Montana – Medical Homes

Led by the state’s Commissioner of Securities and Insurance, Montana announced the launch of a voluntary statewide multipayer medical home initiative in March 2014. The Montana Patient-Centered Medical Home Program includes participation by Montana Medicaid and three commercial health plans: Allegiance Benefit Plan Management, Inc.; Blue Cross Blue Shield of Montana; and PacificSource Health Plans. According to the state’s website, as of December 2014, 47 practices have been qualified as PCMHs and an additional 28 have been provisionally qualified.

Chapter 363 of the Montana Session Laws of 2013 laid the foundation for the Montana PCMH Program. This law gave the Securities and Insurance Commissioner, in consultation with a 15-member Stakeholder Council, authority to set participation, reporting, and payment standards for providers and insurers. The law also provided state action immunity, allowing multiple payers and practices to participate in the design of the program without the risk of violating federal antitrust laws. Regulations governing Montana medical homes are available here.

In January 2012, Montana was selected to join the North Carolina Infrastructure for Maintaining Primary Care Transformation (IMPaCT) Learning Community. As a part of this Learning Community, Montana 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. Montana leveraged its participation in the IMPaCT project to promote awareness of PCMH and to help pass state medical home legislation described above.

Prior to participating in the multipayer initiative, Montana Medicaid launched several patient-centered initiatives as part of Passport to Health, a primary care case management (PCCM) program for most Medicaid enrollees. Notably, the Montana Health Improvement Program connects nurse care managers and health coaches working for one of fourteen community and tribal health centers with high risk beneficiaries identified through predictive modeling software. The care managers and health coaches work closely with beneficiaries’ primary care providers. The model is profiled in this 2011 NASHP report.

Last updated: March 2015

Forming Partnerships Montana Patient-Centered Medical Home Program leadership has engaged stakeholders throughout the process. Prior to the creation of the 15-member Stakeholder Council authorized by Chapter 363 of the Montana Session Laws of 2013, Montana convened a 27-member Advisory Council, which included broad payer (including Medicaid) and provider representation. The Advisory Council, which itself was preceded by a Working Group, was charged with “mak[ing] recommendations about a patient-centered medical home pilot project and provid[ing] advice about how to administer it efficiently and encourage its success and expansion.”  Minutes from the Advisory Council meetings (2011 to 2013) are available here, and minutes from the Stakeholder Council meetings (2013 to present) are available here.Montana first convened stakeholders in March 2010 with support of a technical assistance grant from the National Academy for State Health Policy. Furthermore, in November 2011, the Securities and Insurance Commissioner surveyed Montana providers to “determine how the Medical Home model can be molded to fit Montana’s unique needs.”Montana 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, Montana was able to support and strengthen important partnerships, both among state agencies and with external partners including non-profits, provider associations, practices, Area Health Education Centers (AHECs) and others.
Defining & Recognizing a Medical Home Definition:
In March 2010, stakeholders initially agreed on the following definition of the patient-centered medical home: “In Montana, a patient-centered medical home is health care directed by primary care providers offering family centered, culturally effective care that is coordinated, comprehensive, continuous, and, when possible, in the patient’s community and integrated across systems. Health care is characterized by enhanced access, an emphasis on prevention, and improved health outcomes and satisfaction. Primary care providers receive payment that recognizes the value of medical home services.” Chapter 363 of the Montana Session Laws of 2013, passed in April 2013, echoes this language.Regulations prohibit primary care practices from identifying themselves as a medical home unless qualified by the Montana Commissioner of Securities and Insurance.Recognition:
In order to be qualify as a medical home in Montana, practices must receive either: NCQA PCMH recognition, Accreditation Association for Ambulatory Health Care Medical Home accreditation or certification, or Joint Commission Primary Care Medical Home certification.
Aligning Reimbursement & Purchasing The Montana Commissioner of Securities and Insurance promulgated regulations setting the payment standards for the Montana Patient-Centered Medical Home Program.The regulations stipulate that medical home payment models are required to support enhanced primary care, and payers may select from the following approved payment methodologies:

  • Payment for PCMH recognition/certification/accreditation;
  • Reimbursement for care coordination, care management, disease management, population health, behavioral health specialist, and clinical pharmacist services;
  • Payment for quality improvement;
  • Shared Savings; or
  • Block grants to support medical home capabilities.

Payers may adopt alternative payment methodologies that support the intent of the program subject to the Commissioner of Securities and Insurance’s approval.

Specifically, Medicaid pays an additional per-member per-month (PMPM) payment ranging from $3.33 to 15.33 depending on patient acuity. The commercial payers have taken various approaches, including new fee-for-service codes, PMPM payments, shared savings, performance-based payment, and lump-sum grants. Additional information for each payer follows: Allegiance Benefit Plan Management, Inc.; BlueCross BlueShield of Montana; PacificSource Health Plans.

Supporting Practices
The Montana Commissioner of Securities and Insurance maintains a list of practice transformation resources for interested primary care providers, including a series of five webinars hosted by the Commissioner’s Office. The webinar content was informed in part by the results of a 2011 provider survey.
Measuring Results

No later than March 31, 2015, participating medical home practices must submit a uniform set of health care quality and performance measures. Specifically, practices must report on three of the four following measures: hypertension, tobacco use and intervention, A1C control, and childhood immunizations. Pediatric practices are expected to report on immunizations only. Additional information is available here.

Furthermore, no later than March 31, 2015, participating payers are required to report both emergency room visit and hospitalization rates. If a payer tracks patient attribution to medical homes, they are required to submit this data for both their PCMH members and their entire member population.

Montana 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.