California Legislature—2013–14 Regular Session

Assembly Concurrent Resolution No. 152

Introduced by Assembly Member Pan

May 22, 2014

Assembly Concurrent Resolution No. 152—Relative to patient centered medical homes.

LEGISLATIVE COUNSEL’S DIGEST

ACR 152, as introduced, Pan.

This measure would state that the Legislature supports and encourages the development and expansion of a California health care delivery system that identifies patient centered medical homes and is based upon certain principles of coordination of patient care.

Fiscal committee: no.

WHEREAS, Patients frequently confront health care providers
working in independent silos that impede care coordination and
cause patients with multiple health issues to fall through the cracks;
and

WHEREAS, Numerous studies identify fragmented care at the
national, state, and community levels as one of the main causes of
the poor performance of health care systems in the United States;
and

WHEREAS, Patients are forced to navigate an exceedingly
complex system with little or no guidance, seeing multiple
physicians and other health care providers in various settings; and

WHEREAS, The lack of coordination of patient care, and the
lack of communication between patients and health care providers
regarding the coordination of patient care, increases inefficiency
and the chance of medical errors, waste, and the duplication of
costly services; and

WHEREAS, An absence of accountability, quality improvement
programming, and clinical information systems leads to poorer
quality of patient care; and

WHEREAS, The “patient centered medical home” is a health
care delivery system model in which health care providers work
in partnership with one another, their patients, and their patients’
families to coordinate care, navigate the complex and often
confusing health care system, and ensure that patients receive the
right care at the right time; and

WHEREAS, Medical homes address the ominous trends in
health care, including increasing costs, a shortage of primary care
professionals, and the sharp increase in the demand for services
for those with chronic diseases and mental health disorders; and

WHEREAS, Several other states have leapt ahead in their
commitment to the patient centered medical home model and are
reaping the rewards, including, but not limited to, quality
improvement and costs reduction; and

WHEREAS, Several other states have obtained substantial
federal funding for implementation of medical home demonstration
projects; and

WHEREAS, Fee-for-service model rewards volume for services
provided, and can unnecessarily drive up the costs and capitation,
which can result in the under provision of services; and

WHEREAS, Inclusion of a blended payment model to support
patient centered medical homes tempers the negative incentives
of capitation and fee-for-service models and allows for flexibility
in how to organize and provide medical home services; and

WHEREAS, Thirty-nine states have created a definition for
“medical home,” “patient centered medical home,” or another
synonymous term; and

WHEREAS, Having a definition for “patient centered medical
home” in California would send an important signal to health care
providers and patients that our state supports care that is patient
centered, cost efficient, continuous, focused on prevention, and
based on sound, evidence-based medicine rather than episodic,
illness-oriented siloed care; now, therefore, be it

Resolved by the Assembly of the State of California, the Senate
thereof concurring, That the Legislature supports and encourages
the further development and expansion of a California health care
delivery system that identifies a patient centered medical home
model and is based on the following principles of coordination of
patient care, including, but not limited to:

(a) A collaborative team approach to providing comprehensive
health care that fosters a partnership among the patient, the
physician-led practice team, and other health care professionals,
and, if appropriate, the patient’s family or the patient’s
representative, upon the consent of the patient.

(b) The ability to provide access to continuous and
comprehensive care, or, if appropriate, referrals to health care
professionals that provide continuous and comprehensive care.

(c) A provider, working in concert with a multidisciplinary team
of individuals, who takes responsibility for the ongoing health care
of patients, including appropriately arranging health care by other
qualified health care professionals and making appropriate referrals.

(d) Care that is coordinated and integrated between all elements
of the complex health care system, including, mental health and
substance use disorder care, and the patient’s community.

(e) Care that is facilitated by health information technology,
such as electronic medical records, electronic patient portals, health
information exchanges, and other means to ensure that patients
receive the indicated care when and where they need and want this
care in a culturally and linguistically appropriate manner.

(f) A payment structure designed to reward the provision of the
right care in the right setting that discourages the delivery of too
much or too little care and that encourages the appropriate
management of complex medical cases, increased access to care,
the measurement of patient outcomes, continuous improvement
of care quality, and the comprehensive integration and coordination
across all stages and settings of a patient’s care.

(g) Compensation that recognizes the increased services and
overhead associated with the medical home practice model and
the potential savings from better management of chronic diseases
and conditions, recognizing the value of non-face-to-face
communication by telephone and email, the coordination of care
with other providers and community agencies, and the use of health
information technology to support medical home functions; and
be it further

Resolved, That “patient centered medical home” and “medical
home” means a health care delivery model in which a patient
establishes an ongoing relationship with a personal primary care
physician or other personal licensed health care provider working
in a physician-led practice team to provide comprehensive,
accessible and continuous evidence-based primary and preventative
care, and to coordinate the patient’s health care needs across the
health care system in order to improve quality and health outcomes
in a cost-effective manner; and be it further

Resolved, That all of the following quality and safety
components are incorporated into the patient centered medical
home model:

(a) Advocacy for patients to support the attainment of optimal,
patient-centered outcomes that are defined by a care planning
process driven by a compassionate, robust partnership between
providers, the patient, and the patient’s family or representative.

(b) Evidence-based medicine and clinical decision support tools
that guide decisionmaking.

(c) The licensed health care providers in the practice accept
accountability for continuous quality improvement through
voluntary engagement in performance measurement and
improvement.

(d) Active patient participation in decisionmaking and feedback
is sought to ensure that the patient’s expectations are being met.

(e) Information technology is utilized appropriately to support
optimal patient care, performance measurement, patient education,
and enhanced communication.

(f) Patients and families, or representatives, participate in quality
improvement activities.

(g) Patients are provided with enhanced access to health care;
and be it further

Resolved, That the Chief Clerk of the Assembly transmit copies
of this resolution to the author for appropriate distribution.