Health Homes. The Washington Way

Transcription

1 Health Homes The Washington Way April 23, 2014

2 Washington s Medicaid Program Health Care Authority and Department of Social and Health Services share responsibility for Medicaid program HCA contracts through five managed care organizations for medical services; most eligibles are enrolled (people with eligibility related to disability added in July 2012) DSHS manages separate capitated mental health program; long term supports & services and chemical dependency program are FFS

3 HCA and DSHS: Cultural Competency Guide HCA Historically, medical orientation Responsible for medical services and the medical providers payment Acute episode focused; continuity less important In emergency, go to the Emergency Department DSHS Historically, social work orientation Responsible for the supports needed for the client to live in community Recovery model; personcentered care plan In emergency, activate a 24/7 response system

4 Health Homes Making the Case

5 Service Needs for High Risk/High Cost Medicaid-Only Beneficiaries Overlap 29% served by ALTSA AOD only LTC only SMI only DD only

6 Service Needs Overlap for High Risk/High Cost Beneficiaries who are Eligible for Medicare & Medicaid 95% served by ALTSA

7 Programs that Preceded Washington s Health Home Model Immobility Project: clients served by Aging and Adult Services Administration and at high risk for medical complications due to immobility were offered additional nurse case management Chronic Care Management Program: AASA clients in pilot counties with select chronic conditions offered education on self-management King County Care Partners: Clients at risk for higher than average costs identified for intensive care management and team-based care coordination

8 Lessons Learned from Early Care Management Programs Importance of predictive risk model to identify those with probable future avoidable utilization Combination of skills and experience needed to address high needs population: behavioral health, social support, complex medical conditions, etc. Need for training and fidelity to model: education on self-management, client-centered assessment and goal-setting, motivational interviewing Return on investment application to Medicaid only

9 Stakeholder feedback during Duals planning Improve coordination and align incentives Single point of contact and intentional care coordination Improve on what works, including flexibility to allow for local variances based on population need and provider networks

10 Authority for Health Home Federal law Section 2703, Affordable Care Act State law SSB 5394 (passed in 2011) State Plan Amendments (July and October 2013)

11 Health Homes Implementation Approach

12 Goals Establish person-centered health action goals designed to improve health, health-related outcomes and reduce avoidable costs Coordinate across the full continuum of services including management of care transitions Increase confidence and skills for selfmanagement of medical/bh conditions Single point of contact responsible to bridge systems of care

13 Eligible Beneficiaries Identified chronic condition All ages; proportionally more dually eligible (Medicare/Medicaid) individuals have high risk scores High rates of Emergency Department use, hospitalization and re-hospitalization A risk score of 1.5 or greater; future costs predicted to be 50% higher than average population (disability-related eligible group)

14 Health Home Umbrella Health Homes receive enrollment on a monthly basis: health plans receive a flag on the enrollment file; other Health Home leads receive a unique enrollment file. Health Homes build a network of Care Coordination Organizations that serve mental health, longterm care, and medically complex clients.

15 Payment for Health Home Services $252 for outreach, engagement and health action plan $172 for intensive care coordination services $67 for maintenance Health Home Leads establish a network; may also provide care coordination services directly

16 Health Homes The First Six Months: Successes and Lessons Learned

17 One Example of Qualified Lead Health Home: Optum Emphasis on creation of community partnerships, expert care coordination staff, outreach and high touch services delivered in community setting including a beneficiary s home Optum, a managed behavioral health organization, applied to serve as a Lead Health Home

18 HH Example: Optum Contracted with 10 Care Coordination Organizations throughout Washington; Specializes in providing health home services to those with a mental illness; Developed a network that includes Area Agencies on Aging, Chemical Dependency Treatment Centers and large Federally Qualified Health Centers.

19 Hitting it out of the park!

20 Health Homes: Implementation Challenges Health Home Leads challenges: Locating and engaging clients Planning for network capacity Developing systems to receive and use information from new sources; transmit information to state Care Coordination Organization challenges: Unique information exchanges with Health Home Leads Unique caseload standards and contact requirements Complex cases

21 Health Homes: Successes The Demonstration required stakeholder outreach and participation. Stakeholder input resulted in a better design on the ground. Coordinated Care Organization model strengthens the role of community providers. Existing chronic care management model allowed knowledge transfer: we have trained over 300! New collaborative arrangements may lead to ACO relationships in the future.

22 Resources Websites: Alice Lind