Final Report: Patient-Centered Medical Home Pilot

In 2009, the Nebraska Legislature, through enabling legislation, initiated the Nebraska Medical Home Pilot Program Act to be designed and implemented by the Division of Medicaid and Long-Term Care (DHHS). The two-year pilot began in February, 2011, with two rural practices and 7000 Medicaid patients. The focus for the pilot was to transform the two practices into recognized patient-centered medical homes (PCMH) in order to improve health care access and health outcomes for patients and contain costs of the medical assistance program. The pilot concluded February, 2013.

The pilot operated under multiple assumptions and constraints, including the factor that it takes one to two years to set up a PCMH properly with any measurable return on investment taking additional years. In spite of this, the early return on findings for this two-year pilot included some noteworthy results:

• significant decrease in the rate of overall Emergency Room (ER) visits per 1,000 o no significant difference in revisits to the ER for the same complaint
• a slight increase in hospital readmissions, yet noticeable reduction in proportion of all admissions that were caused by ambulatory care sensitive conditions tracked in this pilot
• small decrease in costs for high-tech radiology
• significant decrease in the rate of prescriptions written and spending per 1,000
• total expenditures per client per month reflected a slight decrease
• patient indicators suggested an increase in satisfaction with the services provided
• provider and employee satisfaction fluctuated over the course of the pilot and did not reflect overall significant improvement by the end
• distinct improvement in patient health outcome