Between 2013 and 2014, New York State experienced nearly 20 percent growth in the number of health care providers formally recognized as Patient-Centered Medical Homes (from 4,908 to 5,832 providers). According to a new report from the United Hospital Fund, much of this growth was the result of implementation of the Hospital Medical Home program, a $250-million quality demonstration program involving teaching hospitals.
The growth rate differed substantially by region. In New York City, the number of Patient-Centered Medical Homes grew by 5.0 percent during this period (from 2,533 to 2,660), compared to 33.6 percent for the rest of the state (from 2,375 to 3,172).
The report, Recent Trends and Future Directions for the Medical Home Model in New York, notes that New York State is currently developing and promoting a more robust model of primary care, known as “Advanced Primary Care,” whose structures and capabilities will go beyond those of Patient-Centered Medical Homes. Nevertheless, Patient-Centered Medical Home recognition is a good marker for primary care transformation and performance improvement, and providers that have set up its structures, processes, and competencies will be positioned well to succeed under Advanced Primary Care.
“Primary care practices that have met rigorous standards, as validated by a highly regarded third party, are a critical piece of system transformation,” said the report's author, Gregory Burke, director of innovation strategies at the Fund. “While there are different primary care models out there—and I expect Advanced Primary Care will be an important new one—it's remarkable to see the broad effort and the progress statewide that is paving the way for higher-performing health care delivery.”
New York State continues to lead the nation in the adoption of the medical home model, as measured by the number of practices recognized as Patient-Centered Medical Homes by the National Committee for Quality Assurance and the number of providers working in those practices. New York's 7,608 Patient-Centered Medical Homes (practices and providers combined) represent 14 percent of the national total, more than double California's second-greatest 3,483.
The report also examines the drivers of medical home adoption, identifying two principal factors. First, a practice's capacity (practice size and available infrastructure) is important because the required practice enhancements are easier to achieve in practices that are part of organized provider systems and larger practices than in smaller independent practices. Second, the availability of specific payments related to medical home status is crucial. Medicaid is by far the largest payer routinely making such enhanced payments, and clinics that care for substantial numbers of Medicaid enrollees represent over half of the state's medical home providers.
The Hospital Medical Home program, to which the report credits much of the 2013-2014 growth of the medical home model, focused on increasing the number of hospital teaching clinics that are recognized as Patient-Centered Medical Homes. The program supported practice transformation at 62 of the state's teaching hospitals, which enabled their primary care teaching clinics to gain the required recognition. Over 70 percent of the year-to-year growth in Patient-Centered Medical Homes was due to an increase in such providers.
“This is our fourth report published over the past four years tracking the adoption of the medical home model across New York State,” said Jim Tallon, president of the Fund. “We first started tracking the model because we saw its potential as the foundation for higher-performing health care—better managing chronic care, coordinating care in an increasingly complex system, improving the patient experience, and promoting health—and it is already starting to live up to its potential.” He added that the Fund's tracking of medical homes is part of a growing body of its work focused on primary care delivery transformation.
Development of Recent Trends and Future Directions for the Medical Home Model in New York was supported in part by The Peter and Carmen Lucia Buck Foundation, the TD Charitable Foundation, and EmblemHealth. The report is available here.
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.