The Montana Patient- Centered Medical Home Program Amanda Roccabruna Eby, Project Administrator Montana Office of the Commissioner of Securities and Insurance

MT PCMH Program Stakeholder Council Mission Advise the insurance commissioner and direct program development Establish and monitor performance standards that are specific and focused Establish and monitor payment standards that innovatively support enhanced primary care Ensure program efforts support the Triple Aim goals The Montana PCMH Program provides a foundation and sustainability model to orchestrate consistent, standardized PCMH implementation efforts across Montana, and advance an efficient and effective healthcare system based on the foundation of primary care 3

Implementing the Montana PCMH Act Published first administrative rules in September 2013 Appointed the stakeholder council in November 2013 Approved which accrediting organizations meet Montana’s standards in January 2014 Qualified the initial medical practices in February 2014 Developing rules on Montana specific standards to measure quality improvement Developing rules on standards for participating payers to provide consistency and transparency to providers 4

Commissioner Lindeen approved three national accrediting agencies for the Montana PCMH Program: o The National Committee for Quality Assurance (NCQA) The National Committee for Quality Assurance (NCQA) o The Accreditation Agency for Ambulatory Health Care (AAAHC) The Accreditation Agency for Ambulatory Health Care (AAAHC) o The Joint Commission The Joint Commission There are currently 38 Qualified PCMHs in Montana There are currently 39 Provisionally Qualified PCMHs o Must receive recognition within 12months from an approved agency. Implementing the Montana PCMH Act

The Chronic Disease Prevention Bureau at the Montana Department of Public Health has been working with CSI and the stakeholder council The public health department proposed four measures to track how PCMHs improve the quality of care and broadly improve public health. The stakeholder council unanimously agreed on the measures: o Hypertension control o Tobacco cessation o Childhood immunizations o A1C control Clinical Quality Reporting Standards

Insurers wishing to participate in the Montana PCMH Program must submit a letter of intent describing their proposed method of compensation for approval Letters will be available to the public, excepting trade secrets PCMH payers will report ER visits and hospitalization rates in aggregate for their entire population and separately for PCMH patients, annually Payment & Utilization Reporting Standards

Under the PCMH law, the commissioner must make rules on quality standards and payment standards The Quality Metrics Subcommittee and Payer Subcommittee are working with CSI staff to develop the standards Quality reporting standards need to glean meaningful data, but not be an administrative burden Payment standards need to create transparency and set a minimum threshold for payers, yet be flexible for innovation Overall – Are PCMHs in Montana improving the quality of care and health of their patients and are they reducing their utilization? Program Standards

Lessons Learned in 1 st Year of Implementation Providers being regulated by the insurance commissioner is a new relationship requiring patience and understanding from both sides Even when you think everyone understands and is on board, they usually don’t, expect to have to pause and reverse several times to explain options, get buy in and move forward

Call Or visit Commissioner Monica J. Lindeen Questions?