MHPA statement highlights common ground between Medicaid health plans, PCMH model

Today, Medicaid Health Plans of America (MHPA) released a policy statement and white paper highlighting the common ground between Medicaid health plans and the patient-centered medical home (PCMH) model.  According to MHPA, the capabilities of Medicaid plans are closely aligned with the principles of PCMHs and therefore plans should be included in states' PCMH implementation strategies. MHPA's Policy Statement notes that collaboration between states, medical home providers and health plans is essential for coordinating complex inpatient and outpatient needs of Medicaid beneficiaries.

In Role of Medicaid Health Plans in Patient-Centered Medical Homes, MHPA maintains that Medicaid health plans are well-positioned to support development of a PCMH system for Medicaid beneficiaries. The white paper highlights evidence showing that coordinated, comprehensive primary care as offered in a PCMH can reduce preventable hospitalizations and improve health outcomes.  But, the transformation of medical practices into medical homes is time and resource intensive and most medical home demonstrations are in the pilot testing phase. Along with a solid track record of ensuring access to high quality care for Medicaid beneficiaries, health plans have the data, the analytic capability and care management infrastructure to support medical home implementation and aid in physician practice transformation.  In partnership with State Medicaid programs, health plans also have the flexibility to adopt payment innovations to reward value.

"The scope of Medicaid health plans – their experience in care coordination, financial management, and quality improvement, as well as their mature data infrastructures for quality and cost reporting in all care settings – makes Medicaid health plans a natural and essential partner with states as they begin to roll out medical homes for the complex and vulnerable populations in their communities," explained Thomas L. Johnson, President and CEO of MHPA. "Medicaid health plans have the capability to link members to primary care physicians, coordinate access to specialists, even facilitate access to care by providing language interpretation services and transportation, a benefit that's especially useful given the unique characteristics of the people they serve."

MHPA encourages states to draw on the valuable experience of Medicaid health plans and include health plans in PCMH implementation strategies. "The Medicaid health plan industry has much to offer and we're looking forward to collaborating with both states and providers to make the PCMH model work to provide better care to Medicaid enrollees," said Mr. Johnson.