The standards include many provisions that come straight from the seven principles of the Primary Care Medical Home, including:

* Patient Access: The standards require 24 hour/7 day week phone access and access to “expedited or same day care for immediate health needs.” Hospital outpatient departments that operate at least 40 hours a week must have at least eight hours of evening and weekend availability.

* Coordinated Care: Physicians will be expected to “arrange inpatient care, specialty consultations with specialists, laboratory and radiologic services…coordinate findings and recommendations of specialist and diagnostic results;” and “maintain a current medical record for the patient.”

* A Relationship with a Personal Physician: The standards call for Medicaid patients to “be offered the opportunity to select or change their own primary care clinician.” They also call for practices to identify to patients the name of their physician and promote an ongoing doctor/patient relationship.

These may seem like simple, common sense ways of practicing primary care. Some might find it surprising that physicians have not already adopted such procedures. That’s because it is expensive to implement the changes necessary to be considered a medical home. Meanwhile, neither private insurers nor Medicaid pay physicians to deliver this level of service. A system that puts a premium on procedure-intensive, specialty and tertiary care does not give primary care physicians the financial freedom—let alone the incentive—to restructure their practices.

The sad reality is that primary care in New York largely continues to be episodic, poorly coordinated, and unsuited to the needs of patients. New York ranks 45th among the 50 states in Medicaid spending on primary care, while spending more than any other state on Medicaid overall.

These standards begin to take us in the right direction, but many questions remain – chief among them is how to ensure compliance. One of the most important levers the State has is its ability to modify reimbursement rates. New York has started to do this by raising Medicaid reimbursement rates for ambulatory care and lowering them for inpatient care. Some health insurance companies and large corporations are experimenting with incentives to providers who qualify as medical homes, and the recently-passed Medicare bill supports model programs that will provide higher Medicare reimbursements for these kinds of providers.

The Medicaid standards are a very important step forward, and demonstrate the leadership that New York is taking not just on Medicaid, but in broader health systems reform. The next step is for Albany to develop the incentives to help primary care providers achieve the high level of care that patients deserve. If we get it right, it could lead the way for other payers to adopt strong primary care standards that improve health outcomes, reduce costs, and lessen healthcare disparities.

Comments to the NYS Department of Health on the draft standards are due by August 8th. To provide comments, click here.