Home Care Association of WA April 15, Health Homes and Accountable Communities of Health State Innovation Model (SIM)
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1 Home Care Association of WA April 15, 2015 Health Homes and Accountable Communities of Health State Innovation Model (SIM) 1
2 WASHINGTON STATE HEALTH HOME PROGRAM 2
3 The Affordable Care Act The Affordable Care Act (ACA) includes several opportunities to support Medicaid in transforming the health care delivery system. One of these is detailed in Section 2703 of ACA Health Homes. Washington State is participating in Health Home for Medicaid beneficiaries, including the Duals Demonstration for dual eligible beneficiaries. 3
4 WA Implementation Two State Plan Amendments allowed us to phase in Health Home services. o Phase 1 covered 3 Coverage Areas (July 2013) o Phase 2 added 3 additional Coverage Areas (October 2013) We use a structure of Lead Entities and Care Coordination s. o Four Managed Care s and Four Community Based s (Leads) o 71 s 4
5 WA State Model of Health Homes Health Path WA DSHS and HCA Coverage Area Coverage Area Coverage Area Lead Entity Lead Entity Lead Entity Lead Entity Lead Entity Lead Entity Lead Entity Lead Entity Lead Entity 5
6 Who is eligible for health home? Health Home services are targeted to high risk, high cost individuals who are likely to have multiple chronic conditions, including mental illness and substance use disorders. These services promote the beneficiary s involvement in improving their health; CCs offer much needed support and care coordination for the people who need it most. PRISM Risk Score > or = to 1.5 Adults and children 6
7 What are Health Home Services? Health homes comprise six services that Medicaid programs can provide to eligible beneficiaries: o Comprehensive care management; o Care coordination and health promotion; o Comprehensive transitional care/follow-up; o Patient and family support; o Referral to community and social support services; o Use of health information technology (HIT) to o link services, if applicable. 7
8 The Investment Health Home s are reimbursed for providing services to eligible individuals. The Health Home program is a key building block to future innovation models aimed at promoting health, preventing and managing chronic disease, and controlling health care costs. 8
9 Expected Outcomes (ROI) Decreased hospital utilization Decreased emergency department utilization Increased use of Long Term Services and Supports (community based) Improved quality of life Improved access to primary care 9
10 STATEWIDE Health Home Enrolled and Engaged clients Enrolled Clients 50,344 Engaged Clients 5,595 Managed Care engagement rate 3.5% FFS engagement rate 12.5% Clients with 1 or more HAP s 11.0% Data as of 03/13/
11 Join the client on their Health Path Explore: Goals Values Patient Activation Importance Confidence Barriers Measure 11
12 Health Action Planning Fostering Hope is the most important element of coaching and planning. Help the individual engage in their health and their healthcare by taking an active role in the process. 12
13 Keys to Successful Meeting the client where they are Engagement Collaboration Consistent and regular contacts Transitional care supports Confidence and skill building for selfmanagement support. 13
14 Demographics and HAP clinical findings 14
15 15
16 Health Home Discussion Questions 1. What do you see as the opportunities for providing Health Home/ services? 2. What are your strengths and assets? 3. What are your challenges and concerns? 4. How do you see your organization participating in Health Home; now and in the future? 16
17 WA Health Home Information Health Care Authority Health Home website aspx For more information on this partnership with CMS and DSHS, visit the DSHS Office of Service Integration website. For budget, funding or program questions us at 17
18 STATE INNOVATION MODEL (SIM) Health Homes and Accountable Communities of Health 18
19 19
20 20
21 The Regional Service Areas 21
22 Health System Transformation CURRENT SYSTEM Fragmented clinical and financial approaches to care delivery Achieving the Triple Aim TRANSFORMED SYSTEM Integrated systems that deliver whole person care Disjointed care transitions Volume based payment Disengaged clients Capacity limits in critical service area Individuals impoverish themselves to access needed LTSS Inconsistent measurement of delivery system performance Coordinated care and transitions Value based payment Activated clients Optimal access to appropriate services Timely supports delay or divert need for Medicaid LTSS Standardized performance measurement with accountability for improved health outcomes 22
23 Accountable Communities of Health What is an Accountable Community of Health (ACH)? A group of public and private organizations and individuals working together to integrate health care and improve health in their region Participants include: public health, housing, and social service providers; MCOs; insurers; county and local government; Tribes; and consumers Clinical ACHs Community 23
24 Accountable Communities of Health ACHs are intended to regionally align with Regional Service Areas (RSAs) in order to enable ACH input on Medicaid purchasing priorities to ensure they are responsive to regional health needs. ACH input will be informed by data on population health produced by HCA and DSHS and its partners and provided to the ACH for development of a health action plan. The State proposes phased engagement of ACHs based on the evolution of the ACH Initiative and the maturation of ACHs as follows: 1. Statewide procurement objectives that address regional needs and perspectives; 2. Assessment of MCO RFP responses for the ACH s specific region; 3. On-going oversight of MCO and BHO effectiveness; 4. Sharing of public health and managed care data to inform priorities for improving health within the ACH in partnership with public and private entities within the ACH boundary. 24
25 Accountable Communities of Health The ACH Timeline 25
26 Health Homes are Community Based The s providing Health Home program services are community based and represent a broad array of providers. These organizations may also be engaged in their ACH: Home Health and Home Care Agencies Area Agencies on Aging Community Mental Health Agencies Federally Qualified Health Centers Faith Based s 26
27 How does a Health Home organization connect with an ACH? ACH s are regional partnerships of care providers, social service providers and community organizations. Intention is to serve as regional connectors to better address the needs of the whole person and improve the well-being of the community. ACH for instance would link Health Home organizations with housing, food banks and health systems providers. 27
28 Accountable Communities of Health Discussion Questions 1. Have you heard of your regional ACH? 2. If not, do you know where to go to get more information? 3. How do you envision your organization participating in Healthier WA initiatives you have head about today? 4. How will an ACH benefit your organization? a) Your clients? b) Your providers? c) Your community? 5. What additional information would be helpful to you? 28
29 29
30 Contact Information Candace (Candy) Goehring MN RN Behavioral Health and Service Integration Administration/DSHS Chief Office of Service Integration
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