Healthcare Innovation Has Stronghold in Montana

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Montana Patient-Centered Medical Home Program celebrates first year

HELENA, Mont. – One year after Montana Insurance Commissioner Monica Lindeen launched an innovative program to reduce costs and keep Montanans healthier; the program boasts dozens of enrolled medical clinics and participation by four major healthcare payers, including the state’s largest health insurance company.

The Montana Patient-Centered Medical Home Program, administered by Lindeen’s office after she successfully steered the program through the 2013 Montana Legislature, enhances the way medical providers are paid – emphasizing coordinated, primary care over more costly care, like hospitalization or going to the emergency room.

Importantly, the program tracks key health statistics of all patients involved in the program to ensure that methods intended to preserve health and lower costs actually work.

“It’s been an exciting first year for us – and for all the Montana healthcare providers, insurance companies and others who believe in this approach as much as we do,” Lindeen said. “Statistics and stories are starting to come in suggesting that this approach works. I’m proud of all the Montana providers who are willing to change the way they do business to keep Montanans healthy.”

The business model of a traditional clinic is organized around caring for sick patients; it is not always structured around keeping patients healthy and providers are paid the same regardless of their patients’ health outcomes. Care, especially of complicated conditions like diabetes or depression, is not coordinated.

In a patient-centered medical home – or PCMH – care is coordinated by a provider. Insurance companies and other payers offer extra payments for coordinating care and bonuses for keeping patients healthy through preventing and managing disease better.

The Montana PCMH Program passed out of the 2013 Legislature. Lindeen’s office spent the next year working with a broad group of healthcare providers, insurance companies, public health officers and others to define the rules under which the program would run. By February of 2014, Montana’s program qualified its first PCMH practices. Today, the program has 70 clinics enrolled around the state and participation from Blue Cross Blue Shield of Montana, Allegiance, PacificSource and the Montana Medicaid program.

Lindeen’s office is analyzing key health statistics about the patients treated at Montana-certified PCMH clinics to ensure the PCMH model is working. But they’ve already heard success stories from clinics around the state.

  • A northwest Montana woman with diabetes saw her blood sugar drop nearly in half after the coordinated care at her PCMH clinic identified her as a “high-risk” patient and she made lifestyle changes that helped control her diabetes.
  • A Billings man learned he needed cataract surgery – and also meets the legal qualifications for blindness – after he received a comprehensive examination that focused on his complete health and allowed him to spend more time with his provider.