Find answers to frequently asked questions about the Adirondack Medical Home Initiative.
- What is the Adirondack Medical Home Initiative?
- What do I have to do to join the program?
- Why should I want to be a member?
- How will the medical home initiative affect my care?
- How much does the initiative cost and how is it paid for?
- Do physicians support the patient-centered medical home model?
- How does the Adirondack Medical Home Initiative compare to the old health care system?
- How will Adirondack Medical Home Initiative affect my medical bills?
- Is the AMHI one of its kind?
- How do I find information on NCQA Patient Centered Medical Home Standards?
The Adirondack Medical Home Initiative is an extension of the Adirondack Region Medical Home Pilot and is a collaborative effort by health care providers and public and private insurers to transform the health care delivery system in our rural, upstate New York region. Its goals are to improve quality, ensure access and contain costs for health care. It will accomplish these goals by emphasizing preventive care, enhanced management of chronic conditions, and by assuring a close relationship between patients and their primary care providers. (Please see About AMHI for more information.)
Nothing. You are automatically part of the initiative if your primary care practice is participating and you are considered an “active” patient – someone who has been seen by a practice physician in the last two years. You are also automatically included if you are a household family member of an active patient.
We believe that this approach will result in a strengthened patient/physician dialogue and relationship. Increased emphasis will be placed on prevention and your overall health. Measures will be taken to encourage and remind you about wellness steps and practices. The medical home concept should result in improved health and health care, particularly for people who may have chronic health problems.
You can expect to hear more, and regularly, from your primary care physician. You will be encouraged to schedule annual exams and stay current with age and gender-related screenings (i.e. pap smears, mammograms, prostate exams, immunizations, flu shots). If you are a patient with one of the chronic conditions addressed by the pilot (diabetes, hypertension, coronary artery disease, asthma), you can expect frequent communications from your primary care practice to ensure that you are following an effective care plan to keep you as healthy as possible. Should you need hospitalization or care from a specialist, your primary care physician will act as a team leader, coordinating your care.
The initial cost will be the increased payments for primary care services. These will be underwritten by the public and private payers (Medicaid and private health insurance plans). Over time, the additional funds spent on primary care are expected to lower costs by reducing emergency room visits, use of specialists, hospital admissions and readmissions. The initiative is expected to slow the upward rise of health care costs and associated insurance fees.
The American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians, and the American Osteopathic Association strongly support the model. In 2007, these groups jointly issued seven basic, long-term goals of for patient-centered medical homes. They are:
- Each patient will have a continuous, up-to-date partnership with a primary care doctor.
- The Primary Care doctor will be part of a team, which will take responsibility for the health of the patient and his surrounding population.
- The Primary Care doctor will provide a health care outline for the patient to lead a healthier, more productive life.
- The patient-centered medical home will help facilitate a partnership between the hospital, home health agencies, and the community.
- The quality and safety of health care will be heightened by the expectation of physicians to monitor the micro-details of individual patients.
- Patients will have enhanced access to their physicians through open scheduling, expanded hours, and new communication options.
- The financial cost of health care will be re-focused to avoid preventable illnesses to avoid future, more expensive treatment costs. Patients and insurance companies can expect to pay less, while physicians can expect to share in the savings from decreased hospitalization and administration costs.
The traditional health care model (known as “fee for service”) pays physicians for the volume of the service they provide, instead of the results of their care. Important preventive care is often not reimbursed or underpaid, so patients end up getting treated only when a disease or complaint becomes severe. There are also no incentives for coordination of care and managing chronic conditions.
The AMHI shifts the focus to preventive care and health maintenance. The pilot creates funding incentives that reward keeping people as healthy as possible rather than paying for procedures without regard to effectiveness. This approach allows patients to stay healthier and doctors to concentrate more on quality of care rather than volume of care.
On the patient side, increased contact with the primary care practitioner will help to enable earlier diagnosis of problems. Early diagnoses generally translate into better health and lower costs.
In the long run, patient medical bills are expected to gradually lessen as early diagnoses save patients from paying for expensive, later-term treatment. Moreover, patients who follow primary care recommendations for diet, physical activity, smoking cessation and other behaviors associated with good health are likely to experience fewer preventable medical problems – hence lower medical costs.
The Adirondack Medical Home Initiative is one of five Multi-payer Advanced Primary Care Practices (MAPCP) demonstrations nationwide to receive an extension by Centers for Medicare & Medicaid Services (CMS). The extension runs through 12/31/2016.
Launched in 2011, the Adirondack Medical Home was a five-year pilot study. The health care goals included improving quality, ensuring access and containing costs. The AMHI emphasis continues to be on preventive care, enhanced management of chronic conditions, and the assurance of a close relationship between patients and their primary care providers.
The NCQA PCMH Standards are summarized in the document “NCQA Patient Centered Medical Home 2014 Standards – Frequently Asked Questions” document located under “Resources” on the DSRIP Project 2.a.ii page.
Contact Us for more information.