6 Health Plans Jointly Fund $1.5M Patient-Centered Medical Home Program

Six health plans in New York State funded incentives worth $1.5 million to establish patient-centered medical homes that will serve nearly 500,000 people in the Hudson River Valley region, program coordinator Taconic Health Information Network and Community announced Wednesday.

The health plans--Aetna, CDPHP, Hudson Health Plan, MVP Health Care, UnitedHealthcare, and Empire BlueCross Blue Shield--represent 65% of the commercial insurance market in the Hudson Valley and 43% of Medicaid managed care. THINC said the plans set aside competition in favor of cooperation, and paid the incentives to 236 primary care physicians in 11 practices that achieved patient-centered medical home recognition from the National Committee for Quality Assurance.

The PCMH transformation project was managed over one year by not-for-profit THINC.

"This success of this project means we've reached critical mass for the medical home in the Hudson Valley," said Susan Stuard, THINC's executive director. "A majority of the commercial and public program insurance plans serving the Hudson Valley worked together to support the foundation of primary care -- bring better preventive care, improved chronic condition care, and better access to coordinated care. Ultimately, this project shows that those caring for the people of the Hudson Valley can move beyond competition to enhance quality."

Along with the promise of incentive payment once NCQA recognition was achieved, the health plans provided data which will be used to evaluate the project's outcomes, part of a five-year commitment from the plans to help practices delivery enhanced care.

"The project evaluation will go beyond what the national demonstration project was able to measure, giving us information about physician satisfaction, patient satisfaction, and improvements in quality of care, which we can report in 2011," Stuard said. "For the first time, the data set will allow us to benchmark this quality data and then look at those issues over time."  

Moving forward, Stuard said THINC wants care management within NCQA Level 3 patient-centered medical homes to improve efficiency and quality. Borrowing technical support from Geisinger Health System’s ProvenHealth Navigator program, THINC will create a small pilot at several sites before rolling out to medical home recognized primary care providers across the region. Stuard said the program will serve as a national model operating outside of an integrated health system.