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New Law Bolsters Cost-Saving "Medical Homes"

Lindeen's market-driven health care reform signed into law

May 9, 2013

HELENA, Mont. – While the federal government continues to roll out the national health reform law, a state-based, market-driven reform pioneered by Montana Insurance Commissioner Monica J. Lindeen has cleared its final legislative hurdle.

A law signed by Gov. Steve Bullock will allow Montana's insurers and medical community to pursue patient-centered medical homes (PCMH) across Montana. The new law, sponsored by Sen. Christine Kaufmann (D-Helena) at Lindeen's request, is the culmination of years of work with medical providers, insurers, and patient advocates in Montana.

"Everyone talks about lowering healthcare costs and improving the health of Montanans; here's a law that actually does something to accomplish that," said Lindeen. "I thank lawmakers from both parties for putting results ahead of politics. I also thank the doctors, hospitals, providers and insurers who worked so hard with me over the years to make the dream of patient-centered medical homes a reality."

Despite its name, the patient-centered medical home isn't a place, like a nursing home or a retirement community, but a different way of providing health care services. Under the medical home model, a team of health care providers focus on preventing serious illness and managing chronic conditions like diabetes and high blood pressure. By helping patients stay healthy, the medical home model saves money spent on expensive, high-risk procedures down the road.

But in order to make medical homes a reality in Montana, providers and insurers needed protection from anti-trust laws that could leave them vulnerable to expensive lawsuits. The law signed today will allow insurers and providers to collaborate under Lindeen's supervision.

Participation in the patient-centered medical home program is voluntary. Montana's insurers and medical community will decide if the medical home model lives up to its potential. However, many providers are already looking to capitalize on the medical home model, which should reduce physician stress in addition to improving patients' health and cutting costs.

Montana already has a total of 96 clinicians and 17 practices that have adopted the model and many enjoy the results of healthier patients and a more satisfied workplace. However, few insurers are paying providers for the care coordination and expanded services of the PCMH model. The new law will allow private insurers to agree on a standard way to pay providers in the medical home model. Having a single standard in Montana will prevent medical homes from becoming an administrative burden on practices.

Dr. Joseph Sofianek, the Chief Medical Information Officer at Bozeman Deaconess, said he is pleased to see the law catch up with the market.

"Bozeman Deaconess Health Services thanks our legislators for passing legislation to promote patient-centered medical homes in Montana," said Sofianek. "This legislation will set the stage for much needed primary care delivery reform. Bozeman Deaconess Health Group is excited to be a partner in this process and, as Montana's first recognized level three PCMH clinic, hopes to be able to share its experiences and successes with other primary care clinics and the patients they serve."

Tom Roberts, president of Western Montana Clinic in Missoula, said the legislation comes at a critical time, when few medical students are choosing to be primary care physicians.

"At a time when less than 7 percent of U.S. medical school graduates are choosing a career in general medicine, it is vital that we look for ways to support primary care in our state," Roberts said. "This bill helps create a payment and practice approach that works for our primary care providers and for our patients. Through prevention, early treatment of acute problems, and management of chronic disease, the patient centered medical home is a proven, effective model. I am happy to be part of this effort moving forward. "