HD9 - Chronic Health Care Homes (HJR 82, 2010)

Executive Summary:

This is the final report of the study requested in House Joint Resolution 82 by Delegate Patrick A. Hope in 2010. HJR 82 directed the Joint Commission on Health Care to complete a two-year study of the “feasibility of developing chronic health care homes in the Commonwealth." (The interim report was published as HD No. 4 – 2011.)

Chronic diseases are the most prevalent, most costly and most preventable of illnesses. According to the Centers for Disease Control and Prevention, chronic diseases account for 70 percent of all deaths and more than 75 percent of the nation’s $2 trillion in medical care costs. The fragmented way in which medical care is typically delivered means patients with multiple chronic conditions typically receive care from multiple providers working independently and therefore in a less effective, more costly manner. The patient-centered medical home (PCMH) involves a team-based model of care in which a personal physician leads a team of providers responsible for planning and delivering ongoing care for the “whole person."

When HJR 82 was introduced, the concept of a PCMH was just beginning to gain attention. Since that time, there has been substantial growth in the development PCMH pilot programs, indicating that medical homes may become a useful, sustainable model. As of December 2010, the National Committee for Quality Assurance (NCQA) had recognized 1,506 practices across the country. A number of PCMH initiatives have been undertaken in Virginia: 18 Carillion physician practices in the Roanoke and New River valleys are recognized as Level-3 (highest) Patient- Centered Medical Homes by the NCQA; and an increasing number of practices in the Hampton Roads area are working toward transforming into medical homes including physicians and faculty of Eastern Virginia Medical School and several Sentara practices.

The Department of Medicare and Medicaid Assistance Services (DMAS), partnered with the Southwest Virginia Community Health Systems, Community Care Network of Virginia, and Carillion to transition a Medicaid primary care program in southwestern Virginia into a medical home pilot. DMAS recently modified its contract language to allow for participation in a PCMH pilot.

Furthermore, provisions of the Patient Protection and Affordable Care Act (PPACA) created the Center for Medicare and Medicaid Innovation within CMS to test innovative payment and service delivery models (including PCMHs) to reduce the rate of growth of Medicare and Medicaid expenditures. In Virginia, an Innovation Center will be established as a nonprofit center hosted by the Virginia Chamber of Commerce. While many of the details of how the Center will operate have not been determined yet “the Innovation Center will serve as a resource in Virginia by:

• Researching and disseminating knowledge about innovative models of health promotion and health care to Virginia employers, consumers, providers, health plans, public purchasers, and communities;

• Developing multi-stakeholder demonstration projects aimed at testing innovative models of health promotion and health care; and,

• Helping Virginia employers, providers, purchasers, health plans, and communities accelerate their pace of innovation for the benefit of Virginians."

Based on the study findings, the Joint Commission on Health Care approved a policy option to continue to monitor the progress of primary care medical homes and other health care innovations in Virginia by including reports on initiatives in the 2012 work plan of the Healthy Living/Health Services Subcommittee.

Kim Snead
Executive Director
January 2012