Montana PatientCentered Medical Home Program 2015 Public Report

The Montana Patient-Centered Medical Home Program (PCMH) is in its infancy with one year of data to report since the program launched. However, the baseline data is encouraging and supports the proposition that the PCMH program advances comprehensive primary care and will keep Montanans healthier. PCMHs in Montana promote high-quality, cost-effective care by providing primary care providers with better opportunities and resources to enhance care coordination. In order to qualify for the Montana PCMH program, healthcare providers must submit a Comprehensive Application, obtain accreditation from an approved accreditation agency and report on 3 out of 4 quality-ofcare “metrics” identified by the Commissioner in administrative rule. A qualified clinic in the Montana PCMH program can promote and market itself as a PCMH and can engage in PCMH enhanced compensation contracts with Montana insurersand Medicaid.

This report summarizes data from the Comprehensive Application, the Quality Metrics Report and an additional narrative report on patient experiences submitted by the PCMH healthcare providers. The report also summarizes data from private health insurers and Medicaid (payors) on their utilization reports (rates of healthcare use - ER visits and hospitalizations) and their narrative reports document how they partner with providers to improve Montanan’s healthcare experience. The PCMH healthcare providers and payors report on quality and utilization measures, which allows the program to gauge its success against documented national health outcomes and utilization benchmarks and the federal Healthy People 2020 targets.