Care Coordination in. the Health Home Program A benefit available to high risk Medicaid beneficiaries. Northwest Regional Council 1

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1 Care Coordination in the Health Home Program A benefit available to high risk Medicaid beneficiaries Northwest Regional Council 1

2 Northwest Regional Council Develops and advocates for a comprehensive and coordinated service delivery system Responds to the needs of: Older individuals People with disabilities Those whose lives are disrupted by significant health challenges Serves Island, San Juan, Skagit and Whatcom Counties Northwest Regional Council 2

3 Health Home Care Coordination is available to people who are: High-risk, high-cost Medicaid adults and children, including beneficiaries dually eligible for Medicaid and Medicare Those with at least one chronic condition and at risk for a second Currently serving over 450 clients with over 1,600 additional referrals Northwest Regional Council 3

4 NWRC leads a network of care coordination providers: Compass Health Northwest Regional Council Sea Mar Community Health Center Sunrise Services, Inc. WAcare Whatcom Alliance for Health Advancement (WAHA) Northwest Regional Council 4

5 Our network has expertise in: Aging programs Community support for people with disabilities Behavioral health Community health Chronic disease management Diverse cultures and languages HIV case management Tribal support Northwest Regional Council 5

6 What do Care Coordinators do? We meet face-to-face with clients each month We help clients gain control over their health and how they use the healthcare system The work starts with their reasons for health Care Coordinators help create a personalized health action plan and support clients by: Attending provider visits Assisting client with self-management and follow-through Help with transition between settings Providing patient and family support Referral to community and social services Northwest Regional Council 6

7 How do Care Coordinators work with clients? Meeting client where they are in thinking about health Improving their ability to manage their conditions Providing support beyond the scope of other providers Assisting with access to community resources Helping multiple providers to get on the same page --- the client s page Northwest Regional Council 7

8 Why do we do offer this service? It yields good results for the person and their health, producing positive health outcomes and lowered costs With the support of a Care Coordinators, clients are: Increasing their activation and engagement in managing use of health care services Improving their mood, experiencing less depression Better controlling their diabetes Walking more to lose weight and getting out of the house Using community resources to find better housing Doing yard work after being homebound Northwest Regional Council 8

9 How do we know we re being effective? The Health Home Program is modeled after an evidence-based care coordination program called Chronic Care Management. NWRC was one of the pilot sites. The pilot reduced inpatient hospital costs by $318 per member per month for program clients Northwest Regional Council 9

10 How do we know we re being effective? Participants have fewer inpatient hospital stays involving emergency room activity Participants increased engagement in their own health and health care and appropriately utilized health and social services Northwest Regional Council 10

11 Cost Savings of Pilot Program $2,513,225 Benefit Cost Savings Cost of Intervention $1,680,480 Cost Benefit Ratio: patients followed for 12 months after the Chronic Care Management program intervention Northwest Regional Council 11

12 How do clients get services? The State enrolls eligible clients with Health Home Lead Organizations. The Health Home Lead refers eligible clients to a Care Coordination Organization (CCO). A Care Coordinator contacts the client to explain the program and offer services. Client participation is voluntary. Declining Health Home services does not impact a client s other Medicaid benefits. Northwest Regional Council 12

13 How can we work together? Hospital Primary Care Provider Health Home Aging Network Client Community Based Agencies Nontraditional Resources Caregivers Pharmacy Skilled Nursing Facility Northwest Regional Council 13

14 Contact Us Phone: (360) Julie Johnson, Care Management Director Katie Stanford, Health & Human Services Planner Northwest Regional Council 14

15 For more information about aging and disability resources contact: Aging & Disability Resource Centers: Whatcom County: (360) Skagit County: (360) Senior Information and Assistance: Island County Oak Harbor: (360) South Whidbey: (360) Camano Island: (360) San Juan County Lopez Island: (360) Orcas Island: (360) San Juan Island: (360) Northwest Regional Council 15

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