New Law Will Establish PCMH Advisory Council, Support Team-Based Care

A new law approved by Gov. Corbett on Oct. 31 establishes a Patient-Centered Medical Home (PCMH) Advisory Council to provide information to the Department of Human Services (DHS, formerly the Department of Public Welfare) and promote the concept of physician-led, team-based care in Pennsylvania.

The Council will be tasked with advising DHS on how Pennsylvania’s Medicaid program can increase the quality of care while containing costs through the following PCMH-model approaches:

  • Coordinate and provide access to evidence-based health care services, emphasizing convenient, comprehensive primary care and including preventive, screening, and well-child health services.
  • Provide access to appropriate specialty care, mental health services, inpatient services, and any evidence-based alternative therapies.
  • Provide quality-driven and cost-effective health care.
  • Provide access to medication and medication therapy management services.
  • Promote strong and effective medical management, including, but not limited to, planning treatment strategies, monitoring health outcomes and resource use, sharing information and organizing care to avoid duplication of services, including the use of EMRs. In sharing information, the protection of the privacy of individuals and of individuals’ information will be priorities. In addition to state and federal laws and regulations regarding the confidentiality of health care information, any information-sharing required by a medical home system will be subject to written consent of the patient.
  • Provide comprehensive care management to patients to align and assist with treatment strategies, health outcomes, use of resources, and organization of care, and address factors of health that impede goals of care.
  • Emphasize patient and provider accountability.
  • Prioritize access to the continuum of health care services in the most appropriate setting and in the most cost-effective manner.
  • Establish a baseline for medical home goals and performance measures that demonstrate that a patient has an established and effective medical home, such as childhood immunization rates, well-child care utilization rates, care management for chronic illnesses, and emergency room utilization.

The Council also will recommend to DHS an organizational model for the PCMH system in Pennsylvania, including possible Medicaid pilot projects; standards and a process to certify PCMHs; and reimbursement methodology and incentives for participation in PCMHs. The organizational model:

  • Will provide a strategy for coordinating health care services, monitoring and collecting data on PCMHs, training and educating health care professionals and families, and transitioning children to the adult medical care system.
  • May include the use of telemedicine resources and may include partnering with pediatric and family practice residency programs to improve access to preventive care for children.
  • Address the need to organize and provide health care to increase accessibility for patients, including using venues more accessible to patients and having hours of operations that are opportune to the patient population.

The Council will be comprised of representatives of family physicians, OB-GYNs, nurse practitioners, internists, pediatricians, pharmacists, hospitals and health systems, PCMHs, mental health care providers, community health centers, managed care organizations licensed in Pennsylvania, and physician assistants. PAMED and other professional organizations that represent these professions may submit names of individuals eligible for appointment to the Council.

This new law went into effect immediately, and expires on June 30, 2020.