[Federal Register Volume 78, Number 31 (Thursday, February 14, 2013)]
[Notices]
[Pages 10610-10611]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-03415]


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DEPARTMENT OF DEFENSE

Office of the Secretary


TRICARE; Demonstration Project for Participation in Maryland 
Multi-Payer Patient Centered Medical Home Program (MMPCMHP) 
Demonstration

AGENCY: Department of Defense (DoD).

ACTION: Notice of Demonstration Project.

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SUMMARY: This notice advises interested parties of a Military Health 
System (MHS) Demonstration project under the authority of Title 10, 
United States Code, Section 1092, entitled Department of Defense (DoD) 
Enhanced Access to Patient Centered Medical Home (PCMH): Participation 
in Maryland Multi-payer Patient Centered Medical Home Program 
(MMPCMHP).

DATES: The demonstration program will be effective 30 days after 
publication in the Federal Register and have a two year duration.

ADDRESSES: TRICARE Management Activity (TMA), TRICARE Regional Office 
North, 1700 North Moore Street, Suite 1200, Arlington, VA 22209.

FOR FURTHER INFORMATION CONTACT: Capt. John O'Boyle, TMA, TRICARE 
Regional Office--North, telephone (703) 588-1831.

SUPPLEMENTARY INFORMATION: The MHS has adopted the PCMH concept as the 
strategy of choice for the direct care system and is now using this 
demonstration to evaluate and provide a PCMH model in the purchased 
care portion of the TRICARE program.
    The MHS defines PCMH as a model of care adopted by the American 
Academy of Family Physicians, the American Academy of Pediatrics, the 
American College of Physicians, and the American Osteopathic 
Association that seeks to strengthen the provider-patient relationship 
by replacing episodic care with coordinated care and a long-term 
healing relationship. In PCMH practices, each patient has an ongoing 
relationship with a personal provider who leads a team that takes 
collective responsibility for patient care. The provider-led care team 
is responsible for providing all the patient's health care needs and, 
when required, arranging for appropriate care with other qualified 
providers.
    A particular challenge in implementing the PCMH concept in the 
purchased care portion of the TRICARE program has been the inability to 
distinguish and employ reimbursement methodologies which encourage 
network providers to accept TRICARE beneficiaries under a Medical Home 
model. Current contractual incentives encourage network discounts which

[[Page 10611]]

may also prove counterproductive in attracting network providers to a 
PCMH model.
    The goal of participation is to test the PCMH model in qualified 
primary care practices to determine if this model: (1) Provides higher 
quality and more cost effective care for TRICARE beneficiaries who 
receive medical care in participating practices and (2) leads to higher 
satisfaction for patients and providers. The demonstration seeks to 
compensate medical homes for additional services not traditionally 
covered through fee for service reimbursement, while creating a viable 
economic model for health care purchasers and maintaining 
administrative simplicity. As part of the demonstration, TRICARE, with 
other payers, will provide additional fixed, semi-annual payments to 
participating practices for providing documented evidence-based 
medicine; use of electronic medical records; care coordination; care 
transition management; collaboration with hospitals to prevent 
readmissions; and patient coaching; services. These fixed payments will 
be weighted based on practice size, practice share of Maryland based 
TRICARE beneficiaries and National Committee on Quality Assurance 
Patient Centered Medical Home (PPC-PCMH) recognition criteria. TRICARE 
Prime and Standard beneficiaries will be assigned/attributed to the 
MMPCMHP demonstration based on current TRICARE Prime enrollment and/or 
evidence of previous services provided to TRICARE Standard 
beneficiaries by participating practices. TRICARE for Life 
beneficiaries will be excluded from the demonstration. TRICARE will 
continue to pay claims using existing reimbursement methodologies 
established in 32 CFR part 199. In addition, incentive payments will be 
made based upon calculated shared savings and measured quality 
improvements. TMA Defense Health Cost Assessment and Evaluation 
(DHCAPE) staff will calculate TRICARE beneficiary cost savings based on 
Maryland Health Care Commission methodology. Pharmacy costs associated 
with beneficiaries attributed in the demonstration will be measured for 
informational purposes.
    Additional information is available at http://mhcc.maryland.gov/pcmh/ and will be available in the TRICARE Operations Manual.

    Dated: February 1, 2013.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2013-03415 Filed 2-13-13; 8:45 am]
BILLING CODE 5001-06-P