The National Committee for Quality Assurance (NCQA), a not-for-profit organization dedicated to improving health care quality, has implemented criteria that recognize providers who provide this high level of care:
- Care management - every patient has an ongoing relationship with a personal physician who provides continuous and comprehensive care
- Access and communication - which can include open scheduling, expanded hours, and new options for communication between patients, their personal physician and practice staff
- Patient tracking and registry functions - information technology to support optimal patient care, performance measurement, and communication
- Patient self management support - patients actively participate in decision-making and their input is sought
- Electronic prescribing, test tracking, referral tracking, performance reporting and improvement, and advanced electronic communication - technology is used to enhance coordination and continuity of care
Health New England : Over 4,200 of HNE's GIC members who receive their health care at Riverbend Medical Group and Valley Medical Group are receiving the benefits of a Medical Home Program. Both provider groups have earned the highest level of NCQA medical home certification (Level 3). Patients with chronic conditions receive enhanced case and disease management benefits. For example, many are assigned a care coordinator to help them manage appointments, tests and medication adherence. Quality management teams at these facilities meet regularly to address all aspects of a patient's care and electronic medical records and best practices of care are followed. In exchange for this top notch care, the providers receive enhanced payments.
Fallon Community Health Plan: Over 100 high-risk GIC diabetic patients are receiving Medical Home benefits at Fallon Clinics. Patients receive coordination of care, including comprehensive electronic medical records that are accessible by participating providers. Dedicated medical assistants and nurses follow up with patients to be sure they are adhering to prescribed testing, medications, and consultations.
UniCare State Indemnity Plans: Over 700 UniCare members with asthma, diabetes, depression and other chronic conditions who receive care at Acton Medical Associates have medical home benefits. The practice, which offers extended hours and electronic medical records, just received NCQA Level 3 Medical Home accreditation. Additionally, over 800 UniCare members who receive care at Pittsfield Family Practice Associates may soon benefit with a Medical Home Program. The practice is restructuring their office in an effort to meet NCQA's standards. Both practice groups will be working with UniCare over the next two years to improve their quality and coordination of care in compliance with the medical home model in exchange for enhanced reimbursements.
Neighborhood Health Plan has enrolled 18 GIC members into its Community Medical Alliance (CMA) mobile practice that coordinates care for members with complex health care needs. CMA's clinical staff visit the patients at their homes or work settings to assess the patients' physical, behavioral and cultural needs so that an effective plan of care can be developed and implemented. CMA staff has remote access to NHP's care management database and are available 24 hours a day, seven days a week.
Other GIC health plans are currently working to develop Medical Home programs and more GIC members will benefit from these programs in the future.
This information provided by the Group Insurance Commission.