Shared by Peter Prizzio, The Daily Planet:
Medicaid Health Homes: Care Coordination in the States
Charles Ingoglia, MSW, Senior Vice President for Public Policy and Practice Improvement, and Laira Roth, Policy Associate, National Council for Community Behavioral Healthcare
Individuals with multiple chronic conditions represent our healthcare system’s most costly and complex cases. Recent studies show that comorbid behavioral and medical conditions are the expectation — not the exception. In fact, 68% of people with a mental illness also have a physical health condition such as cardiovascular disease, diabetes, and hypertension. These high-need individuals often receive uncoordinated, inefficient care, resulting in higher costs and poorer health outcomes. If we want to improve the care of patients and the overall health of our nation, we must focus on improving care for this population.
Section 2703 of the Affordable Care Act allows us to focus on this population through the Medicaid “health home” option to help states manage and improve care for beneficiaries experiencing two or more chronic conditions, including behavioral health disorders. A health home must provide beneficiaries “one-stop shopping” by maintaining responsibility of providing the full range of services. States with approved Medicaid health home state plan amendments (SPAs) will now receive a 90% federal match for services not previously covered under Medicaid such as care coordination, comprehensive care management, and patient and family support. This approach has the potential to reduce emergency room usage, hospital admissions, and reliance on long-term care facilities, as well as to improve the experience and quality of care for those beneficiaries targeted under the state’s health home.
The Medicaid health home option presents a unique opportunity for behavioral health. With strong focus on Medicaid beneficiaries’ behavioral health needs and emphasis on care coordination, behavioral health organizations could play a vital role in establishing these new service delivery models. The Medicaid option is largely modeled on the patient-centered medical home (PCMH) — which builds on the chronic care model — and supports five key themes for quality care in a health home: (1) self-management support, (2) shares decision-making, (3) delivery system redesign, (4) embedded clinical guidelines, and (5) the use of client registries to organize data.
It is particularly important for behavioral health organizations to prioritize data collection when considering health home participation. As new service delivery models such as health homes and accountable care organizations become more prominent and funding streams become increasingly aligned with health outcomes, healthcare providers will need to demonstrate the ability to collect, organize, and use data to inform treatment. The collection and use of data will prove beneficial as providers strive to market themselves as potential partners in these new service delivery models. They will need to demonstrate the ability to improve health outcomes in a financially efficient manner.