‘Medical home’ program now reaches a third of Medicaid patients

A state program that pays health care providers to take a more active role in patient care now reaches close to a third of Connecticut’s Medicaid clients.

Now in its second year, the “person-centered medical home” program allows primary care providers to earn additional money for meeting standards intended to improve outcomes and access to care for Medicaid patients.

As of Sept. 5, 982 health care providers were participating in the program, either as fully qualified members or as part of a “glide path” for those still working to meet all the standards. Altogether, they see 218,511 Medicaid patients, about a third of the approximately 640,000 Connecticut residents covered by Medicaid.

The growth of the program drew praise from advocates and state officials during a meeting of a committee that oversees the program Wednesday.

The idea behind “medical homes” is to make medical practices more attuned to patients’ needs. Practices that serve as medical homes act as their patients’ regular source of care and coordinate the care their patients get from specialists. To ensure patients can get care when they need it, many offer extended hours or allow patients to communicate with providers by phone or email.

The model has been used by private insurers, Medicare, Medicaid, and the military’s TRICARE health plan.

In the state’s Medicaid medical home program, health care providers must meet medical home standards set by national organizations, as well as several Connecticut-specific measures, including participating in a smoking cessation program and in initiatives to decrease racial and ethnic health disparities.

Practices that are working toward meeting those standards can participate as part of a “glide path,” which makes them eligible for technical assistance as well as a portion of the increased payments that medical home practices get.

Participating health care providers receive the usual Medicaid payments for the medical services they provide, as well as payments that can help cover the cost of care-coordinating activities. They can also receive payments based on meeting certain performance measures, including ensuring children in their care see dentists, using developmental screens at well-child visits, following up with patients who have been discharged from the hospital within a week, and ensuring the patients with conditions like diabetes and asthma receive appropriate monitoring.

Only three practices qualified for performance payments this year, because they were the only ones that participated for all of 2012. Two received an additional 30 cents per month for each member — resulting in lump sums of $464 for one practice and $68,036 for the other — and the third received 15 cents per member per month, getting $2,749.

As of last week, there were 26 practices in the state approved as medical homes for the Medicaid program, with 109 sites and 434 providers between them. Those include ProHealth Physicians, the state’s largest primary care group, which treats more than 20,000 Medicaid patients, and Day Kimball Medical Group, which has eight sites and treats more than 5,300 Medicaid patients.

Another 32 practices, with about 39,600 patients, were on the glide path.

The state’s 14 community health centers are also participating in the program, although they’re not eligible for additional payments because of budget cuts made last year. The majority of patients in medical homes — more than 140,000 — get their care at community health centers.

The medical home program is run by the state Department of Social Services and Community Health Network of Connecticut, which administers the Medicaid program. According to data they presented Wednesday, 245 practices have been approached about the program since Jan. 1, 2012. Of those, 68 are participating in the program, 87 are in an “open” status, 41 are either not interested or merging with practices already in the program, and 49 are on a “watch list,” getting periodic follow ups about joining.

Sheldon Toubman, an attorney with the New Haven Legal Assistance Association and a longtime advocate of the medical home model, praised the program’s progress Wednesday.

He’s been pushing for the model to be more widely adopted by state officials planning a separate initiative aimed at changing how health care is delivered and paid for for the vast majority of state residents.

Planners of that initiative say they’re still trying to decide how to structure their model, but a draft document indicated they’re considering a model that would hold health care providers accountable for the cost of their patients’ care. Toubman and other advocates say that would give doctors an incentive to deny care and would threaten the medical home model, in which Toubman said doctors serve as “honest brokers.” State Healthcare Advocate Victoria Veltri, who is leading the larger initiative, said that under any model the group endorses, health care providers will be required to meet quality standards to ensure they’re not denying care. But she also said it’s important to hold them accountable for providing cost-effective care.