Forming partnerships with key players (including patients, providers and private sector payers) whose practices the state seeks to change.
Patient 1st and Patient Care Networks of Alabama (PCNA): The Alabama Medicaid Agency has established working relationships for this project with the state physician associations (including the Alabama chapters of the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP)), the Alabama Primary Health Care Association (representing federally qualified health centers (FQHCs) in the state), the Department of Public Health (Children’s Health Insurance Program (CHIP) administrator), and the Department of Rehabilitation, among others. In addition, a reengaged and expanded Patient 1st Advisory Council that includes Family Voices and several physicians is guiding the Agency’s work. Alabama held town hall-style meetings with provider around the state to discuss the Patient Care Networks of Alabama (PCNA) program.
Each Patient Care Networks of Alabama network is organized as a 501(c)(3) corporation. At least one half of the board of directors for each network must be comprised of primary care physicians, and in addition the board must also include at least one representative from an FQHC, a hospital, the health department, a Regional Public Mental Health Authority, and a community pharmacist. This composition encompasses representatives from across the community to support practice transformation.
|Alaska||The Alaska Patient-Centered Medical Home Initiative (AK-PCMH-I) is a collaborative effort of the Alaska Mental Health Trust Authority, the State of Alaska Department of Health and Social Services, and the Alaska Primary Care Association.|
|Arizona||No known activity at this time.|
Arkansas has received input on their payment and delivery system transformation initiative from Arkansans via meetings with key stakeholders, workgroups, webinars and town hall meetings. Project staff have met with a wide range of stakeholders, including:
The state Department of Human Services partnered with Arkansas Medicaid and two large private payers, Arkansas Blue Cross and Blue Shield and Arkansas QualChoice, to form the Arkansas Care Payment Improvement Initiative. This group worked with providers, health administrators, patients and advocacy groups to design the initiative.
For more information, visit the state’s archive for this initiative.
|California||No known activity at this time.|
Medical Homes for Children Program: 125-member stakeholder medical home advisory board included provider and family leadership, staffed by Medicaid and included a state-wide survey of providers. Family Voices Colorado has represented parents and families in medical home development since 2000.
Minutes from the Medicaid Medical Assistance Program Oversight Council show that the following groups provided input during the development of the Connecticut medical home initiative:
The Connecticut Department of Social Services also hosted five public forums for HUSKY Health enrollees across the state.
Furthermore, Connecticut Public Act 09-148 required the SustiNetHealth Partnership to include a Patient Centered Medical Home Advisory Committee composed of physicians, nurses, consumer representatives and other selected qualified individuals. The advisory committee is charged with developing proposed regulations for the administration of medical homes serving SustiNet enrollees.
|Delaware||No known activity at this time.|
|District of Columbia||No known activity at this time.|
Chapter 223 of the 2009 Laws of Florida required a Medicaid medical homes task force to include provider and Medicaid enrollee representation. The Secretary of Health Care Administration appointed ten members in total, adding representatives for payers, professional associations, medical schools, and advocacy groups. All five Medicaid Medical Home Task Force meetings were public, and the task force allotted time for public comment at each meeting. More information on the task force members and minutes of each meeting can be found in the 2010 report.
The Medicaid Medical Home Task Force stressed a “bottom-up” approach to developing a medical home program by soliciting input from providers, consumers, and other interested stakeholders. The task force also recommended that an advisory board assist in the planning and implementation of a Medicaid medical home pilot project.
|Georgia||No known activity at this time.|
The following groups are represented on Hawaii’s Health Homes State Plan Option Collaborative:
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.
Representatives from Illinois’s Title V program participated in stakeholders meetings to help develop Illinois Health Connect. Currently, Illinois Health Connect maintains several advisory subcommittees to offer feedback on the design and ongoing operation of the Illinois Health Connect. Participation on the advisory subcommittees is open to any interested patient or provider.
The following stakeholder types are among those represented on the advisory subcommittees:
|Indiana||No known activity at this time.|
IowaCare: The Iowa Medical Home System Advisory Council (MHSAC) is made up of legislators and a variety of stakeholders including Medicaid, the state chapter of the American Academy of Family Physicians (AAFP), the state chapter of the American Academy of Pediatrics (AAP), the physician assistant association, the osteopathic society, the nursing association, the chiropractic society, the medical society, the dental association, consumers, private payers, and the primary care association (PCA). MHSAC is supported by 1.5 full-time staff at the Iowa Department of Public Health and has published two issue briefs to educate policymakers and stakeholders in Iowa about issues regarding the medical home model.
A full list of MHSAC members is available here.
|Kansas||Shortly after passage of Sub. SB 81 (New Section 13) in 2008, the Kansas Health Policy Authority (KHPA) convened a broad stakeholder group to develop systems and standards for the implementation of the medical home in Kansas. Membership in the stakeholder group included a range of providers, consumers, insurers, safety net clinics, state health agencies, and information technology vendors. The full group and three subgroups met frequently during 2008 and 2009 and developed consensus on the broad principles that should underpin the Kansas medical home.|
|Kentucky||No known activity at this time.|
|Louisiana||The Louisiana legislature established the Louisiana Health Care Quality Forum (LHCQF) with House Concurrent Resolution 75 of the 2007 Regular Legislative Session. LHCQF was established to convene all public and private stakeholders to advance quality initiatives in the state, including the medical home. In March 2008, LHCQF held a medical home summit.|
Maine PCMH Pilot: A variety of stakeholders have helped develop Maine’s Patient-Centered Medical Home (PCMH) Pilot, including:
The convening entities – the Maine Quality Forum, Quality Counts, and the Maine Health Management Coalition – also bring the perspectives of a diverse range of constituencies, including employers, unions, and providers.
ACA Section 2703 Health Homes: Maine’s health homes initiative is part of a broader Value Based Purchasing Strategy currently being pursued by MaineCare, Maine’s Medicaid agency. To learn more about Maine’s Value-Based Purchasing Strategy, visit the Maine page on NASHP’s Accountable Care Activity Map.
MaineCare has engaged state policymakers from a variety of offices within the state’s Department of Health and Human Services in planning for the state’s Value Based Purchasing Strategy, including the Maine Center for Disease Control, the Office of Adult Mental Health Services, the Office of Child and Family Services, the Office of Elder Services, the Office of Substance Abuse, and the Office of the State Coordinator for Health Information Technology, among others. MaineCare has also engaged the University of Southern Maine’s Muskie School of Public Service on planning committees.
The Governor’s Council created the Patient Centered Medical Home (PCMH) Workgroup in 2009 to work toward creating an all-payer medical home pilot. Three subgroups—focusing on foundations, practice transformation, and purchaser/consumer education—of workgroup members and other stakeholders were formed. The subgroups were instrumental in selecting the program participation criteria, transformation activities, quality performance measures, and payment strategies.
Project staff has met with a wide range of stakeholders, including:
The Maryland Health Care Commission (MHCC) has also created a web PCMH portal for providers and hosted seven regional symposia to introduce the initiative to providers (for an example, see here).
Maryland 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 participation in this project, Maryland strengthened partnerships between state government and universities, among hospitals, and between practices and external partners such as provider associations and non-profits.
Massachusetts Patient-Centered Medical Home Initiative: The Massachusetts Patient-Centered Medical Home Initiative (PCMHI) Council included representatives of:
For more information, please see the PCMHI Council webpage.
|Michigan||The Michigan Department of Community Health leads the Michigan Primary Care Transformation (MiPCT) Project with guidance from the 18-member steering committee representing state agencies, primary care physicians, physician organizations, health plans, employers, and the Michigan Primary Care Consortium. The project is managed by the University of Michigan. The project has also formed a Patient Advisory Council to advise the steering committee.|
The Minnesota Departments of Health and Human Services hosted many meetings to develop the Health Care Homes Program. Stakeholders in attendance included representatives of:
|Mississippi||No known activity at this time.|
SB577 of the 2007 Session Laws created an 18 member MOHealthNet Advisory Committee to oversee the MOHealthNet program. The Advisory Committee includes government, provider (including physicians, non-physicians and dentists), hospital, and consumer representation.
The Missouri Department of Mental Health acknowledges the following partners in developing Affordable Care Act Section 2703 Health Homes:
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
Nebraska Medicaid Patient-Centered Medical Home Pilot: The Nebraska Medicaid Medical Home Advisory Council consists of one hospital administrator, six primary care providers (representing family, internal, and pediatric medicine), and one ex-officio legislator, each appointed by the governor. The Council began meeting in October 2009 and continues to meet regularly.
The Nebraska Department of Health and Human Services (DHHS) has also worked to engage a variety other stakeholders, including BlueCross Blue Shield of Nebraska and the Dietetic Association.
The Medical Home Advisory Council is supported by DHHS staff. A job description for the DHHS Medicaid Medical Home Program Coordinator is available here.
Multi-Payer Patient-Centered Medical Home Pilot: Representatives of the following individuals and groups signed the pilot participation agreement:
|Nevada||No known activity at this time.|
|New Hampshire||No known activity at this time.|
|New Jersey||New Jersey Medicaid Medical Home Demonstration Project: P.L. 2010, c.74 directed Medicaid to consult with Medicaid managed care organizations (MCOs) in establishing a medical home demonstration.|
New Mexico Medicaid plans to develop a workgroup including, but not limited to, the following organizations:
The workgroup will develop collaborative/cooperative protocols to support the goals and needs of medical homes.New Mexico Medicaid also plans to develop managed care consumer advisory boards to educate enrollees and receive input on what enrollees want from medical homes.
The New York Legislature has guided current and future medical home partnerships:
In addition, Governor Cuomo tasked a multi-stakeholder Medicaid Redesign Team to reduce costs and increase quality and efficiency in the Medicaid program for the 2011-12 Fiscal Year. This team endorsed Medicaid Redesign Proposal 70, which includes the creation of a medical home advisory group to provide recommendations for the development of Health IT-derived quality, safety, and efficiency measures for pay-for-performance demonstrations.
Adirondack Medical Home Demonstration:The Adirondack Medical Home Demonstration is currently governed by a multi-stakeholder committee of payers and providers chaired by a New York State Department of Health official.
Community Care of North Carolina (CCNC): Community Care of North Carolina is a partnership that includes providers supported by the Medicaid agency (Division of Medical Assistance), Office of Rural Health and Community Care, local health departments, and Departments of Social Services and Hospitals. Each network is run locally by an Executive Director, who oversees a team of case managers, as well as a Medical Director, who works with local physicians who provide input.
In 2006, the North Carolina Governor convened a public-private collaboration of government, payers, and provider representatives to develop and implement a common set of best medical quality standards and measures for asthma, diabetes, congestive heart failure, hypertension and post myocardial infarction care. The Governor’s Quality Initiative, now known as the independent non-profit North Carolina Healthcare Quality Alliance (NCHQA), launched in 2008. The NCHQA Board of Directors also includes consumer and business representation. The NCHQA has played a key role in aligning quality initiatives to support and transform primary care.
Early North Carolina Medicaid medical home projects were made possible by support from the North Carolina Foundation for Advanced Health Programs, Inc. and the Kate B. Reynolds Health Care Trust.
|North Dakota||No known activity at this time.|
PCMH Education Pilot Project: Substitute House Bill 198 (128thGeneral Assembly) established an eighteen-member patient-centered medical home (PCMH) education advisory group. Membership statutorily includes:
Non-voting, ex officio:
The advisory group also hosted a statewide webinar and four regional town hall meetings to educate prospective practices and receive feedback from stakeholders.
In addition to administering the pilot, the act directs the advisory group to work jointly with state medical and nursing schools to develop new curricula to prepare future primary care providers for the PCMH model of care.
SoonerCare Choice: In 2007, an 11-member Medical Advisory Task Force, comprised of provider organization representatives and staffed by Medicaid, was formed and recommended providing every SoonerCare Choice member with a patient-centered medical home model.
Chapter 166 of the 2008 Session Laws established a temporary 16-member Medical Home Task Force staffed by the Insurance Department to study implementation of patient-centered medical homes (PCMH) for private and public payers.
Town hall meetings were convened across the state in Fall 2008.
Oregon Patient-Centered Primary Care Home (PCPCH) Program: Chapter 595 of the 2009 Oregon Laws created a 15-member advisory committee and required a diverse constituency (e.g., payers, practices, third-party administrators) guided by public input. In fact, the Director of the Oregon Health Authority convened two advisory committees: a Standards Advisory Committee and the Pediatric Standards Advisory Committee.
OHA has also partnered with the Northwest Health Foundation (NWHF) to convene the NWHF PCPCH Task Force. The task force, made up of clinicians (both primary care and mental health), patients, public health experts, and healthcare delivery technical experts, developed recommendations and action steps to support broad implementation of Patient-Centered Primary Care Homes (PCPCH) in the state.
The Chronic Care Commission, which developed the Chronic Care Initiative (CCI), included representatives from the following groups:
|Rhode Island||The Care Transformation Collaborative of Rhode Island (CTC): Rhode Island’s Office of the Health Insurance Commissioner convened a multi-stakeholder coalition. In addition to the participating payers and purchasers, partnering stakeholders include primary care provider organizations, the Rhode Island Department of Human Services, and the Rhode Island Department of Health.|
|South Carolina||No known activity at this time.|
In April 2012, in response to a 2011 Final Report from the state’s Medicaid Solutions Workgroup, the South Dakota Department of Social Services convened a Health Home Workgroup to guide the implementation and evaluation of ACA Section 2703 health homes in the state. The South Dakota Health Home Workgroup included legislators, representatives from state government including the Department of Social Services, Department of Health, and Bureau of Human Resources, and other stakeholders representing providers, tribes, the South Dakota State Medical Association, the South Dakota Council of Mental Health Centers, and the South Dakota Association of Health Care Organizations. A full membership list is available on the Workgroup’s website.
The group ended its work in October 2012 after developing two draft models for Health Homes to serve Medicaid enrollees in the state. The first model, led by primary care providers, will serve patients with chronic conditions; the second will be led by Community Mental Health Centers and will serve patients with severe mental illness, emotional disturbance, or substance abuse disorders. South Dakota Department of Social Services also proposed a set of health home outcome measures and a payment model, and has identified a Health Home application process.
|Tennessee||The Tennessee Medical Home Project, which is primarily focused on children and youth with special health care needs, has been developed in partnership with:
The following state agencies are represented on the Texas Medical Home Work Group:
Additional participating stakeholders include health plans, providers, provider professional associations, and the primary care association.
It also bears noting that primary care providers in Texas have a history of enthusiastically supporting medical homes. The Primary Care Coalition, a group of almost 15,000 doctors from the Texas Academy of Family Physicians, the Texas Chapter of the American College of Physicians, and the Texas Pediatric Society released a 2008 report The Primary Solution calling for the Texas legislature to, “support a patient-centered primary care medical home for all Texans.”
Key Children’s Healthcare Improvement Collaboration (CHIC) partners include:
Participating practices are expected to include a family partner in their practice teams.
Act 71 of the 2007-2008 legislative session created an executive committee to advise the director of the Blueprint for Health. The legislation requires government, provider, private payer, quality assurance, and consumer representation. Act 128 of the 2008-2009 legislative session expanded membership to include business and home health stakeholder representation.
The executive committee was charged with engaging insurance plans, professional organizations, community and nonprofit groups, consumers, businesses, school districts, and state and local government to create a five-year strategic plan.
The Virginia Department of Medical Assistance Services (DMAS) has engaged a variety of stakeholders to develop the medical home pilot, including:
A wide range of stakeholders have been involved in designing Washington State’s mutli-payer Patient Centered Medical Home (PCMH) Pilot, including:
For more information, please see Appendix K here.
The PCMH Collaborative has been developed as a partnership between the Washington Academy of Family Physicians and the Department of Health (DOH). Many of the stakeholder types referenced above – including providers, professional associations, and payers – have helped guide the Collaborative’s work. For more information, please see page 75 here.
The West Virginia Health Improvement Institute (WVHII), a partner of West Virginia Medicaid, provided a multi-stakeholder forum for development of the Medical Home Performance Incentive Pilot.
The West Virginia Bureau of Medical Services is also leading a stakeholder advisory group for Affordable Care Act Section 2703 Health Homes that is open to all interested stakeholders. This advisory group includes four workgroups:
West Virginia 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 West Virginia built on partnerships developed through the WVHII to strengthen public-private collaboration. West Virginia strengthened important partnerships between health care practitioners, local health departments, MCO officials, and medical school leaders.
|Wisconsin||No known activity at this time.|
|Wyoming||The Wyoming Department of Health has partnered with the Wyoming Institute of Population Health, a division of Cheyenne Regional Medical Center.|