Utah – Medical Homes

Utah is actively building medical homes for children through a Children’s Health Insurance Program Reauthorization Act (CHIPRA) quality demonstration grant. The $10,277,361 grant was awarded to an Idaho-Utah partnership and runs from February 2010 through February 2015. It is supporting the Utah Children’s Healthcare Improvement Collaboration (CHIC) in hosting learning collaboratives, increasing pediatric practices’ use of health information technology, and helping 12 Utah practices become medical homes. The practices, which together serve more than 80,000 children, will be asked to focus on improving care for children with special health care needs.  According to the project’s CHIPRA proposal, payers will share the non-CHIPRA covered costs in proportion to market share.

In March 2010, Utah’s governor signed into law HB 397 entitled “Medicaid Program Amendments.”  Having passed the state house and senate without objection, HB 397 included a requirement for the Department of Health to “determine the feasibility of implementing a three year patient-centered medical home demonstration project in an area of the state using existing budget funds.”  The Department of Health, Division of Medicaid and Health Financing fulfilled this requirement with a December 2010 report. The report concluded that, “without additional funding, and given the many components of a medical home, it would not be feasible to launch a medical home demonstration within existing funding.” The report recommended concentrating on the CHIPRA project.

Federal support:
Last updated: December 2013
Forming Partnerships
  • 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.
Defining & Recognizing a Medical Home Recognition: Practices will be expected to attain National Committee for Quality Assurance (NCQA) medical home recognition.
Aligning Reimbursement & Purchasing Utah’s Children’s Health Insurance Program Reauthorization (CHIPRA) proposal anticipated payments of $40,000 for each participating pediatrician in primary care, and payments of $40,000 for each pediatric subspecialty practice. Over the course of the project, increasing shares of compensation will depend on practice performance. A project budget is included on page 8 of the proposal.
Supporting Practices Practices participating in the Children’s Healthcare Improvement Collaboration (CHIC) will receive support through in-person learning sessions (one or two annually), site visits (three to six times per year, with a practice coach and/or peer mentor), and conference calls (six to ten annually).
Measuring Results Utah’s Children’s Health Insurance Program Reauthorization (CHIPRA) proposal included funding for an independent evaluation. Utah anticipates that the evaluation will focus on:

  • Access
  • Utilization
  • Costs
  • Quality
  • Outcomes
  • Patient and family experience
Project leaders anticipate drawing on Utah’s all-payer claims database to use other practices as controls.