BILL ANALYSIS
AB 1542
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ASSEMBLY THIRD READING
AB 1542 (Health Committee)
As Amended May 6, 2009
Majority vote
HEALTH 19-0
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|Ayes:|Jones, Fletcher, Adams, |
| |Ammiano, Block, Carter, |
| |Conway, De La Torre, De |
| |Leon, Emmerson, Gaines, |
| |Hall, Hayashi, Hernandez, |
| |Hill, Nava, V. Manuel Perez, |
| |Salas, Audra Strickland |
| | |
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SUMMARY : Defines a patient-centered medical home (PCMH) as an
approach to providing health care that fosters partnerships
among the patient and health professionals to promote
coordinated care, ensure quality and access to care, and to
improve health. Specifically, this bill :
1)Defines a medical home as a team approach to providing health
care that fosters a partnership among the patient, the
personal provider, other health care professionals, and the
patient's family where appropriate; utilizes the partnership
to access all needed health-related services to achieve
maximum health potential; maintains a comprehensive record of
health-related services; and, has all the characteristics that
qualify it as a medical home.
2)Defines a personal provider as the patient's first point of
contact in the health care system with a primary care
provider, as specified, and primary care as health care that
emphasizes providing for a patient's general health needs and
utilizes collaboration with other health care professionals
and consultation and referral as appropriate.
3)Specifies that a medical home, for the purposes of this bill,
meets specified standards, including the following: a) A
personal provider to provide first contact, continuous, and
comprehensive care; b) The personal provider leads a team
which takes responsibility for ongoing care; c) Care is
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coordinated and integrated across all elements of the health
care system and the patient's community, and is facilitated by
registries, information technology and exchange, and other
means to ensure culturally and linguistically appropriate
care; d) Patients participate in decisionmaking; e)
Appropriate use of information technology; f) Enhanced access
through systems such as open scheduling, expanded hours, and
new options for communication; and, g) Payment systems
recognize the value of the PCMH, as specified.
FISCAL EFFECT : None
COMMENTS : According to the author, more than three-quarters of
national health spending goes to treating chronic diseases. The
author states that 95% of Medicare costs are spent on patients
with two or more chronic illnesses, and 78% of national health
care expenditures, or nearly $1.8 trillion, can be attributed to
chronic illness. The author argues that with the number of
Americans with a chronic disease projected to increase from 125
million in 2000 to 157 million in 2020, we can expect the PCMH
to have a real effect on health spending.
The PCMH is a model for primary care. In a 1996 report, the
Institute of Medicine (IOM) defines primary care as the
provision of integrated, accessible health care services by
primary care clinicians who are accountable for addressing a
majority of a person's health care needs, developing a sustained
partnership with patients, and practicing in the context of
family and community. The IOM states primary care clinicians
are generally considered to be physicians, nurse practitioners
(NPs), and physician assistants (PAs), and acknowledges that a
broader array of individuals participate in a primary care team.
Research has shown that primary care reduces deaths from heart
and lung disease, leads to longer lives, reduces hospital and
emergency room use, and reduces health disparities. In
addition, according to the Department of Health Care Services
(DHCS), states find that a reliable medical home can magnify the
effect of disease management programs.
According to a 2007 Commonwealth Fund report, when adults have
health insurance coverage and a medical home, racial and ethnic
disparities in access and quality tend to disappear. The report
reveals that linking minority patients to a medical home helps
them manage chronic conditions and obtain preventive care.
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Many other states have adopted medical home legislation and
programs. Community Care of North Carolina (CCNC), the state's
Medicaid program, is a working example of a PCMH. CCNC has
demonstrated excellent quality and cost outcomes through disease
management, evidence-based clinical practice, and an emphasis on
a physician-led team approach. Two evaluations of this program
indicate it saved the state $195 to $215 million in 2003 and
between $230 and $260 million in 2004 when compared to
historical fee-for-service.
In a 2008 report to the United States (U.S.) Congress, the
federal Medicare Payment Advisory Commission (MedPAC)
recommended that Congress establish a budget-neutral payment
increase for primary care services furnished by
primary-care-focused practitioners. MedPAC also recommended
that Congress initiate a Medicare medical home pilot project.
The MedPAC report cites data showing that 83,000 NPs and 23,000
PAs are in primary care practice, and their numbers have grown
faster than those of primary care physicians. In an October
2008 letter to the Secretary of the U.S. Department of Health
and Human Services (DHHS), 13 members of Congress cited the
MedPAC report and encouraged DHHS to include medical home
demonstrations that allow NPs to participate fully in the
medical home model.
Related legislation: AB 1076 (Jones) of 2009 requires DHCS to
expand the Medical Case Management program to include Medi-Cal
beneficiaries with two or more chronic conditions and have used
a hospital emergency department four or more times in the
previous year, and specifies the services which must be included
in case management. AB 1076 also requires the Medi-Cal disease
management benefit to include the designation of a primary care
provider as a patient's medical home. The Assembly Health
Committee approved AB 1076 on May 12, 2009. SB 771 (Alquist),
pending in the Senate, would require a health care service plan
or a health insurer, or a medical group that contracts with a
plan, that uses a pay-for-performance system for the payment of
providers to provide a differential payment to providers who
provide patients with a patient-centered medical home. SB 771
has not been scheduled for a hearing.
Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097
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