Title text here Health Homes: The 4 th Long-Term Care Policy Summit September 5, 2012 Wendy...
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Transcript of Title text here Health Homes: The 4 th Long-Term Care Policy Summit September 5, 2012 Wendy...
Title text here
In 2007, four physician associations developed a set of joint principles for a “patient-centered” medical home Physician-Centered Care Coordination Patient Outcomes and Evidence-Based Care Expanded Hours of Care Payment
23 states have medical home initiatives in Medicaid/CHIP programs
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Option for Medicaid State Plans
Comprehensive system of care coordination for Medicaid enrollees with chronic conditions
Primary, acute, behavioral health, and long-term services and supports for “whole person” care
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Improved quality of care/outcomes for individuals
Improved experience of care for beneficiaries
Reduction in hospital admissions and readmissions
Reduction in emergency room use Less reliance on nursing homes Reduction in overall health care costs
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Comprehensive care management Care coordination Health promotion Comprehensive transitional care Patient and family support Referral to community and social support
services, if relevant Encourages use of health information
technology as feasible
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Alabama ArkansasArizona CaliforniaDistrict of Columbia IdahoMaine MississippiNevada New JerseyNew Mexico North CarolinaWashington West VirginiaWisconsin
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States with Approved State Plan Amendments as of August 2012: Missouri (two Approved SPAs) Rhode Island (two Approved SPAs) New York Oregon North Carolina IowaStates with SPAs on the Clock: Alabama New York (3) Ohio WisconsinDraft Proposals: Oklahoma, West Virginia, Maine, Idaho, Massachusetts
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Medicaid eligible individual having: two or more chronic conditions, one condition and the risk of
developing another, or or at least one serious and
persistent mental health condition
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The chronic conditions listed in statute:
mental health condition,
substance abuse disorder,
asthma,
diabetes,
heart disease, and
being overweight (a BMI of > 25).
Through Secretarial authority, States may add other chronic conditions for approval by CMS.
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Examples include Multiple Disciplines: Physician and/or Group Practice Rural Health Clinic Community Health Center Community Mental Health Center Managed Care Organization Home Health Agency Hospital
* States may include many other providers, subject to CMS approval
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90% enhanced federal match for 1st 8 quarters for health home services for each enrollee
CMS will NOT reimburse for duplicative services
Health home needs to be in place before reimbursement can begin
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Building onto existing medical home and primary care case management program or vs. a new model
Interdisciplinary team Geographic coverage Training and IT infrastructure Payment
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Providers: Report quality measures to the State to receive payment
State : Collect utilization, expenditure, and quality data for an interim survey and an independent evaluation
CMS Reports to Congress : Survey of States & Interim Report to Congress in 2014; and Independent Evaluation & Report to Congress in 2017
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1. Adult BMI Assessment2. Ambulatory Care-Sensitive Condition Admission3. Care Transition – Transition Record Transmitted
to Health care Professional4. Follow-Up After Hospitalization for Mental
Illness5. Plan- All Cause Readmission6. Screening for Clinical Depression and Follow-up
Plan 7. Initiation and Engagement of Alcohol and Other
Drug Dependence Treatment
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Service Utilization Institutional Admissions Emergency Room Visits Cost Savings Use of Health Information
Technology Quality and Outcomes
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Health Information Technology: Electronic medical records and data requirements
Conflict Free Case Management
Financial Sustainability: Only 8-quarters of enhanced Medicaid match
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Health Homes State Medicaid Director Letter
Health Homes information on Medicaid.gov http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Integrating-Care/Health-Homes/Health-Homes.html
Integrated Care Resource Center (TA contractor) www.integratedcareresourcecenter.com
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Health Homes Mailbox at CMS [email protected]
Wendy Fox-Grage, AARP Public Policy [email protected] ; 202-434-3867
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Where to Go for More Info and Help?
