Adirondack Medical Home Demonstration
The Adirondack Medical Home Demonstration is organized into three
geographic regions, each of which includes a “pod” supporting the
practices in its region through shared administrative and care
coordination services. Participating practices received a readiness
assessment to develop individualized work plans and incentive payments
to support practice transformation and new care coordination services.
Practices continue to receive these payments once they obtain National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH)
Level 2 or 3 recognition within a 12-18 month period. Grant funding
has also enabled all participating providers to implement an electronic
Enhanced payments are made by commercial payers, Medicaid and
Medicare Fee-For-Service, and Medicaid managed care plans to
participating practices equivalent to $6.50 per member per month
(PMPM). Providers share a portion of the payments with the pods and
with the organization providing supports to the practices, the Adirondack Health Institute.
A $0.50 PMPM pay-for-performance incentive payment is also available
to practices based on member satisfaction, utilization, and the
development of a practice improvement plan.
Statewide Patient-Centered Medical Home Program
Hospital outpatient clinics that have received NCQA PCMH
recognition, including federally qualified health centers (FQHC) and
office-based practitioners (both physicians and registered nurse
practitioners), are eligible to receive enhanced payments for specific
services for participating enrollees.
Payments are made through a patient’s health plan via capitation
payments or are paid as an ‘add-on’ for qualifying visits for Medicaid
fee-for-service patients. Payments vary by level of NCQA recognition
and whether services are provided within Federally Qualified Health
Centers (FQHC) or by office-based practitioners. As of April 2015, a
PCMH fiscal incentive policy will encourage providers who had initially
qualified through earlier NCQA standards to meet 2014 NCQA standards.
Incentive payments for 2008 NCQA PCMH standards will be eliminated, and
2011 NCQA PCMH standards will be reduced. Clinicians who obtain 2014
NCQA PCMH standards will receive incentive payments ranging from $6 -$8