montana Medicaid draws on its experience with several current programs. Montana has a primary care case management (PCCM) program, Passport to Health, for most of its Medicaid enrollees. The program includes:
- a lock-in primary care case management program for high cost/risk Medicaid patients. The state has found that the lock-in program saves approximately $500 per patient per month.
- a health improvement plan that contracts with federally qualified health centers (FQHCs) to offer care coordination and management for high cost/risk beneficiaries identified through predictive modeling software. The FQHCs hire health coaches who work as part of the care team with Medicaid primary care providers. The model is profiled in this 2011 NASHP report.
Further information is available online on the Montana Medical Home Initiative homepage. A brief history of the project is available here, and proceedings of the advisory council are available here.
Last updated: December 2011
| Forming Partnerships |
Under a technical assistance grant from the National Academy for State Health Policy, Montana Medicaid invited over 20 stakeholders to its first meeting on medical homes in March 2010. Invited stakeholders included: a state legislator and representatives of all commercial Montana payers, the Governor’s office, the state employee benefits program; providers; community and tribal health centers, and Title V/maternal and child health. Subsequent group calls between these stakeholder groups, NCQA, and experts from other states and organizations served to further educate these partners on the recognition process anti-trust laws as they relate to convening payers to work on a medical home payment system.
The Montana Commissioner of Securities and Insurance is now overseeing the state’s medical home work, and has convened an official advisory council. The members of the advisory council are listed here; agendas and meeting minutes are here. In November 2011, the Commissioner announced that her office will survey Montana providers to best, “determine how the Medical Home model can be molded to fit Montana’s unique needs.”
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| Defining & Recognizing a Medical Home |
Definition: In March 2010, stakeholders initially agreed on the following definition of the patient-centered medical home: “In Montana, a patient-centered medical home is health care directed by primary care providers offering family centered, culturally effective care that is coordinated, comprehensive, continuous, and, when possible, in the patient's community and integrated across systems. Health care is characterized by enhanced access, an emphasis on prevention, and improved health outcomes and satisfaction. Primary care providers receive payment that recognizes the value of medical home services.”
Recognition: Montana providers will be expected to meet National Committee for Quality Assurance (NCQA) expectations for practice recognition. “Pilot sites will commit to moving along the NCQA tiered recognition process. Those recognized as Level 1 under NCQA PCMH 2008 standards must reach 2008 Level 2 or higher or 2011 Level 1 or higher by January 1, 2013.”
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| Supporting Practices |
In response to the provider medical home survey results, Montana plans to create educational materials and coordinate a series of webinars on medical home transformation for interested providers.
The Montana Patient-Centered Medical Home Advisory Council has identified key attributes for a practice technology support platform that will be rolled out in conjunction with the state’s medical home initiative. Further information is available here.
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