At the Intersection of Health, Health Care and Policy Cite this article as: Margaret O'Kane Patient-Centered Medical Homes In Louisiana Health Affairs, 34, no.3 (2015):539 doi: 10.1377/hlthaff.2015.0086
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Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2015 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on June 13, 2015 at UCSF Library & CKM RECS Mgmt
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doi:
10.1377/hlthaff.2015.0086
Patient-Centered Medical Homes In Louisiana The study by Evan S. Cole and coauthors (Jan 2015) has shortcomings that undermine its applicability to the current dialogue on the effectiveness of patient-centered medical homes and weaken the article’s conclusions. Prior to Hurricane Katrina, Louisiana’s Medicaid population largely relied on a patchwork of charity care institutions to meet its health care needs. Following the storm, the state made the ambitious decision to rebuild its medical safety net around the concept of coordinated care, covering the cost for Medicaid providers that sought recognition as patientcentered medical homes. The authors’ study period (2007– 10) coincided with the earliest stage of the National Committee for Quality Assurance’s patient-centered medical home recognition program. The 2008 standards for these homes represented an early effort to codify the basic elements of patient-centered care. But this was just the first step on a journey that continues to this day. Standards released in 2011 and in 2014 raised the bar and redefined
how a medical home is organized and what it does. Moreover, the vast majority of the patient-centered medical homes in Louisiana during the study period were recognized at level 1, which required that clinicians demonstrate adherence to the most rudimentary standards and procedures of coordinated care. Finally, unlike patient-centered medical home initiatives that focus on reducing costs, the Louisiana medical homes received no financial incentive to lower hospital admissions, emergency department use, or total costs of care. Nor were they given timely information on progress in these areas or provided with a care management fee to support the additional responsibilities that coordination requires. My colleagues and I submit that, in the context of what the Louisiana patient-centered medical homes were trying to achieve and the environment in which they were working, they have succeeded admirably. Margaret O’Kane National Committee for Quality Assurance WASHINGTON , D . C .
MARCH 2015
34:3
Downloaded from content.healthaffairs.org by Health Affairs on June 13, 2015 at UCSF Library & CKM RECS Mgmt
H e a lt h A f fai r s
539
The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/34/3/539.1.full.html
For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2015 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on June 13, 2015 at UCSF Library & CKM RECS Mgmt
Letters There is a limit of 300 words for letters to the editor. Health Affairs reserves the right to edit all letters for clarity, length, and tone. Letters can be submitted by e-mail, [email protected], or the Health Affairs website, http:// www.healthaffairs.org.
doi:
10.1377/hlthaff.2015.0086
Patient-Centered Medical Homes In Louisiana The study by Evan S. Cole and coauthors (Jan 2015) has shortcomings that undermine its applicability to the current dialogue on the effectiveness of patient-centered medical homes and weaken the article’s conclusions. Prior to Hurricane Katrina, Louisiana’s Medicaid population largely relied on a patchwork of charity care institutions to meet its health care needs. Following the storm, the state made the ambitious decision to rebuild its medical safety net around the concept of coordinated care, covering the cost for Medicaid providers that sought recognition as patientcentered medical homes. The authors’ study period (2007– 10) coincided with the earliest stage of the National Committee for Quality Assurance’s patient-centered medical home recognition program. The 2008 standards for these homes represented an early effort to codify the basic elements of patient-centered care. But this was just the first step on a journey that continues to this day. Standards released in 2011 and in 2014 raised the bar and redefined
how a medical home is organized and what it does. Moreover, the vast majority of the patient-centered medical homes in Louisiana during the study period were recognized at level 1, which required that clinicians demonstrate adherence to the most rudimentary standards and procedures of coordinated care. Finally, unlike patient-centered medical home initiatives that focus on reducing costs, the Louisiana medical homes received no financial incentive to lower hospital admissions, emergency department use, or total costs of care. Nor were they given timely information on progress in these areas or provided with a care management fee to support the additional responsibilities that coordination requires. My colleagues and I submit that, in the context of what the Louisiana patient-centered medical homes were trying to achieve and the environment in which they were working, they have succeeded admirably. Margaret O’Kane National Committee for Quality Assurance WASHINGTON , D . C .
MARCH 2015
34:3
Downloaded from content.healthaffairs.org by Health Affairs on June 13, 2015 at UCSF Library & CKM RECS Mgmt
H e a lt h A f fai r s
539
