Forming Partnerships

Forming partnerships with key players (including patients, providers and private sector payers) whose practices the state seeks to change.

Alabama	The Alabama Medicaid Agency has established working relationships for this project with the state physician associations (including the Alabama chapters of the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP)), the Alabama Primary Health Care Association (representing federally qualified health centers (FQHCs) in the state), the Department of Public Health (Children’s Health Insurance Program (CHIP) administrator), and the Department of Rehabilitation, among others. In addition, a reengaged and expanded Patient 1st Advisory Council that includes Family Voices and several physicians is guiding the Agency’s work. Alabama held town hall-style meetings with provider around the state to discuss the Patient Care Networks of Alabama (PCNA) program. Each PCNA network is organized as a 501(c)(3) corporation. At least one half of the board of directors for each network must be comprised of primary care physicians, and in addition the board must also include at least one representative from an FQHC, a hospital, the health department, a Regional Public Mental Health Authority, and a community pharmacist. This composition encompasses representatives from across the community to support practice transformation.
Alaska	No known activity at this time.
Arizona	No known activity at this time.
Arkansas	The state Department of Human Services proposed the “Transforming Arkansas Medicaid” inititative in early 2011, and worked throughout the year to gather input from stakeholders and partners, including providers. For more information, visit the state’s archive for this initiative.
California	No known activity at this time.
Colorado	*Medical Homes for Children Program:* 125-member stakeholder medical home advisory board included provider and family leadership, staffed by Medicaid and included a state-wide survey of providers. Family Voices Colorado has represented parents and families in medical home development since 2000. *Accountable Care Collaborative (ACC) Program:* The Accountable Care Collaborative Program included stakeholder input through public forums and a formal Request for Information process. *HealthTeamWorks Multi-payer Pilot:* In 2009, HealthTeamWorks, then known as the Colorado Clinical Guidelines Collaborative, convened a public-private multi-payer pilot.
Connecticut	Minutes from a July 2011 Medicaid Medical Assistance Program Oversight Council Meeting show that the following groups provided input during the development of the Connecticut medical home initiative: Medicaid Medical Assistance Program Oversight Council A Primary Care Case Management Sub-committee A Provider Advisory Workgroup A Pediatric Workgroup Consumers Advocates Providers Payers The Connecticut Department of Social Services also hosted five public forums for HUSKY Health enrollees across the state. Furthermore, Connecticut Public Act 09-148 required the SustiNet Health Partnership to include a Patient Centered Medical Home Advisory Committee composed of physicians, nurses, consumer representatives and other selected qualified individuals. The advisory committee is charged with developing proposed regulations for the administration of medical homes serving SustiNet enrollees.
Delaware	No known activity at this time.
District of Columbia	No known activity at this time.
Florida	Chapter 223 of the 2009 Laws of Florida required a Medicaid medical homes task force to include provider and Medicaid enrollee representation. The Secretary of Health Care Administration appointed ten members in total, adding representatives for payers, professional associations, medical schools, and advocacy groups. All five Medicaid Medical Home Task Force meetings were public, and the task force allotted time for public comment at each meeting. More information on the task force members and minutes of each meeting can be found in the 2010 report. The Medicaid Medical Home Task Force stressed a “bottom-up” approach to developing a medical home program by soliciting input from providers, consumers, and other interested stakeholders. The task force also recommended that an advisory board assist in the planning and implementation of a Medicaid medical home pilot project.
Georgia	No known activity at this time.
Hawaii	The following groups are represented on Hawaii’s Health Homes State Plan Option Collaborative: Hawaii Department of Human Services Hawaii Department of Health Hawaii Primary Care Association Medicaid managed care plans Other providers
Idaho	Gov. C. L. “Butch” Otter created an eight–member multi-stakeholder Governor’s Select Committee on Health Care in Executive Order 2007-13. The Select Committee was charged with providing recommendations from the Idaho Health Care Summit, including advancing medical homes. As a result of the Select Committee’s recommendations, Gov. Otter established the Idaho Medical Home Collaborative (IMHC) in Executive Order 2010-10. Participation in the IMHC includes: Payers (including Medicaid, Blue Cross of Idaho, Regence, and PacificSource Health Plans); State officials from the Governor’s Office, the legislature, and state agencies; Providers and their representative organizations (including the Idaho Academy of Family Physicians, the Idaho Academy of Pediatrics, the American College of Physicians, the Idaho Medical Association; the Idaho Hospital Association; the Idaho Primary Care Association; and the Veteran Administration (VA) Medical Center; and Patient and employer representatives. The IMHC established Payment Reform and Practice Transformation workgroups in Fall 2010.
Illinois	Representatives from Illinois’s Title V program participated in stakeholders meetings to help develop Illinois Health Connect. Currently, Illinois Health Connect maintains several advisory subcommittees to offer feedback on the design and ongoing operation of the Illinois Health Connect. Participation on the advisory subcommittees is open to any interested patient or provider. The following stakeholder types are among those represented on the advisory subcommittees: Providers and provider professional associations Foundations Hospitals State agencies, including the Division of Alcoholism and Substance Abuse and the Division of Mental Health
Indiana	No known activity at this time.
Iowa	The Iowa Medical Home System Advisory Council (MHSAC) is made up of legislators and a variety of stakeholders including Medicaid, the state chapter of the American Academy of Family Physicians (AAFP), the state chapter of the American Academy of Pediatrics (AAP), the physician assistant association, the osteopathic society, the nursing association, the chiropractic society, the medical society, the dental association, consumers, private payers, and the primary care association (PCA). MHSAC is supported by 1.5 full-time staff at the Iowa Department of Public Health and has published two issue briefs to educate policymakers and stakeholders in Iowa about issues regarding the medical home model. A full list of MHSAC members is available here.
Kansas	Shortly after passage of Sub. SB 81 (New Section 13) in 2008, the Kansas Health Policy Authority (KHPA) convened a broad stakeholder group to develop systems and standards for the implementation of the medical home in Kansas. Membership in the stakeholder group included a range of providers, consumers, insurers, safety net clinics, state health agencies, and information technology vendors. The full group and three subgroups met frequently during 2008 and 2009 and developed consensus on the broad principles that should underpin the Kansas medical home.
Kentucky	No known activity at this time.
Louisiana	The Louisiana legislature established the Louisiana Health Care Quality Forum (LHCQF) with House Concurrent Resolution 75 of the 2007 Regular Legislative Session. LHCQF was established to convene all public and private stakeholders to advance quality initiatives in the state, including the medical home. In March 2008, LHCQF held a medical home summit.
Maine	A variety of stakeholders have helped develop Maine’s Patient-Centered Medical Home (PCMH) Pilot, including: Consumers Providers, including the state primary care association and several professional associations Payers Employers Academia Government, including Medicaid (MaineCare) The convening entities – the Maine Quality Forum, Quality Counts, and the Maine Health Management Coalition – also bring the perspectives of a diverse range of constituencies, including employers, unions, and providers.
Maryland	The Governor’s Council created the Patient Centered Medical Home (PCMH) Workgroup in 2009 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 were formed. The subgroups were instrumental in selecting the program participation criteria, transformation activities, quality performance measures, and payment strategies. Project staff has met with a wide range of stakeholders, including: the state medical society; professional family practice and pediatric associations; the hospital association; federally qualified health centers (FQHCS); nurse practitioners; private insurers and managed care organizations (MCOs); local health departments; the Department of Health and Mental Hygiene (DHMH) Office of Minority Health & Health Disparities; and private, academic, and hospital based practices. The Maryland Health Care Commission (MHCC) has also created a web PCMH portal for providers and hosted seven regional symposia to introduce the initiative to providers (for an example, see here).
Massachusetts	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.
Michigan	The Michigan Department of Community Health leads the Michigan Primary Care Transformation (MiPCT) Project with guidance from the 18-member steering committee representing state agencies, primary care physicians, physician organizations, health plans, employers, and the Michigan Primary Care Consortium. The project is managed by the University of Michigan. A Patient Advisory Council is being formed to advise the steering committee.
Minnesota	The Minnesota Departments of Health and Human Services hosted many meetings to develop the Health Care Homes Program. Stakeholders in attendance included representatives of: providers and their professional associations health plans patients and families patient advocates For more information, please see the 2009 Annual Report.
Mississippi	No known activity at this time.
Missouri	SB577 of the 2007 Session Laws created an 18 member MOHealthNet Advisory Committee to oversee the MOHealthNet program. The Advisory Committee includes government, provider (including physicians, non-physicians and dentists), hospital, and consumer representation. The Missouri Department of Mental Health acknowledges the following partners in developing Affordable Care Act Section 2703 Health Homes: Missouri Coalition of Community Health Centers Missouri Foundation for Health Missouri Primary Care Association ACS Heritage Care Management Technologies Bailit Health Purchasing Health Management Associates
Montana	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.”
Nebraska	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.
Nevada	No known activity at this time.
New Hampshire	No known activity at this time.
New Jersey	P.L. 2010, c.74 directed Medicaid to consult with Medicaid managed care organizations (MCOs) in establishing a medical home demonstration.
New Mexico	New Mexico Medicaid plans to develop a workgroup including, but not limited to, the following organizations: The New Mexico Hospital Association The New Mexico Medical Society The New Mexico Primary Care Association The workgroup will develop collaborative/cooperative protocols to support the goals and needs of medical homes. New Mexico Medicaid also plans to develop managed care consumer advisory boards to educate enrollees and receive input on what enrollees want from medical homes.
New York	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: Chapter 59 of the Laws of 2011 authorized the state health commissioner to establish an advisory group of state agencies and stakeholders (including professional organizations/associations and consumers) to identify care management and coordination barriers and make recommendations for statutory and/or regulatory changes to address them. Chapter 58 of the Laws of 2009 provided the Adirondack Medical Home Demonstration Parker state action immunity to providers and commercial payers to plan, implement, and operate future multi-payer initiatives. Chapter 59 of the Laws of 2011 provides the same protections for future multi-payer initiatives. 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.
North Carolina	Community Care of North Carolina is a partnership that includes providers supported by the Medicaid agency (Division of Medical Assistance), Office of Rural Health and Community Care, local health departments, and Departments of Social Services and Hospitals. Each network is run locally by an Executive Director, who oversees a team of case managers, as well as a Medical Director, who works with local physicians who provide input. In 2006, the North Carolina Governor convened a public-private collaboration of government, payers, and provider representatives to develop and implement a common set of best medical quality standards and measures for asthma, diabetes, congestive heart failure, hypertension and post myocardial infarction care. The Governor’s Quality Initiative, now known as the independent non-profit North Carolina Healthcare Quality Alliance (NCHQA), launched in 2008. The NCHQA Board of Directors also includes consumer and business representation. Early North Carolina Medicaid medical home projects were made possible by support from the North Carolina Foundation for Advanced Health Programs, Inc. and the Kate B. Reynolds Health Care Trust.
North Dakota	No known activity at this time.
Ohio	Substitute House Bill 198 (128^th General Assembly) established an eighteen-member patient-centered medical home (PCMH) education advisory group. Membership statutorily includes: Voting: Four individuals with expertise in training and educating primary care physicians appointed by of the deans of four of the state’s allopathic and osteopathic medical schools; One individual with expertise in training and educating advanced practice nurses appointed by the Ohio Council of Deans and Directors of Baccalaureate and Higher Degree Programs in Nursing; Two individuals appointed by the Ohio Academy of Family Physician; One individual appointed by the Ohio Chapter of the American College of Physicians; One individual appointed by the American Academy of Pediatrics; One individual appointed by the Ohio Osteopathic Association; One individual appointed by the Ohio Nurses Association; One individual appointed by the Ohio Association of Advanced Practice Nurses; and One member of the Health Care Coverage and Quality Council (now defunct) appointed by the superintendent of insurance. Non-voting, ex officio: The state Medicaid Director (or a designee); The Director of Health (or a designee); The Chancellor of the Ohio Board of Regents (or a designee); The Executive Director of the State Medical Board (or a designee); and The Executive Director of the Board of Nursing (or a designee). The advisory group also hosted a statewide webinar and four regional town hall meetings to educate prospective practices and receive feedback from stakeholders. In addition to administering the pilot, the act directs the advisory group to work jointly with state medical and nursing schools to develop new curricula to prepare future primary care providers for the PCMH model of care.
Oklahoma	In 2007, an 11-member Medical Advisory Task Force, comprised of provider organization representatives and staffed by Medicaid, was formed and recommended providing every SoonerCare Choice member with a patient-centered medical home model. Chapter 166 of the 2008 Session Laws established a temporary 16-member Medical Home Task Force staffed by the Insurance Department to study implementation of patient-centered medical homes (PCMH) for private and public payers. Town hall meetings were convened across the state in Fall 2008.
Oregon	Chapter 595 of the 2009 Oregon Laws created a 15-member advisory committee and required a diverse constituency (e.g., payers, practices, third-party administrators) guided by public input. In fact, the Director of the Oregon Health Authority convened two advisory committees: a Standards Advisory Committee and the Pediatric Standards Advisory Committee. More recently, OHA has partnered with the Northwest Health Foundation (NWHF) to convene the NWHF PCPCH Task Force. The task force, made up of clinicians (both primary care and mental health), patients, public health experts, and healthcare delivery technical experts, will develop recommendations and action steps to support broad implementation of Patient-Centered Primary Care Homes (PCPCH) in the state.
Pennsylvania	The Chronic Care Commission, which developed the Chronic Care Initiative (CCI), included representatives from the following groups: providers, including primary care physicians, registered nurses, nurse practitioners, physician assistants, pharmacists, and specialists; health insurance carriers; hospitals; home health care; philanthropy; and consumers.
Rhode Island	The Chronic Care Sustainability Initiative (CSI-RI) coalition has been convened by the Rhode Island Office of the Health Insurance Commissioner. In addition to the participating payers and purchasers, partnering stakeholders include primary care provider organizations, the Rhode Island Department of Human Services, and the Rhode Island Department of Health.
South Carolina	No known activity at this time.
South Dakota	No known activity at this time.
Tennessee	No known activity at this time.
Texas	The following state agencies are represented on the Texas Medical Home Work Group: Department of State Health Services (the convening entity) Department of Assistive and Rehabilitative Services, Early Childhood Intervention Program Department of Family and Protective Services Health and Human Services Commission Additional participating stakeholders include health plans, providers, provider professional associations, and the primary care association. It also bears noting that primary care providers in Texas have a history of enthusiastically supporting medical homes. The Primary Care Coalition, a group of almost 15,000 doctors from the Texas Academy of Family Physicians, the Texas Chapter of the American College of Physicians, and the Texas Pediatric Society released a 2008 report The Primary Solution calling for the Texas legislature to, “support a patient-centered primary care medical home for all Texans.”
Utah	Key Children’s Healthcare Improvement Collaboration (CHIC) partners include: The Utah and Idaho Medicaid and Children’s Health Insurance Programs (CHIP) The University of Utah The Utah Department of Health The Utah Legislative Health Reform Task Force Intermountain Healthcare HealthInsight Utah Family Voices and Voices for Utah Children The Utah Clinical Health Information Exchange The Utah Chapter of the American Academy of Pediatrics Participating practices are expected to include a family partner in their practice teams.
Vermont	Act 71 of the 2007-2008 legislative session created an executive committee to advise the director of the Blueprint for Health. The legislation requires government, provider, private payer, quality assurance, and consumer representation. Act 128 of the 2008-2009 legislative session expanded membership to include business and home health stakeholder representation. The executive committee was charged with engaging insurance plans, professional organizations, community and nonprofit groups, consumers, businesses, school districts, and state and local government to create a five-year strategic plan.
Virginia	The Virginia Department of Medical Assistance Services (DMAS) has engaged a variety of stakeholders to develop the medical home pilot, including: federally qualified health centers (FQHCs); health systems; provider practice groups; private insurers that have established medical home programs; and managed care organizations.
Washington	A wide range of stakeholders have been involved in designing the Washington State Patient Centered Medical Home (PCMH) Multipayer Reimbursement Pilot, including: providers and their professional associations state agencies and the Governor’s Office the Puget Sound Health Alliance the University of Washington hospitals payers large purchasers For more information, please see Appendix K here. The PCMH Collaborative has been developed as a partnership between the Washington Academy of Family Physicians and the Department of Health (DOH). Many of the stakeholder types referenced above – including providers, professional associations, and payers – have helped guide the Collaborative’s work. For more information, please see page 75 here.
West Virginia	The West Virginia Health Improvement Institute, a partner of West Virginia Medicaid, provided a multi-stakeholder forum for development of the Medical Home Performance Incentive Pilot. The West Virginia Bureau of Medical Services is also leading a stakeholder advisory group for Affordable Care Act Section 2703 Health Homes that is open to all interested stakeholders. This advisory group includes four workgroups: Health Home Workgroup Community Care Coordination Workgroup Member Engagement Workgroup Measures and Outcomes Workgroup
Wisconsin	No known activity at this time.
Wyoming	No known activity at this time.

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