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Care Providers & Care Coordination
Medicare MAPCP Medical Home Demo: CMS Kicks Sands in the States’ Faces
by Jaan Sidorov, MD and Vince Kuraitis
The Medicare MAPCP (Multi-Payer Advanced Primary Care Practice) demo promised to be Medicare’s Biggest Change in 40 Years…
…but the emerging reality isn’t living up to the promise.
In this post, we’ll discuss:
The Promise
An Overview of the MAPCP Demo
Our Main Takeaway: Emerging Reality Suggests Medicare Will Be a “Difficult” Partner
Conclusion: Think Twice Before Signing Up
1) The Promise
The sandbox metaphor was first used by the National Academy for State Health Policy:
For the 10 or more […]
PCMH and Healthcare Reform: Avoiding Drowning in an Ocean of Opportunity
This article appears in the April 2010 issue of Medical Home News.
First, the good news: There are a lot of pilot and demonstration projects potentially involving the Patient Centered Medical Home (PCMH) in newly enacted Federal health care reform legislation – the Patient Protection and Affordable Care Act (PPACA).
Then, the bad news: There are a lot of pilot and demonstration projects potentially involving the PCMH in the PPACA.
…so many that the PCMH risks being drowned in an ocean of opportunity.
I’d […]
How Long Have We Known This?
Hospitals charge on a cost basis, which places no penalty on inefficient operations. Moreover, present systems of hospital management make it very difficult to maintain effective control over hospital costs. The Commission concluded:
“If the needs for health care are to be met, the health care system must be organized to employ its resources with more wisdom and effectiveness. The two areas which appear to offer the greatest potential for improvement are (1) reducing unnecessary (or unnecessarily […]
Medicare’s Biggest Change in 40 Years on the Horizon?
Earlier this week CMS issued a typically cryptic Announcement indicating that they were shelving the Medicare Medical Home Demonstration (MMHD) and instead would focus on the recently announced Multi-Payer Advanced Primary Care Initiative (MAPCI). My blog post from Tuesday provides details and asks the question “What does all this mean?”
Today’s blog post will tackle:
Medicare’s biggest change in 40 years?
The rise of MAPCI
The fall of MMHD
Implications/discussion
Medicare’s Biggest Change in 40 Years?
CMS Shelves Medicare Medical Home Demonstration
I just received an email from CMSÂ announcing the latest official word on the Medicare Medical Home Demonstration (MMHD):
10/26/2009 – In Washington, the efforts to reform health care and health insurance include proposed legislative language that would have an impact on the Medicare Medical Home Demonstration as described in section 204 of the Tax Relief and Health Care Act of 2006 and amended by section 133 of the Medicare Improvements for Patients and Providers Act of 2008. Specifically, section 1302 of […]
Part II — The Medicare Medical Home Demonstration: Crawling Out From Under the Rock
In Part I of my guest post on The Collaborative Forum blog, I wrote that the Medicare Medical Home Demo is in BIG Trouble. Here’s a recap:
Political reality dictates that the MMHD must save costs.
As currently structured, the MMHD cannot achieve cost savings
In any given year, only a small percentage of patients account for the vast majority of costs
Lessons from previous Medicare disease/care management demonstrations has shown that effective care coordination interventions must be targeted at this population
Medicare has structured the […]
Medical Home Savings Claims in Medicaid are Not Plausible
by Al Lewis, Disease Management Purchasing Consortium International, Inc.
Medical homes probably do save money in very controlled settings, where the entire team is literally or at least figuratively under one roof, such as Kaiser. However, the belief that one can overlay a traditional medical home model across an entire state and save money in the process turns out to be total fiction.
The poster child for that fiction, North Carolina’s Community Care program, turns out to cost state taxpayers probably $400 […]
Medicare Medical Home Demo (MMHD) is in BIG Trouble
Between the time the MMHD was authorized in 2006 and now, we’ve learned a lot about what works and what doesn’t work in Medicare care coordination programs. The MMHD is between a rock and a hard place — conflicted by two “must achieve” objectives that are diametrically opposed:
As a political matter, the MMHD must save money
As currently structured, the MMHD cannot save money
Please read my guest post
The Medicare Medical Home Demonstration (MMHD): Between a Rock and a Hard Place
over at […]
Landmark Report: “The Promise of Care Coordination” in Medicare
Download a copy here . Excerpts from the Executive Summary:
Effective Interventions
Three types of interventions have been demonstrated to be effective in reducing hospitalizations for Medicare beneficiaries with multiple chronic conditions who in general are not cognitively impaired:
Transitional care interventions in which patients are first engaged while in the hospital and then followed intensively over the 4 – 6 weeks after discharge
Self-management education interventions that engage patients for 4 -7 weeks in community-based programs designed to “activate” them in […]
Medical Home “Model” Transmogrifies to: The Medical Home Movement
Part Medical Home 101, part strategy session to rescue primary care, part revival meeting — the National Medical Home Summit held earlier this week in Philadelphia was an amazing event.
The optimism, energy, and dogged persistence of attendees and presenters was pervasive. The event was standing room only with another 200 people tuning in to a live Internet video cast.
Dr. Joseph Scherger captured the mood of the day when he proclaimed:
The Medical Home “model” has […]