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The Massachusetts Executive Office of Health and Human Services (EOHHS) has convened the state’s Patient-Centered Medical Home Initiative (PCMHI). The process started in June 2009, when the state Secretary of Health and Human Services invited a wide range of stakeholders to participate in a PCMHI Council.  The council developed the PCMHI model, and the state used a request for responses process to select practices to join the PCMHI. In December 2010, EOHHS announced that a diverse group of 46 practices throughout the state were selected to join the project. All 46 practices – which together employ about 500 providers – are receiving a package of technical assistance to support practice transformation. Of these, 32 are receiving enhanced payment in exchange for meeting medical home recognition standards within 18 months of project launch. Approximately 500,000 patients receive care from these practices. Participating practices are expected to master 12 core competencies.
 
The PCMHI is a step towards meeting the EOHHS goal of having all Massachusetts primary care practices functioning as medical homes by 2015. Massachusetts’s work with the Safety Net Medical Home Initiative, which launched in 2009 with the goal of helping 14 community health centers become medical homes, represents another step towards the EOHHS vision.
 
Federal support: The federal government provides federal financial participation (FFP) for the enhanced reimbursements that Medicaid/CHIP and Medicaid managed care organizations pay to participating providers. 
 
Massachusetts has also received a duals demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to “coordinate care across primary, acute, behavioral health and long-term supports and services for dual eligible individuals.”
 
Last Updated: May 2012

 

Forming Partnerships
The Massachusetts Patient-Centered Medical Home Initiative (PCMHI) Council includes representatives of:
  • state primary care provider professional associations
  • payers, including state employees
  • hospitals
  • key state agencies
  • philanthropy
  • consumers
  • advocates
  • community health centers
For more information, please see the PCMHI Council webpage.
Defining & Recognizing a Medical Home
Definition: The Massachusetts Patient-Centered Medical Home Initiative (PCMHI) has identified 12 core competencies for participating practices:
  1. Patient/family-centeredness
  2. Multi-disciplinary team-based approach to care
  3. Planned visits and follow-up care
  4. Population-based tracking and analysis with patient-specific reminders
  5. Care coordination across settings, including referral and transition management:
  6. Integrated care management focused on high-risk patients
  7. Patient and family education
  8. Self-management support by all members of the practice team
  9. Involvement of the patient in goal setting, action planning, problem solving and follow-up
  10. Evidence-based care delivery, including stepped care protocols
  11. Integration of quality improvement strategies and techniques:
  12. Enhanced access
Recognition: PCMHI practices are required to achieve at least National Committee for Quality Assurance (NCQA) Level 1 recognition. In addition, practices are expected to achieve three otherwise optional NCQA standards. Participating practices must achieve NCQA Level 1 “plus” recognition within 18 months of project launch.
Aligning Reimbursement & Purchasing
The following payers and purchasers are making enhanced payments through the Massachusetts Patient-Centered Medical Home Initiative (PCMHI):
  • MassHealth Primary Care Clinician (PCC) Plan
  • Health Safety Net
  • Blue Cross Blue Shield of Massachusetts
  • Boston Medical Center HealthNet Plan
  • CeltiCare
  • Fallon Community Health Plan
  • Harvard Pilgrim Health Care
  • Health New England
  • Neighborhood Health Plan
  • Network Health
  • Tufts Health Plan
  • Senior Whole Health
  • UniCare
  • The Health Connector Authority
  • Group Insurance Commission (state employees)
Payers have committed to making several types of payments to support medical homes:
  • Start-up payments to practices to support medical home infrastructure: these practices will range up to $15,000 in the first year of the PCMHI and $3,500 in the second year.
  • Ongoing payment for medical home activities: $1.50 per member per month (PMPM)
  • Ongoing support for clinical care management services: $0.60 PMPM for individuals under age 18, $1.50 PMPM for individuals age 18-64, $6.00 PMPM for individuals age 65 or older
  • Shared savings payments: the payers have agreed to share savings with the participating practices if they generate savings relative to a control group of practices. However, the methodology has not yet been announced.

It should be noted that Medicaid managed care plans are required to make PCMHI payments.
Supporting Practices
Patient-Centered Medical Home Initiative (PCMHI) practices are receiving a variety of supports, including:
  • Access to a patient registry, if the practice lacks an electronic medical record (EMR) with registry functionality
  • Use of an online portal to see practice performance on key metrics over time and compared to other practices
  • Nine days of in-person learning collaborative meetings over February 2011 and January 2013
  • Monthly hour-long webinars or conference calls
  • The assistance of medical home facilitators
Measuring Results
The University of Massachusetts Medical School’s Department of Commonwealth Medicine will conduct an evaluation of the Patient-Centered Medical Home Initiative (PCMHI).