State grabs major role In patient centered medical home project

November 29, 2010
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Michigan is expected to have a major role in setting national policy after recently being chosen as one of eight states for a federal demonstration project on patient-centered medical homes, a Michigan Department of Community Health official said.

Medicare and 15 insurers could pump as much as $100 million in payments to certified patient-centered medical home practices during the three-year project, said Carol Callaghan, director of MDCH’s division of chronic disease and injury control.

The new Centers for Medicare and Medicaid Service Innovation Center plans to study 1,200 practices in eight states, and 40 percent of them — 477 — are located in Michigan. If Medicare finds that patient-centered medical homes provide value by averting the need for more expensive crisis care, it is likely to enact national policies to move care toward that model, Callaghan said.

“It will almost certainly set policy for Medicare,” Callaghan said. “I think all this input from all these different payers means that it could change, fundamentally, the whole primary care health system. Michigan will have, hands down, the largest patient-centered medical home demonstration project in the country.”

Under the project, payments from Medicare and the other payers will be funneled to a state administrative organization, which will then distribute them to 32 physicians’ organizations. The POs will then disperse the money to participating primary care practices. The rates are planned at $7.76 per member per month for patients covered by Medicaid and private payers and $9.76 for the Medicare set, divided for state administration, the physicians’ organizations for practice support and directly for doctors’ practices.

Participating payers include Blue Cross Blue Shield of Michigan, which pioneered the patient-centered medical home concept in the state, Priority Health, Blue Care Network, HAP, HealthPlus, McLaren, Physicians Health Plan of Mid-Michigan, CareSource, Great Lakes Health Plan, Health Plan of Michigan, Midwest Health Plan, Molina Healthcare, Total Health Care and the Upper Peninsula Health Plan.

About 1.75 million Michigan residents, including 358,000 Medicare recipients, could see improvements to their health care because of the demonstration project, MDCH Director Janet Olszewski said.

Among the participating physician organizations is Physicians Organization of West Michigan, said Keith Deans, director of clinical operations at POWM. He said two smaller organizations in southwestern Michigan and in Zeeland will join POWM for the project.

Deans said POWM will have at least 13 certified patient-centered medical homes participating by the time the project begins April 1. Other participating primary care groups include Metro Health PHO, Advantage Health and Spectrum Health’s MMPC, which has 11 certified patient-centered medical homes moving from POWM to the Spectrum Health Medical Group in 2011, he said. He said POWM expects to add certified practices to replace the MMPC practices and two others that are joining SHMG.

Dr. Paul Ponstein, medical director of Muskegon-based Lakeshore Health Network, served on the planning committee for the grant application with representatives of the Michigan Primary Care Consortium and the MDCH. Callaghan and Dr. Jean Malouin, associate chair for clinical programs at the University of Michigan Medical School’s Department of Family Medicine, are leaders of the project.

The practices must be certified as patient-centered medical homes by BCBSM or the National Committee for Quality Assurance, Deans said. As many as 38 POWM doctors will be part of the project, he added.

The demonstration project will focus on four areas of patient-centered medical home practices: care management, self-management support, care coordination and linkage to community services.

Callaghan said the statewide committee plans to zero in on data it will need to evaluate the demonstration project. Patient-centered medical home initiatives at BCBSM and Priority Health also are undergoing additional study.

“They believe that the patient-centered medical home really is the answer, but they need data to prove it,” Callaghan added.

Primary care commands the lowest pay grade in medicine, Callaghan said. Primary care providers need more funding to be able to carry out the additional tasks required to anchor care.

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