Baker’s Medicaid bill moves to House

HARRISBURG – Legislation designed to improve patient care and reduce health care costs through the development of a Patient-Centered Medical Home Advisory Council for the state’s Medicaid program has gained approval from the House Health Committee.

The bill, authored by state Rep. Matthew E. Baker, R-Wellsboro, chairman of the committee, was spurred on by changes to the nation’s health care system coming with the Affordable Care Act.

“My legislation would ensure those patients enrolled in Medicaid would have the best care possible through a health care model that is driven by a primary care physician who coordinates patient care with other professionals within the health care network,” Baker said.

State physicians believe that strengthening health care teams is critical as the ACA goes into effect.

“Strong, physician led health care teams can prevent fragmentation of care,” Baker said.

Baker hopes that through the bill, state physicians and leaders who want to work with legislators, Gov. Tom Corbett and other stakeholders, “would come together on a multi-pronged effort to protect our patients and Pennsylvania’s health care future.”

The advisory council would assist the Department of Public Welfare in devising policies to implement the team-based delivery of care into the Medicaid program, Baker said.

House Bill 1655 would bring together on the council representatives of the commonwealth, with health provider groups including the Pennsylvania Medical Society, the Pennsylvania Academy of Family Physicians, the American Academy of Pediatrics, the Pennsylvania Pharmacists Association, Coalition of Nurse Practitioners, and the Hospital and Healthsystem Association of Pennsylvania to assist the DPW in exploring and developing a Pennsylvania specific PCMH plan.

“Through better coordination of care, we can improve a patient’s health outcome and reduce medical costs,” he added.

Earlier this year, Corbett’s administration was awarded a center for medicare and medicaid state innovation models planning grant to explore transforming Pennsylvania’s Medicaid program.

The PCHM care model has been identified as a main component to be included in the state’s future application to CMS for implementation funding.

Specifically, the bill would provide improved access to preventive and primary care, by expanding community based primary care health clinics.

It also would include measures to recruit and retain health care professionals, especially student debt forgiveness for physicians and other practitioners who in return, will provide care in underserved areas and expanded residency slots.

Measures to harness health information technology including telemedicine and electronic health records, also would be included, to bring high quality services to all Pennsylvanians.

The bill would work in tandem with HB 1694, to combat prescription drug abuse, through a system to monitor “doctor shopping” while serving patients with pain medication needs.

Baker noted 26 state Medicaid programs nationwide already have launched patient-centered medical home initiatives on a state or regional level and private insurers are already using PCMH models.

The PCMH model basically has a primary care physician or nurse practitioner be the primary point of contact for all medical care having to deal with an individual patient.

This model of care is especially effective for those who have chronic diseases who require one or more specialists.

Doctors, nurses, physical therapists and others are all communicating to ensure the patient is receiving coordinated care, which includes making sure the patient does not undergo duplicative testing, receives important routine exams and is alerted when immunizations are needed, Baker said.

“This is a proven model of care that makes sense to implement as a way to increase quality health care and reduce costs within our Medicaid system, which accounts for 30 percent of the commonwealth’s general fund budget,” he said.

“With some type of Medicaid expansion on the horizon, thousands more people will become a part of the system, and we need to be proactive in our approach to managing the additional enrollees while ensuring top-quality care that doesn’t financially undercut the state.”

House Bill 1655 now goes to the full House for consideration.