Montana Joins Leading States in Building New Health Care Model

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HELENA, Mont. – A Montana initiative led by Insurance Commissioner Monica J. Lindeen has earned national attention and won Montana a spot among only three other states in a learning collaborative that will help drive Montana’s effort to lower health care costs and improve medical outcomes.

The National Academy for State Health Policy, a national non-profit organization, has selected Montana, Nebraska, Pennsylvania and West Virginia to receive assistance in continuing to establish “patient-centered medical homes” – a team-based approach to patient care long known to improve health and lower costs.

“Patient-centered medical homes can be a solution to the rising costs and limited access issues that plague our health care system,” Lindeen said. “Getting health insurers, public programs, and health care providers working together isn’t always easy, but I believe a market-driven approach is the best way to make effective, enduring improvements to health care in Montana.”

The “patient-centered medical home” concept was first coined in 1967 by the American Academy of Pediatrics. It was designed as a way to approach medical care for children, particularly children with special needs who needed coordinated care.

The “home” does not refer to an actual place, but a team of health professionals led by a primary care provider. Together, the team coordinates all aspects of patient care, relieving stress on the primary care provider and using the entire team to its full potential. Patients build a personal relationship with one provider who oversees all care – including coordination with specialists.

In 2011, Blue Cross of Idaho’s efforts to adopt a team-based, patient-centered approach to health care resulted in a $1 million reduction in medical claims and a 4 to 1 return on investment for disease management programs.

In Montana, Blue Cross Blue Shield has started a patient-centered medical home program and other insurers have followed suit. The NASHP collaborative will help Montana develop its program with multiple private insurers, as well as public programs like Medicaid.

The push toward patient-centered medical homes in Montana requires greater coordination between insurers and medical providers. To avoid anti-trust complications, Lindeen has requested legislation to provide required state oversight while maintaining the market-driven guidance of insurers and health care providers. The legislation, SB 84, was drafted based on the recommendations of insurers, health care providers, and consumer advocates and is sponsored by Senator Christine Kaufmann.

Lindeen embraced the medical home idea shortly after taking office in 2009 and began working with insurers and health care providers to remove the roadblocks to establishing patient-centered medical homes in Montana.

The National Academy for State Health Policy award will give Montana access to national experts, federal officials and a state mentor to help Lindeen continue to develop Montana’s patient-centered medical home model. The program begins with a kick-off meeting in March and lasts for eighteen months. Representatives from Lindeen’s office, Montana Medicaid, Bozeman Deaconess Health Group, and Blue Cross Blue Shield of Montana will lead Montana’s participation in the collaborative.