Case study: NY pilot changes how 'medical home' is reimbursed

While there's much discussion of the "medical home" model at industry meet-ups, few health plans have gotten to the point where they're actually willing to restructure their reimbursement model to make such a scheme work. However, Albany, NY-based Capital District Physicians Health Plan (CDPHP), seems to be willing to do just that, investing $1 million to mount a pilot program testing the model.

Rather than just talking about primary care-driven care management, the CDPHP program will actually compensate PCPs differently than they have been paid in the past, including pay for phone calls and paperwork. Also, physicians' service fees would be based on a risk-adjusted model based on a patient's condition, with additional pay for good outcomes and strong patient satisfaction.

The pilot will include three medical practices--Latham Medical, Community Care Schodack and Capital Care Family Practice--that will begin offering the program in January 2009. To build out the program, CDPHP is working with TransforMED, an affiliate of the American Academy of Family Physicians that just completed a major study of medical homes. TransforMED will begin helping the practices prepare for the transition this month.

To learn more about the CDPHP program:
- read this piece from The Business Review of Albany

Related Articles:
Health plans, MD groups plan 'medical home' project
New Orleans creates medical home for poor residents
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Questions arise over "medical home" payments

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