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The Nebraska Department of Health and Human Services (DHHS), guided by a governor-appointed physician Medicaid Medical Home Advisory Council, launched a two-year medical home pilot. This pilot is limited to two practices selected through a Request for Information process. The program operates under the authority of a 1932(a) state plan amendment, approved by CMS in January 2011. The pilot launched in early 2011, and is set to last for two years. Nebraska will review the feasibility of expanding the initiative if improved outcomes and decreased costs are observed.
Nebraska began its process in 2009 with a statutory definition of the medical home and a legislative mandate to implement a pilot. The state then:
- engaged several key stakeholders
- conducted an RFI selection process to determine the practices to participate in the pilot
- developed recognition standards
- developed the payment structure
- developed pilot outcomes and measures
- contracted with TransforMED to provide technical assistance to the pilot practices.
Further information on Nebraska’s program is available on the pilot homepage. Advisory Council agendas and minutes are available online here.
It should be noted that Nebraska is implementing managed care in regions of the state that were previously fee-for-service. The managed care request for proposals (RFP) requires selected managed care organizations (MCOs) to actively promote medical homes in accordance with state-developed medical home recognition standards. The RFP is available here.
Last updated: May 2012
| Forming Partnerships |
The Medical Home Advisory Council consists of one hospital administrator, six primary care providers (representing family, internal, and pediatric medicine), and one ex-officio legislator, each appointed by the governor. The Council began meeting in October 2009 and continues to meet regularly.
The Nebraska Department of Health and Human Services (DHHS) has also worked to engage a variety other stakeholders including BlueCross Blue Shield of Nebraska and the Dietetic Association.
The Medical Home Advisory Council is supported by DHHS staff. A job description for the DHHS Medicaid Medical Home Program Coordinator is available here.
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| Defining & Recognizing a Medical Home |
Definition: In Nebraska, a medical home is defined as a health care delivery model in which a patient establishes an ongoing relationship with a physician in a physician-directed team, to provide comprehensive, accessible, and continuous evidence-based primary and preventive care, and to coordinate the patient’s health care needs across the health care system in order to improve quality, safety, access, and health outcomes in a cost effective manner. For further information, see the Medical Home Pilot Program Act (LB 396).
Recognition: Nebraska has developed two tiers of recognition. Tier 1 practices are required to meet 29 standards in five “core competencies.” Achieving Tier 2 recognition entails meeting eight additional standards. TransforMED will assist in verifying that a practice has met standards, and the Nebraska Department of Health and Human Services (DHHS) will then certify the practice.
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| Aligning Reimbursement & Purchasing |
Nebraska has developed a unique payment structure. Upon signing an agreement with the Nebraska Department of Health and Human Services (DHHS), practices are paid $2.00 per member per month (PMPM). After achieving Tier 1 recognition, the PMPM increases to $4.00. The practice then has the option of continuing to transform to meet the advanced standards (Tier 2). For achieving Tier 2 recognition, practices receive 105% of standard rates for select evaluation and management and preventive codes.
Authority for Nebraska’s payment methodology came in January 2011 with the approval of a 1932(a) state plan amendment.
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| Supporting Practices |
The Nebraska Department of Health and Human Services (DHHS) has provided each practice with:
In addition, the state conducted an orientation and will provide two day-long learning collaboratives. Physicians, nurses, and key office staff attend and the practice receives honoraria and travel reimbursement.
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| Measuring Results |
Nebraska is in the process of collecting data for five pilot outcomes of interest, and identified measures for each. These outcomes are:
A list of outcomes and measures is available here. Outcomes will be measured through analysis of claims data, provider records, and surveys.
In addition, TransforMED is collecting metrics on the progress of the transformation of the practices through the Patient Experience Assessment Tool (PEAT) and provider/staff surveys.
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