Paving the Way for. Health Homes

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1 Paving the Way for Health Homes

2 Paving the Way for Healthcare Homes Affordable Care Act The Affordable Care Act passed by Congress and signed into law by the president in March 2010, provides a variety of approaches to improving the U.S. healthcare system. Section 2703 of the Act allows states to amend their Medicaid state plans to provide Healthcare Homes for enrollees with chronic conditions.

3 Paving the Way for Health Homes Missouri s s Health Homes Missouri is the first state to amend its Medicaid state plan to implement Health Homes. Missouri will have three types of Health Homes o Primary Care Chronic Conditions Health Home Federally Qualified Health Centers (FQHCs) Rural Health Centers (RHCs) Physician practices o Community Mental Health Center Health Home o Multi Payer Person Centered Medical Homes

4 Paving the Way for Healthcare Homes Why CMHC Healthcare Homes? Because addressing behavioral health needs requires addressing other healthcare issues o Individuals with SMI, on average, die 25 years earlier than the general population. o 60% of premature deaths in persons with schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious diseases. o Second generation anti psychotic medications are highly associated with weight gain, diabetes, dyslipidemia (abnormal cholesterol) and metabolic syndrome.

5 Paving the Way for Healthcare Homes HH Functions: We are well positioned CPR teams already fulfill many Healthcare Home functions: o Providing individualized services and supports o Linking consumers to community and social supports o Hospital admission and discharge follow up o Communicating with collaterals o Have already added primary care nurse liasons o Utilizing health information technology (CyberAccess, CMT reports, etc.) to manage care

6 Paving the Way for Healthcare Homes Expectations: We can meet them A recent study of 6,757 consumers eligible for Missouri s Chronic Care Improvement Program (CCIP) served by CMHCs showed significant savings when compared with projected costs for this population These individuals had mental illness and one of the following conditions: o Asthma o Pre diabetes or diabetes o Cardiovascular disease o Chronic obstructive pulmonary disease (COPD) o Gastroesophageal reflux disease (GERD) o Sickle cell disease

7 Paving the Way for Healthcare Homes Expectations: We can meet them Cost Savings Analysis of CMHC Clients Enrolled in CCIP Initial PMPM Cost $1,556 Expected PMPM Cost w/o intervention Actual PMPM Cost following enrollment w/ CMHC Savings $1,815 $1,504 $21 million

8 Missouri s s Goals: Reduce inpatient hospitalization and E.R. visits, Enhance the amount of primary care nurse liaison staffing and primary care physician consultation available at CMHCs, Enhance the behavioral consultation available at primary care centers, and Enhance the State s ability to provide transitional care between institutions and the community.

9 Partners in Planning The planning process for Missouri s Health Home model has included stakeholders and has been a collaborative effort between the following: DSS, DMH MO Foundation for Health MO Primary Care Association (PCA) MO Coalition of Community Mental Health Centers (CMHCs) Consultants: Michael Bailit & Alicia Smith Missouri Hospital Association Missouri Institute of Mental Health

10 Paving the Way for Health Homes HH Functions: Added Emphasis Because Health homes take a whole person approach o Behavioral Health provides will transform their practice to Provide health and wellness education and opportunities Assure consumers receive the preventive and primary care they need o Primary Care Providers will transform their practice to Better recognize and address the behavioral health and support service needs of individuals in primary care settings o Both Behavioral Health and Primary Care providers will Assure patients with chronic physical health conditions receive the care they need and assist them in managing their chronic illnesses and accessing needed community and social supports

11 Eligibility Who is eligible to be served in by a Health Home? 1.Persons covered by Mo HealthNet including those covered through Mo HealthNet s Managed Care Plans; 2.Persons with 2 chronic conditions; 3.Persons with 1 chronic condition who are also at risk for a 2nd chronic condition; and/or 4.Persons who have 1 serious and persistent mental health condition

12 Chronic Conditions: Chronic health conditions include: 1. Asthma 2. Diabetes* 3. Cardiovascular disease including hypertension 4. Overweight (BMI >25) 5. Tobacco use* 6. Developmental Disabilities * Smoking or diabetes qualifies a person for being at risk of having a 2 nd chronic condition

13 Enrollments Cut Off for Auto Enrollments 1.Behavioral Health: Over $10,000 annually 2.Primary Care: Over $2,600 annually Patients Enrolled 1.Behavioral Health: 17,782 clients enrolled in November 2.Primary Care: 20,239 patients enrolled January through April

14 Services of a CMS Section 2703 Health Home 1. Comprehensive care management 2. Care coordination 3. Health promotion 4. Comprehensive transitional care including followup from inpatient and other settings 5. Patient and family support 6. Referral to community and support services

15 Paving the Way for Health Homes Health Home Team Practices will be augmented by adding: o Nurse Care Managers (1FTE/250pts) o Care Coordinators (1FTE/500pts) o Health Home Director o Behavioral Health Consultants (primary care) o Primary Care Physician Consultant (behavioral health) o Learning Collaborative training o Next day notification of Hospital Admissions

16 Paving the Way for Health Homes Reimbursement The additional staffing associated with the Health Home Teams is paid for by a PMPM payment o Based on number of enrollees receiving a health home service and projected staffing costs o Primary Care PMPM $58.57 o Behavioral Health PMPM $78.74 Incentive Payment o Potential for 50% of the Medicaid savings to be shared with providers who achieve savings and performance targets o Proposal being considered by CMS

17 CyberAccess Utilizing Health Information Technology o Allows providers to view patients histories based on Medicaid claims, including diagnoses, pharmacy, services, ER & hospital Metabolic Screening o Required for all individuals receiving anti-psychotic medications o Provides data on Height/Weight/BMI/Waist Circumference Plasma Glucose/Fasting and/or A1c Cholesterol/LDL/HDL/Triglycerides Taking an anti-psychotic? Pregnant? Smoker?

18 CMT Reports o Caveats Utilizing Health Information Technology Based on Medicaid claims data Does not include Medicare or procedures/meds that are provided free, paid by the consumer, or for which no claim was submitted o Medication Adherence Reports Based on Medicaid pharmacy claims Enables CMHCs to identify all prescriptions that have been filled by consumers and determine Medication Possession Ratios

19 CMT Reports Utilizing Health Information Technology o Behavioral Pharmacy Management Report Includes a series of Quality Indicators to identify prescriptions that deviate from Best Practice Guidelines o Inappropriate polypharmacy o Doses that are higher or lower than recommended o Multiple prescribers of similar medications Sent to prescribing physician with Clinical Considerations that includes Best Practice Guidelines and recommendations Sent to CMHC for all their consumers and includes information for all physicians, regardless of whether they are employed by the CMHC

20 CMT Reports Utilizing Health Information Technology o Disease Management Report Based on Medicaid claims and Metabolic Screening data Identifies individuals with specific diagnoses who are not meeting specific indicators o Asthma/COPD have not been prescribed inhaled corticosteroids o Coronary Artery Disease do not have appropriate lipid or BP levels, or have not been prescribed Statins o Hypertension do not have appropriate lipid levels or BP levels o Diabetes do not have appropriate A1c or lipid levels

21 Shared Savings A Separate State Plan Amendment o Providers share in any savings after the first year o Based on provider performance Performance Measures o 25 measures o Benchmark Goals o Gap Closing Goals o Also used to assess progress at six months

22 Training Medical Home Learning Collaborative o Funded by the Greater KC Health Foundation and the Missouri Foundation for Health o Managed by the CIS Consulting Group o Includes Primary Care Heath Homes CMHC Healthcare Homes Multi-payer Health Homes

23 Evaluation Medical Home Learning Collaborative o Evaluating the transformational change of Health Homes over an 16 th month period as evidenced by PCMH-A assessment score improvement Achievement of NCQA PCMH recognition for primary care organizations Documented changes in 8 domains Improvement in performance measures

24 Rutgers University Evaluation o External evaluation of CMHC Healthcare Homes o Evaluation Aims Characterize variation in program implementation across the CMHCs and over time Characterize program impact on treatment processes and outcomes; examine associations between organizational variations in implementation and patient-level impact Translate lessons learned into program improvement within Missouri and to other states

25 Paving the Way for Health Homes Questions? Website: Click on Healthcare Home link

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