Health Home Models Session 3.6. National Alliance to End Homelessness Annual Conference July 17, 2012 Kathy Moses, CHCS

Transcription

1 Health Home Models Session 3.6 National Alliance to End Homelessness Annual Conference July 17, 2012 Kathy Moses, CHCS

2 CHCS Mission To improve health care access and quality for low-income children and adults, people with chronic illnesses and disabilities, frail elders, and racially and ethnically diverse populations experiencing disparities in care. Our Priorities Enhancing Access and Coverage to Services Improving Quality and Reducing Racial and Ethnic Disparities Integrating Care for People with Complex and Special Needs Building Medicaid Leadership and Capacity 2

3 Health Homes (ACA Section 2703) New state plan option prioritizes coordinating care for beneficiaries with mental illnesses, substance use disorders, and other chronic conditions Effective 1/1/ % FMAP available for qualifying health home services for 1 st 8 quarters Subject to CMS approval of SPA State planning grants available Per Supreme Court ruling, states may expand Medicaid eligibility in 2014, and receive significant federal funds to do so 3

4 What are the health home services? Six core services: Comprehensive care management; Care coordination and health promotion; Comprehensive transitional care/follow-up; Patient and family support; Referral to community and social support services; and Use of HIT to link services. May or may not be provided within the walls of a primary care practice May or may not be incorporated into a medical home initiative 4

5 Who can receive services? Medicaid beneficiaries with: Two or more chronic conditions (mental health, substance abuse, asthma, diabetes, heart disease, or overweight); OR One chronic condition and at risk for a second; OR One serious and persistent mental health condition. Cannot exclude dual eligibles Regardless of focus, coordination of physical and behavioral health must occur Planning to include consultation with SAMHSA 5

6 Who can provide services? 1. Designated provider: May be physician, clinical/group practice, rural health clinic, community health center, community mental health center, home health agency, pediatrician, OB/GYN, other 2. Team of health professionals: May include physician, nurse care coordinator, nutritionist, social worker, BH professional Free standing, virtual, hospital-based, CMHC, etc. 3. Health team: Must include medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, BH providers, chiropractics, licensed complementary and alternative medical practitioners, physician assistants 6

7 What must health home providers do? Provide quality-driven, cost-effective, culturally appropriate, person-/family-centered services; Coordinate/provide access to: high-quality, evidence-based services; preventive/health promotion services; MH/SA services; comprehensive care management/ coordination/ transitional care across settings; DM; individual/family supports; LTC supports and services; Develop a person-centered care plan that coordinates/ integrates clinical/non-clinical health care needs/services; Link services with HIT, communicate across team, individual and family caregivers, and provide feedback to practices; and Establish a continuous QI program. 7

8 How are services reimbursed? Flexibility in payment methods, including, but not limited to: Tiered payment methods Adjustments by patient severity Adjustments by provider s skill set/capabilities Alternatives to per member per month (PMPM) approaches Can deploy directly from state or through health plans 8

9 Related to, but not the same as, the medical home Medical home can be foundation Health homes expand on traditional medical home models by: Focusing on patients with multiple chronic and complex conditions; Coordinating across medical, behavioral, and long term care; and Building linkages to community and social supports. Focus on outcomes reduced ED, hospitalizations/ readmissions, reduced reliance on LTC facilities 9

10 How might a health home look from a patient s perspective? Continuity of support across lifespan of chronic condition Continuity of support across provider settings Home could be multi-disciplinary team of health care professionals Behavioral health professional may be health home Care plan integrating all clinical and non-clinical health care related needs and services Significant one-on-one support from health home in accessing services and supports 10

11 How might a health home look from a provider s perspective? Comprehensive and new care management supports from multi-disciplinary team for highest need patients Access to better data on patients physical, behavioral, long-term care, social needs, services, providers More timely information on patients who visit ED Increased revenue for coordination with health home team 11

12 Visit CHCS.org to Download practical resources to improve the quality and cost-effectiveness of Medicaid services. Subscribe to CHCS Updates to learn about new programs and resources. Learn about cutting-edge efforts to improve care for Medicaid s highest-need, highest-cost beneficiaries. 12