Montana Patient-Centered Medical Home Initiative

Program Location: 
Helena, MT
Payer Type: 
Blue Cross Blue Shield of Montana
PacificSource Health Plans
Allegiance Benefit Plan Management
Montana Mediciad
Joint Commission

In the fall of 2009 the Montana Department of Health and Human Services (DPHHS) received a technical assistance grant from the National Academy on State Health Policy (NASHP) to advance a multi-payer Patient-Centered Medical Home Initiative that included Medicaid and CHIP patients. In August of 2011, Commissioner Lindeen reformed the working group as an official state advisory council. The council includes insurance companies, medical providers, public agencies, and consumer advocates working together to lay the groundwork for patient-centered medical homes in Montana. On April 30, 2013 the project was codifed into law. 

The Montana Patient-Centered Medical Home Act  sets clear expectations for the Montana PCMH program to help payors, providers, and patients achieve better health outcomes and lower costs. A primary care practice participating in the Montana PCMH program must obtain accreditation from one of the following nationally recognized accrediting organizations: The National Committee for Quality Assurance [NCQA], The Joint Commission [JCo], and The Accreditation Association for Ambulatory Health Care [AAAHC].

In August of 2015, the Office of the Montana State Auditor released the first year of program data in a 2015 public report. The report notes that while the program is still in its infancy "the baseline data is encouraging and supports the proposition that the PCMH program advances comprehensive primary care and will keep Montanans healthier." 

Payment Model: 

Blue Cross Blue Shield of Montana pays a PMPM particiaption fee for each attributed member and a PMPM fee for chronic disease management. 

PacificSource Health Plans compensates providers with:

  • traditional FFS payments
  • PMPM infastructure support payments fo promote care coordination, care management, disease management, population management, integrated behavioral health services, clinical pharmacy services
  • grant-based funding to support care integration, medical home support, and population health approaches
  • shared savings and quality bonuses for performance

Allegiance Benefit Plan Management compensates providers through care coordination CPT codes:

  • non-physician services to achieve patient engagement and acceptance of Complex Care Coordination Program (CPT 99487)
  • developing a Plan of Care and non-physician services to achieve compliance with the Plan of Care (CPT 99488)

Montana Medicaid compensates providers with traditional FFS payment and one of 3 PMPM fees for each enrolled PCMH member:

  • $3.33 preventive and participation PMPM fee
  • $9.33 for a single chronic disease management PMPM fee for hypertension, asthma or depression
  • $15.33 PMPM fee for ischemic vascular disease, diabetes, or more than one of hypertension, asthma, or depression
Last updated September 2015
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