The Medicare Demonstration

• In the Tax Relief and Health Care Act of 2006, Congress required the US Department of Health and Human Services to establish a three-year medical home demonstration in eight states.
  
  
• The Centers for Medicare and Medicaid Services has not yet launched this demonstration, but it has made great strides in that direction, designing a demonstration that for the first time could test the medical home concept in a population that needs it most, Medicare patients.
  
  
• By some estimates, more than 80 percent of Medicare beneficiaries have at least one chronic condition, and almost a quarter have at least five co-morbidities, making Medicare an ideal environment in which to test the medical home.

Medical Home Demonstrations in New York

• New York is one of the country’s leading innovators when it comes to the medical home. One example is the Adirondack Region Medical Home Pilot, a comprehensive medical home demonstration that brings together providers from throughout the North Country. This particular medical home will provide a new model for the delivery of health care services that emphasizes the role of comprehensive primary care services. The pilot is expected to improve access to services, improve the quality of care, and lower costs over the long-term.
  
  
• Under the pilot, primary care providers in the Adirondack Region of New York State will receive increased reimbursement in exchange for expanded responsibility for coordinating care, providing preventive care and managing chronic diseases. The increased reimbursement is expected to be offset by decreased costs from fewer hospital admissions, less frequent referrals to specialists, lower prescription costs, and overall better health.
  
  
• Pilot participants include health care providers in 40 practices (representing 120 physicians and 76 physician assistants and nurse practitioners), four hospitals, New York Medicaid, the State of New York, the Medical Society of the State of New York, the New York State Association of Counties, the Empire Plan, and potentially five other interested commercial health plans.
  
  
• The pilot includes parts or all of Clinton, Essex, Franklin, Hamilton, Saratoga and Warren counties.
  
  
• The New York State Department of Health will provide supervision and arrange for ongoing evaluation of
  the program.
  
  
• The pilot is scheduled to begin in the fall of 2009.