New York Medicaid is directly participating in two medical home initiatives created in Chapter 58 of the Laws of 2009, the 2009-2010 state budget.
- The Adirondack Medical Home Demonstration, a five-year regional multi-payer initiative in the Northeast corner of the state
- A statewide Patient-Centered Medical Home Program for individuals enrolled Medicaid, Family Health Plus or Child Health Plus.
Additionally, Chapter 59 of the Laws of 2011, the 2011-2012 state budget, included a section that authorizes the Commissioner of Health to establish additional multi-payer medical home initiatives similar to the Adirondack demonstration throughout the state. In response, New York Medicaid has submitted a state plan amendment (SPA) to test new models of payment to qualifying medical homes, including risk-adjusted global payments and/or pay-for-performance.
Governor Cuomo’s Medicaid Redesign Team’s has also supported a recommendation (Proposal 70) to expand the statewide Patient-Centered Medical Home Program to include new payers.
Federal Support: New York is receiving several types of federal support:
- New York has submitted a state plan amendment to CMS in November 2011 to implement Affordable Care Act Section 2703 Health Homes for Medicaid enrollees with chronic conditions.
- Medicare is participating in the Adirondack Medical Home Demonstration as part of the Medicare Advanced Primary Care Practice (MAPCP) demonstration program.
- New York is also participating in a CMS Demonstration to improve the care of all dual-eligible enrollees across the state.
- HEALTHeLINK received a Beacon Community grant, creating the Western New York Beacon Community.
Last Updated: November 2011
| Forming Partnerships |
Adirondack Medical Home Demonstration:The Adirondack Medical Home Demonstration is currently governed by a multi-stakeholder committee of payers and providers chaired by a New York State Department of Health official.
The New York Legislature has guided current and future medical home partnerships:
In addition, Governor Cuomo has tasked a multi-stakeholder Medicaid Redesign Team to reduce costs and increase quality and efficiency in the Medicaid program for the 2011-12 Fiscal Year.This team endorsed Medicaid Redesign Proposal 70, which includes the creation of a medical home advisory group to provide recommendations for the development of Health IT-derived quality, safety, and efficiency measures for pay-for-performance demonstrations. |
| Defining & Recognizing a Medical Home |
New York medical home programs are aligned on the following principles and recognition process:
Definition: Joint Principles of the Patient-Centered Medical Home. New York Medicaid further describes a medical home as a physician-led care team that is responsible for providing all of a patient's health care needs, including referrals to other physicians as necessary. Medical homes provide enhanced care that is accessible and culturally and linguistically appropriate.
Recognition: NCQA PPC-PCMH. |
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Adirondack Medical Home Demonstration: Participating payers made incentive payments totaling $84 per-member per-year to support practice transformation and new care coordination services. Payment frequency was left to each payer (i.e., some paid $7 monthly, some $21 quarterly). Providers must reach NCQA PCMH Level 2 or 3 recognition within 12-18 months to continue receiving these enhanced payments.
Providers receiving Adirondack Demonstration payments are not eligible for additional payments under the Statewide Patient-Centered Medical Home Program.
Statewide Patient-centered Medical Home Program: NCQA-recognized hospital outpatient clinics and office-based practitioners are eligible to receive enhanced service rates for certain evaluation and management (E&M) and preventative medicine codes for participating enrollees. Payments vary by NCQA level. Hospital outpatient clinics (including FQHCs):
Office-based practitioners:
Medicaid will discontinue payments to Level 1 NCQA PCMH providers in December 2012.
Managed care plans pay a per-member per-month (PMPM) incentive payment for each participating enrollee. This payment is also tiered by NCQA recognition:
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| Supporting Practices |
Adirondack Medical Home Demonstration: Each participating Adirondack Medical Home Demonstration practices received a readiness assessment to develop individualized work plans to guide practice transformation. Practices are receiving grant-supported consulting assistance from EastPoint Health to achieve practice transformation.
Practices also receive additional support from one of three sub-regional Pods (community-based organizations providing shared care coordination services to participating practices including patient education and care management). The Adirondack Health Institute is serving as an umbrella organization for the three Pods.
A $7 million HEAL NY Phase 10 grant (HEAL NY 10) enabled all participating providers to implement an electronic health record.
It also should be noted that Chapter 59 of the Laws of 2011 authorizes the commissioner of health to provide technical assistance to regional multi-payer program participants (providers, payers and consumers), which may impact the Adirondack initiative as well as future initiatives as well.
Statewide Patient-centered Medical Home Program: There is limited practice support from a quality organization contracted by the state.
HEAL NY 10 grants were also made available to support health IT infrastructure development for non-Adirondack medical homes. |
| Measuring Results |
Adirondack Medical Home Demonstration: The four major goals of the Adirondack Medical home demonstration are to:
Statewide Patient-centered Medical Home Program:
Chapter 58 of the Laws of 2009 requires the state health commissioner to report on the Statewide Patient-centered Medical Home Program’s impact on quality, cost, and outcomes to the legislature and governor by December 31, 2012.
In addition, Chapter 59 of the Laws of 2011 requires the state health commissioner to prepare a similar annual report for the effects of regional multi-payer medical home initiatives on Medicaid, Family Health Plus, and Child Health Plus enrollees. |
