HD4 - Chronic Health Care Homes

    Executive Summary:

    House Joint Resolution 82 introduced by Delegate Patrick A. Hope (2010) directed the Joint Commission on Health Care /(JCHC) to complete a two-year review of available information about chronic health care home systems in other states and to “develop recommendations related to:

    (i) standards for chronic health care homes…;

    (ii) standards for certification of health care facilities as chronic health care homes including ongoing reporting requirements for chronic health care homes;

    (iii) development of a chronic health care home collaborative to provide opportunities for chronic health care homes and state agencies to exchange information related to quality improvement and best practices;

    (iv) enrollment of state medical assistance recipients with chronic health problems in chronic health care home programs; and,

    (v) costs associated with implementing a successful demonstration program to test whether chronic health care homes can improve health care quality and patient outcomes, and reduce costs associated with chronic health problems."

    This executive summary addresses the work completed in the first year of the study which focused on background research on chronic disease, medical homes, and the impact of federal health reform. (The second year of the study will focus on developing specific recommendations related to chronic health care homes.)

    Chronic diseases are a leading cause of adult disability and death in the United States, accounting for 70 percent of deaths. Additionally, more than 70 million Americans have at least one chronic illness and 11 million have more than one. People with multiple chronic conditions typically receive health and home care services from different systems, often from multiple providers within each system. As a result, the health care delivery system for those with chronic conditions is complex and confusing, and care is often fragmented, less effective and more costly.

    There is a growing body of evidence that earlier identification of chronic disease coupled with preventive care can halt or slow the progression of chronic diseases, thereby improving patient health and well-being while reducing medical costs. Furthermore, a number of experts believe that many of the problems identified with chronic diseases and the United States’ health system can be addressed by using the model of a health care home. A health care home or patient-centered medical home (PCMH) is an approach in which primary care providers, families and patients work in partnership to improve health outcomes and quality of life for individuals with chronic health conditions and disabilities. A major goal of a PCMH is to reduce costs by avoiding duplicate or unnecessary testing and services and result in better quality care at a more affordable cost.

    The National Committee for Quality Assurance (NCQA) has developed standards to identify which primary care practices have achieved designation as a medical home. As of March 2010, NCQA had reviewed and recognized approximately 450 practices in 24 states and the District of Columbia as medical homes. Practices that achieve NCQA’s PCMH recognition are positioned to take advantage of financial incentives offered by health plans and employers, as well as federal and state-sponsored pilot programs.

    The Center for Medicare and Medicaid Innovation, authorized in the Patient Protection and Affordable Care Act (PPACA), will test various payment and service delivery models to reduce the rate of growth of Medicare and Medicaid expenditures. Among the models to be tested are those that “promote broad payment and practice reform in primary care, including PCMH models…." In addition, PPACA authorizes the testing of medical homes through demonstration projects. These demonstration projects will be detailed in the second year of the study.

    A report will be submitted to the General Assembly and the Governor for publication after completion of the second year of study.

    Kim Snead
    Executive Director
    January 2011