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Maryland

In April 2010, Maryland enacted SB 855/HB 929, which requires the Maryland Health Care Commission (MHCC) to establish a Maryland Patient Centered Medical Home multi-payer pilot. All payers with premium revenues of over $90 million are required to participate. SB 855/HB 929 reserves $450,000 to conduct an independent evaluation of the multi-payer PCMH pilot. MHCC is scheduled to release a request for proposals (RFP) in Summer 2010.

The Maryland initiative is unique in that:

  • medical home patients will have to “opt-in” through enrollment forms.
  • explicit allowance is made for single-carrier pilots (distinct from the multi-payer pilot), with authorization form the MHCC.

For more information, please see the Maryland Health Quality and Cost Council’s PCMH Workgroup website.

Targeted population: All Marylanders.
Aligning Reimbursement & Purchasing

SB 855/HB 929 grants the Maryland Health Care Commission (MHCC) discretion in developing a medical home payment methodology to be used by all participating payers.
Supporting Practices

The Community Health Resources Commission (CHRC) has agreed to use their grant funds to support the PCMH program. CHRC has a budget of approximately $3 million, a large portion of which will be dedicated to PCMH practice transformation. CHRC has indicated a willingness to leverage its commitment by working with its sponsors and stakeholders interested in making financial commitments to the program.  They have scheduled conference calls with several other states to examine how those states used area health education centers (AHECs) and other state organizations to train care coordinators.
Measuring Results

SB 855/HB 929 directs the Maryland Health Care Commission (MHCC) to adopt a “uniform set of health care quality and performance measures that the participating patient centered medical home is to report to the commission and” health plans.  The legislation directs MHCC to engage a consultant to evaluate the effectiveness of the pilot in “reducing health casts and improving health care outcomes,” and reserves $450,000 for that purpose.
Forming Partnerships

The Governor's Council created the Patient Centered Medical Home (PCMH) Workgroup to work toward creating an all-payer medical home pilot. Three subgroups – focusing on foundations, practice transformation, and purchaser/consumer education – of workgroup members and other stakeholders have been formed.
 
In establishing the medical home pilot, SB 855/HB 929 directs the Maryland Health Care Commission (MHCC) to consult with health plans, primary care practices, the Community Health Resources Commission , and the Department of Health and Mental Hygiene.
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Defining & Recoginizng a Medical Home

Definition: SB 855/HB 929 defined a patient centered medical home as: “a primary care practice organized to provide a first, coordinated, ongoing, and comprehensive source of care to patients to:

  1. foster a partnership with a qualifying individual;
  2. coordinate health care services for a qualifying individual; and
  3. exchange medical information with carriers, other providers, and qualifying individuals.”

Recognition: National Committee for Quality Assurance Physician Practice Connections - Patient-Centered Medical Home (NCQA PPC-PCMH).