United Hospital Fund Report Identifies 3,741 Patient-Centered Medical Home Providers in New York, By Far Most in Nation

Report Points to the Three Forces Leading to Rapid PCMH Adoption and Outlines Remaining Questions about Even Broader Adoption

Release Date: 11.21.2011
Contact: rdeluna@uhfnyc.org
Contact Phone: 212-494-0733

A new report from the United Hospital Fund finds that 3,741 health care providers in New York State have been recognized by the National Committee for Quality Assurance (NCQA) as working in Patient-Centered Medical Homes, by far the largest number of such NCQA-recognized providers of any state in the country.  The report looks at the forces that have led to the rapid adoption of the Patient-Centered Medical Home (PCMH) model in New York, which account for nearly 20 percent of all primary care physicians in the state; it also looks at the outstanding questions as to what will be required to enlist the other 80 percent of providers.

The report, The Patient-Centered Medical Home: Taking a Model to Scale in New York State, was originally presented in Albany at an October 26 meeting—co-sponsored by the United Hospital Fund, the Primary Care Development Corporation, and the New York chapter of the American College of Physicians, and convened at the request of the state’s Department of Health—focused on Patient-Centered Medical Homes. The report shaped the day’s discussion.

For many, the Patient-Centered Medical Home model—which entails a variety of changes to the organization, management, and financing of primary care services—holds significant promise as a way to address some of the major problems identified in the delivery of primary care, improving access, quality, coordination of care, and the patient experience. It also puts into place systems and staff with the potential to reduce the costs of care, particularly for patients with chronic disease.

According to the report, three forces have stimulated the rapid adoption of the PCMH model in New York State over the past four years: the conduct of nine pilot and demonstration projects, involving providers and plans across the state; the implementation by the state’s Medicaid program of a new payment system to support this care model; and, more generally, the model’s appeal accompanied by anticipation of other changes in payment policies.

“There are many who can share credit for PCMH adoption in New York,” said Gregory Burke, a consultant for the Fund who wrote the report. “Primary care physicians, other health care providers, and health plans have shown real leadership, working together on pilot projects to test and assess the value of the medical home model. Physicians have really changed the way that they provide primary care, and plans have agreed to pay differently, and more, for that care. Also, and critical to the success of this effort to date, the state health department has provided extraordinary leadership and support for these efforts. These pilot projects are only beginning to produce evidence of success, but this model is showing real promise as a way to improve quality of care and the patient/family experience, and to reduce preventable utilization and cost.  But there are still challenges ahead.”

In addition to examining the similarities and differences of nine medical home pilot projects around the state, the report takes a prospective look at what it will take to move this new model of care from demonstration projects to statewide implementation. Among the challenges:

• The PCMH model requires a real commitment on the part of primary care physicians: they must change many aspects of their practices to improve access, quality, and coordination of care, and they will need to invest in health information technology to support those changes and to facilitate real-time care management. 
• To support this care model on a larger scale, health plans will need to be confident that the model really works—that it improves quality and the patient experience and that it saves more money than they need to invest.
• Health plans in most parts of the state will need to work together to stimulate and support widespread adoption, but multipayer arrangements are complicated to organize and manage.
• Medicare currently participates in only one demonstration project in New York, but its broader participation is seen as “important, if not critical,” in achieving scale.
• Currently, a number of key elements—from standards and payments to measures and incentives—vary from one project to another, but standardization will be important for broader adoption.

In addition, while the State has already demonstrated its commitment to the PCMH model, including its willingness and ability to invest in expansion, as well as the time and effort of key staff, various other time-critical priorities make it unclear whether the State will have the capacity to continue providing a similar level of leadership and guidance.

“This report reflects an enormous amount of innovation that is taking place in New York, with real change happening in communities across the state” said Jim Tallon, president of the Fund. “It touches on government; public and private payers; health care providers in small and group practices, health centers, and hospitals; and patients from the healthy to those with complex, chronic illness. There is some real momentum behind Patient-Centered Medical Homes, and we’re starting to see good reason for the related enthusiasm.”

Prepared with support from the New York Community Trust and EmblemHealth, The Patient-Centered Medical Home: Taking a Model to Scale in New York State is available on the Fund’s website, www.uhfnyc.org.

This report complements two earlier Fund publications, The Adirondack Medical Home Demonstration: A Case Study and A Multipayer Approach to Health Care Reform, both of which focus on the same PCMH demonstration in upstate New York. They, too, are available from the Fund’s website.

About the United Hospital Fund: The United Hospital Fund is a health services research and philanthropic organization whose primary mission is to shape positive change in health care for the people of New York.

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