United Hospital Fund has released the third in a series of reports tracking medical home growth in New York State. Compared to previous periods, this update notes slower growth of patient-centered medical homes within New York City. It also notes that much of the overall recent growth of medical homes is occurring in hospital clinics as they expand their primary care programs—the explicit goal of several state initiatives.
New York State continues to lead the nation in adoption of the medical home model by primary care practices, according to the report, The Growth of Medical Homes in New York State, 2014 to 2016. The number of health care providers working in Patient-Centered Medical Homes in New York State grew by 7 percent between 2014 and 2016 (from 5,832 providers to 6,264). Over one-quarter of the state's primary care physicians work in primary care medical homes—one-eighth of all such providers in the country, and substantially more than any other state. Notably, much of that growth is occurring in hospital clinics, health centers, and New York City Health + Hospitals clinics, which have received strong encouragement to implement or expand primary care from several New York State programs, including the Hospital-Medical Home Demonstration program, a federal waiver program running from 2011 to 2014; and through incentive payments from the State's Medicaid program.
A chartbook section of the report presents data on the spread of medical homes, breaking them out by practice type, across regions and New York City boroughs. Among the findings of the examination: The number of primary care medical home providers in New York grew by 28 percent over the last three years, though the growth was slowest in the most recent year analyzed. New York City led in early adoption of the model and while it still has considerable numbers of these providers, most of the recent growth occurred in four other regions: Finger Lakes, Long Island, Mid-Hudson, and Western New York.
Looking ahead, the report notes that the primary care medical home is still the most widely adopted model of medical home, but it is no longer the only one. Over the next few years, it will be competing with other models—including “advanced primary care” (APC). New York has an ambitious goal of making sure that 80 percent of the state's population will receive primary care in an APC setting. “The growing attention to and investment in primary care is undoubtedly a positive for New York, said Gregory Burke, author of the report. “But the proliferation of different models is creating some confusion among providers, as we all try figure out what the next new standard will be.”
The State faces four major questions as it steps up its efforts in promoting primary care:
- Which model to pursue. There is a need to better align the competing programs, and to give clearer direction to primary care practices in picking which medical home model makes the most sense for them.
- How to achieve multipayer support for medical homes. The considerable expense of adopting the medical home model is a much riskier venture without broad multipayer support.
- How to pay for medical homes under value-based payment. Securing an initial infusion of startup costs of transforming a medical home may be at odds with value-based payment systems.
- How to make sure small practices are not left behind in this effort. Small practices are critical in getting care to high-need populations around the state, in both urban and rural settings.
Development of The Growth of Medical Homes in New York State, 2014 to 2016 was supported in part by The Peter and Carmen Lucia Buck Foundation. The report is available 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.