Health Homes Overview

David Johnson, MSW, ACSW

Director Health Services

Virginia Association of Health Plans Annual Meeting

Point of View

• Health Homes are focused on individuals at risk for multiple co-occurring chronic conditions or a severe mental illness

• A Health Home represents collaborative and integrated health services, addressing physical and behavioral health issues/conditions inclusive of community resources, as well as long-term services and supports

• A managed care organization (MCO) provides end-to-end care coordination in collaborating with a Health Home partner organization that represents a place-of-service with co-located physical, behavioral health services, as well as a co-located care manager

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What Is a Health Home?

Definition: An integrated, person-centered, and physical and behavioral service delivery system aimed at populations with complex, chronic conditions – fueled by exchange of health information, evidence-based practices and care coordination. Intended to improve outcomes by reducing fragmented care and promoting patient-centered care.

Health Home Services Required Comprehensive care management Care coordination Health promotion Comprehensive transitional care Individual and family support (includes Auth Rep) Referral to community and social support services HIT to link services, as feasible and appropriate

Eligible Populations (ACA Section 2703) At least two chronic conditions, including

– Asthma– Diabetes– Heart disease

One chronic condition and be at risk for another One serious and persistent mental health condition

States have option to define population eligible for HH services

– Obesity– Mental condition – Substance abuse disorder

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Key Differences From Patient-Centered Medical Homes

• Statutorily defined with enhanced FMAP for 2 years to eligible populations, conditions and services

• Multi-provider care team focus—does not have to be physician lead

• Chronic condition focus with integration of medical and behavioral health

• Integration of community resources, family/social supports• New potential primary care roles for Health Home (e.g. BH

specialists or community-based providers)• New payment methodologies (e.g. patient management fee,

shared savings, P4P, e-consult payments)• Extensive health information sharing

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PCMH and Health HomesPatient Centered Medical Homes focus on prevention and management of chronic disease, seek to increase coordinated and integrated care across multidisciplinary provider teams, and improved wellness and preventive care.

Primary Care Behavioral Care

PCMH Health Home

Health Homes will further integrate primary care and behavioral health care for members with severe mental illness.

NY Health Home Model Care Coordination Model

Lead HH

Case Manager

CM Agency

Primary Care

BH Services

Hospital

Community

Medicaid Agency

MCO

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KS Health Home Model- Place of Service Model

Medicaid Agency

MCO CBO

Care Manager

Specialty Services Hospital and Facility Services

Community and Support Services

Health Home

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Primary Care

Anthem Working with Health Home Partners to Evolve the Health Service Delivery Model

Move From Move To

Admit/discharge Engagement/follow-up

Acute—in-the-moment focus Long-term care

Specific presenting condition Holistic—mind and body

Compliance Adherence

Physician decision-making Shared decision-making

Passive patient Active/engaged individual

Episodic documentation Registries, alerts and reminders

File audits, episodic events Outcomes — clinical, financial and consumer

Disease coping Disease management and health behaviors

Individual provider Service team

Volume financial model (FFS) Value-based financial model (shared risk)

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Program Activities: Roles and ResponsibilitiesHealth Home MCOOutreach and engagement Identify members from data files for health home

Biopsychosocial assessment, establish personal health plan inclusive of safety, advanced directive

Benchmarks, expected outcomes

Outpatient physical and behavioral health services —assessment and health plan

Provide sample clinical guidelines — pathways to manage members with chronic conditions

Wellness visits and health promotion Monitor health screenings completed

Chronic condition management: acute episodes of care, education and self-management (chronic care)

Monitor care for chronic conditions, duplication of test and procedures, ER/inpatient admissions

Case management; refer to community/social supports Comprehensive care management — communicate with Health Home on social supports

Individual and family support Respite services, value-added benefits

Care coordination between physical health and behavioral health; primary care and specialists

Vendor servicesAncillary services

Facilitate transitions in care Utilization management

Monitor members over time — registries to track QA/QI reporting

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Health Homes—Quality Measures

• Capacity to track quality indicators and program outcomes• CMS has established eight recommended core measures:– Adult body mass index– Ambulatory Care –Sensitive Condition Admissions– Care Transitions– Follow-up after hospitalization for mental illness– Plan—all cause readmission– Screening for depression and follow-up plan– Initiation and engagement of alcohol and other drug dependence treatment– Controlling high blood pressure

• PPACA provides for independent program evaluation to include a reduction in hospital admissions and emergency department utilization

• Establish program evaluation and define outcomes

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Health Home Implementation Challenges• Health Home Models—identifying and assigning

members

• Communication—challenge to establish communications across sites of care

• Provider issues—lack of resources to manage program start-up costs, hiring and training care managers who are expected to address physical health, mental health and social supports

• HIT Infrastructure—the inadequacy of Electronic Health Records

• Role of complementary programs

Source: Urban Institute

Anthem’s Health Home Implementations

Challenges and issues• Eligibility—inclusion and exclusion criteria; data mining, who determines

• Health home assignment logic and processes

• Accuracy of member contact information

• Member “churn” changes in enrollment with health plans as well as with providers

• Health home partners “staffing up”

• HIT challenges; data submission of health action plan, billing, bi-directional information flow

Early Results—Health Home Outcomes

Missouri—after 18 months report positive outcomes for Behavioral Health Homes• Patients with at least one hospital admission had a 9.1% reduction after 12

months

• Good cholesterol improved from 22% of population to 50%

• Blood pressure in normal range improved from 27% of population to 67%

• Normal blood sugar improved from 18% to 57% of population

• ED usage per 1,000 decreased 8.2%

• Overall, total cost savings estimated at $23.1 million

Source: Missouri Coalition of Community Mental Health Centers

Early Results—Health Home Outcomes

Anthem• Behavioral Health Home Patients in Kansas program after 6 months had a

reduction in hospital costs by 16.1% reduction; 21% decrease in inpatient days per 1,000

• In Washington, a pre/post comparison of members claims costs 6 months prior to enrollment in a health home compared to 6 months post enrollment had a 17% reduction ($221 PMPM) in total healthcare costs (This excluded program costs as well as deducting a 20% regression to the mean calculation)

Summary

• Health homes have potential to reduce fragmentation and enhance care coordination

• Health homes address chronic heath conditions with a holistic focus

• Health homes are likely to involve changes in the way health professionals practice

• Numerous implementation challenges

• Outcomes from early results are promising