pcmh for patients

The Montana PCMH Program


Where Your Health Happens

A patient-centered medical home (PCMH) is not so much a place but a community of health care professionals, lead by your primary care provider, focused on helping you be as healthy as you can be. The Montana PCMH Program began in 2013. Today, there are more than 60 qualified as a Montana PCMH — maybe yours. Ask your provider.

Montana qualified its first PCMH practices in early spring of 2014. Today, we have 66 clinics around the state qualified as a PCMH.

What Can I Expect From a PCMH?

More input and responsibility from you
The patient is at the heart of a PCMH. You can expect to participate in your own care and will have the education and support you need to do so.

Better access to primary care providers
A key component to any PCMH is the concept of access to a provider. Patients are encouraged to discuss all aspects of their health, not only the condition that prompted the appointment.

Phone calls, emails or texts to remind you about important health screenings.

A follow-up call after you visit the emergency room or are hospitalized.

Tracking of key health statistics
A major component of any PCMH is the use of certain key health data from all patients to better identify and track high-risk patients and address gaps in care.

Where Can I Find a PCMH?

Montana has dozens of qualified PCMH practices and more that are working toward full qualification in the program, known as “provisionally qualified” practices. These practices treat many thousands of Montanans in our state. Find one here:

Click here for a list of PCMH clinics by city

Payors are defined in Montana law as the entities who pay the medical costs of patients, other than the patients themselves. In essence, these are insurance companies or government healthcare programs, like Medicaid. Montana has four payors participating in our program. Approved payors must submit a letter of intent to Commissioner Lindeen for each year they wish to participate in the program. Montana’s approved payors are below:

History of the Montana PCMH Program

In a traditional medical practice, providers are usually paid to treat your illnesses or injuries, providing incentives for excessive treatment, tests, and medication, leading to greater cost throughout the system. A PCMH is a different way of organizing your primary care. Your care is coordinated by a team of providers who meet to prepare for patients and make your visit more efficient. Your continued health is the focus of your health care.

Providers receive enhanced payment from health insurance companies and Medicaid coordinate this care. They receive bonus payments for preventing and managing diseases. A PCMH-qualified clinic empowers its patients to take control of their health. Achieving and continuing good health is the focus of the entire clinic organization.

Statistics from PCMH-oriented clinics prove the approach works to keep patients healthier and help lower overall medical spending.

The PCMH concept is not new. The American Academy of Pediatrics coined the term in 1967 as a way of describing the family-oriented approach best suited to maintaining the health of children with special needs. Various scientific studies in the early 2000s confirmed the success of the PCMH model and in 2007 the largest primary care physician organizations in the United States released their standards for what a PCMH should meet.

In 2013, Commissioner Lindeen brought her idea of a Montana PCMH Program to the Legislature in Senate Bill 84. That law, passed by the 2013 Legislature, requires the insurance commissioner to rely on a council of stakeholders in creating standards for the program, qualifying health care providers and insurers to participate, and promoting the program. The volunteer council consists of representatives of primary care providers, health plans, Medicaid, public health, and consumer advocates.

Have more questions?
Call Marissa Stockton at 406-444-2006