DSRIP spurs growth of patient-centered medical home model
NEW YORK, NEW YORK, April 18, 2019— The number of primary care providers in New York State adopting a high-performing, health care delivery model known as the patient-centered medical home (PCMH) rose by more than 35 percent between May 2017 and May 2018, a dramatic increase in the rate of growth over prior years, according to a United Hospital Fund report released today.
Over the past eight years the number of clinicians working in PCMH practices has increased at an average rate of roughly 15 percent a year, from 3,400 clinicians in 2011 to more than 9,000 at the end of May 2018. The recent growth coincides with the Delivery System Reform Incentive Payment (DSRIP) program, the state’s Medicaid reform initiative, which provided incentives for health systems to help practices to adopt the National Committee for Quality Assurance’s (NCQA) PCMH model, in which all or most of a patient's health care needs are coordinated through a primary care physician.
“It appears that DSRIP accounted in large part for the sharp rise in PCMH clinicians from 2017 to 2018,” said Gregory Burke, director of Innovation Strategies at UHF. “The increased adoption of the medical home model moves us further toward achieving a higher-performing health care system overall.”
The recent growth in PCMH adoption also adds momentum to the implementation of the state’s $100 million State Innovation Models initiative, focused on spreading a New York State-specific model (New York State PCMH), which is built on NCQA’s PCMH model.
However, the report notes that uptake of the PCMH model continues to be uneven across the state. Over the past five years, growth has consistently been slower in New York City compared with the rest of the state
The report, Patient-Centered Medical Homes in New York, 2018 Update: Drivers of Growth and Challenges for the Future, is part of a series UHF has produced since 2011 tracking the adoption of the PCMH model across New York State, with support from The Peter and Carmen Lucia Buck Foundation.
New York State continues to lead the nation in the adoption of the medical home model, accounting for 15 percent of the nation’s NCQA-recognized PCMH clinicians. PCMH is a patient-centric model of care that strengthens relationships between patients and their clinical teams, focusing on improving the health of the population served by the practice. It is especially valuable for treating people with multiple chronic conditions, who generate a disproportionate share of U.S. health care costs.
Payment reform is critical to sustaining the recent growth of PCMH, the report notes. Operating as a medical home requires new functions and staff that increase operating costs, which are not covered by traditional fee-for-service payments or by most emerging value-based payment arrangements. Since 2010, New York’s Medicaid program has offered incentive payments to PCMH practices; but few payers other than Medicaid support medical homes. This leaves many practices – particularly small independent primary care practices -- unable to afford to switch to the PCMH model. Further adoption of the PCMH model requires securing buy-in by payers beyond Medicaid, the report concluded.
Primary care practices that have adopted the PCMH model are also struggling with a rapidly changing, and challenging health care landscape. The emergence of, telemedicine, convenient care (e.g., retail clinics and urgent care centers), and concierge medicine, among other innovations, threatens to make it more difficult for PCMH practices to thrive. The report offers suggestions that could make medical homes better able to compete, including: improving access by expanding hours; focusing on prevention and health education; helping patients negotiate the health system during and after acute episodes and hospitalization; and helping patients with multiple chronic diseases better manage their conditions.
“The continued growth of the PCMH model across the state has been impressive,” said UHF president Anthony Shih MD, MPH. “Sustaining the model requires innovative responses that take into consideration new trends in delivery and payment.”
The full report can be downloaded from UHF’s website here.
About United Hospital Fund
United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care. For more on our initiatives and programs please visit our website at www.uhfnyc.org and follow us on Twitter.