Idaho – Medical Homes
After the Governor’s Health Care Implementation Committee identified Patient-Centered Medical Home (PCMH) implementation as a priority, Gov. C.L. “Butch” Otter created the Idaho Medical Home Collaborative (IMHC) in Executive Order 2010-10.
The IMHC launched a two-year multi-payer medical home pilot on January 1, 2013, with 21 participating practices. For this pilot, Idaho Medicaid is collaborating with all three of the state’s commercial insurers: Blue Cross of Idaho, Pacific Source, and Regence Blue Shield of Idaho. Practices participating in Idaho’s pilot may partner with two or more participating payers. Each participating payer has developed unique qualification standards for practices, payment models, and eligibility requirements for patients for which practices will receive enhanced payment for medical home services.
In January 2012, Idaho was selected to join the North Carolina Infrastructure for Maintaining Primary Care Transformation (IMPaCT) Learning Community. As a part of this Learning Community Idaho was one of four states to receive technical assistance and guidance from North Carolina on how to develop a primary care support and quality improvement system. Through the IMPaCT project, Idaho created strong partnerships aligned around the common goal of primary care practice transformation.
Idaho is also one of five states participating in the Safety Net Medical Home Initiative (SNMHI), a partnership between The Commonwealth Fund, Qualis Health, and The MacColl Institute for Healthcare Innovation at the Group Health Research Institute. The Idaho PCA acts as the Regional Coordinating Center for the SNMHI in Idaho, supporting 13 safety net clinics in the state as they transform into patient-centered medical homes.
- On November 21, 2012, the Centers for Medicare & Medicaid Services (CMS) approved a Section 2703 health home state plan amendment for Medicaid enrollees with chronic conditions. It is through this state plan amendment that Idaho Medicaid is participating in the Idaho Medical Home Collaborative. Idaho had previously received a planning grant from CMS to develop a state plan amendment to implement Section 2703. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.
- The Washington State Beacon Community of the Inland Northwest serves northern Idaho.
Last Updated: April 2014
|Forming Partnerships||Idaho Medical Home Collaborative (IMHC): 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.The Idaho Department of Insurance oversees the IMHC, and the Governor appoints all members (including payer, provider, and patient representation). The IMHC provides recommendations to the Department of Insurance and the Governor regarding:
The IMHC established Payment Reform and Practice Transformation workgroups in Fall 2010. The IMHC is required to report to the Department of Insurance and to the Governor quarterly.
Participation in the IMHC includes:
The IMHC is working closely with the Safety Net Medical Home Initiative, a partnership between The Commonwealth Fund, Qualis Health, and The MacColl Institute for Healthcare Innovation at the Group Health Research Institute.
In addition to funding allocated by the Idaho legislature in 2011, the pilot has received a number grants and donations from a number of Idaho non-profit groups and health systems to support pilot administration.
Idaho also participated in the North Carolina Infrastructure for Maintaining Primary Care Transformation (IMPaCT) Learning Community, where it was one of four states to receive technical assistance and guidance from North Carolina on how to develop a primary care support and quality improvement system. Through this project Idaho strengthened key partnerships between provider associations, health systems, and practitioners. Furthermore, the core public and private partners, who partnered on IMPaCT, now collaborate on broader transformation activities within the state, such as Idaho’s State Innovations Model Design grant.
|Defining & Recognizing a Medical Home||
Idaho Medical Home Collaborative (IMHC): The IMHC identifies 11 “critical elements” of a patient-centered medical home:
ACA Section 2703 State Plan Amendment: Idaho’s state plan amendment states that health home providers will “identify and lead the team based care coordination aproach between the clinic and specialist so the whole person’s care is taken into account in both chronic disease and mental health treatment.”
Idaho Medical Home Collaborative (IMHC):There are common minimum standards for participating pilot practices. These common standards include:
Practices must qualify for enhanced reimbursement from two or more payers to participate in the pilot, which requires practices to also meet additional standards set by the insurers with whom they contract. The IMHC describes provider requirements by payer: Idaho Medicaid, Blue Cross of Idaho, Pacific Source, and Regence Blue Shield of Idaho. To learn more, visit the IMHC’s matrix of Multi-Payer Pilot provider requirements.
ACA Section 2703 State Plan Amendment: In addition to the common standards required to participate in the IMHC pilot, daho health homes are required to be participating providers in the state’s Health Connections program (primary care case management).
|Aligning Reimbursement & Purchasing||
Idaho Medical Home Collaborative (IMHC): Participating payers have each developed unique payment methodologies to support participating practices in providing medical home services. Per-member per-month payment amounts for each payer are list below:
Participating payers limit payment to patients who qualify based on chronic conditions or medical complexity; to learn more about each payer’s criteria, visit the summary of additional requirements: Blue Cross of Idaho, Pacific Source, and Regence Blue Shield of Idaho. To learn more Idaho Medicaid, see below.
ACA Section 2703 State Plan Amendment: Medicaid is making payments of $15.50 PMPM to participating health home practices on behalf of qualifying Medicaid participants. Qualifying Medicaid participants include:
Idaho Medical Home Collaborative (IMHC): The IMHC is supporting pilot practices through learning collaboratives and practice coaching. Program staff will lead learning collaborative activities; provide technical assistance to facilitate practice transformation using Safety Net Medical Home Initiative materials; and support practices in preparing for NCQA PCMH recognition.
Learn more on IMHC’s Expectations, Roles, and Responsibilities page.
Idaho Medical Home Collaborative (IMHC): Practices participating in the IMHC multi-payer pilot report on measures in three categories:
For a complete list of required measures, visit the Idaho Medical Home Collaborative Pilot Measures matrix.
Beyond this list, some participating payers require reporting on additional measures. For more information, visit the summary of additional requirements for each payer: Blue Cross of Idaho, Pacific Source, and Regence Blue Shield of Idaho. For more information on Idaho Medicaid, see below.
ACA Section 2703 State Plan Amendment: Idaho Medicaid is using claims and chart-based process and outcome measures endorsed by the National Quality Forum to track progress on six goals for the state’s health home program:
For more information on provider reporting requirements in addition to requirements under the IMHC program (see above), see the Idaho Medicaid summary.