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By Athena Mandros

Community-based care is the concept where health care and social services are delivered to the consumer wherever they are, outside of the traditional office setting. This may be in their home, daycare, community center, park, or group home. Over the past ten years, the use of community-based care has increased both due to consumer preference and to lower costs (see Over 50% Of Medicaid LTSS Expenditures For HCBS In 2013, HCBS Enrollment Up 5%; Expenditures Per Participant Down 2%). And with the increase in value-based reimbursement, provider organizations have increasing flexibility on how and where services are delivered.

Kevin Kumpf, Ph.D.

Our session, Innovative Community-Based Care Models For Consumers With Complex Conditions, led by OPEN MINDS Senior Associate Annie Medina, MBA, ACNP-BC, featured two models—the Healthy Together Care Partnership model operated by Banner University Health Plans, and the dual diagnosis treatment team operated by Merakey (formerly NHS)—presented by Kristin Cline, Clinical Lead Specialist, Merakey; Kevin Kumpf, Ph.D., Clinical Director, Merakey; and Nancy Wexler, Program Manager, Healthcare Innovation, Banner University Health Plan.

There is a wide range of community-based program models which vary in their enrollment of consumers, the clinical professionals included on the care team, the payer, the rate, etc. The models shared by Banner and Merakey varied significantly in their individual components, but both were focused on wrapping around the member, coordinating their care, and building the skills to manage their own care.

The results from the HTCP program were impressive. In the initial year, the program resulted in $61 per member per month in savings, and a 10% decline in medical expenses for the population. Overall there was a 16% decline in emergency department visits and a 26% decline in inpatient admissions. Additional, population-specific analyses in 2016 showed that for consumers with a behavioral health diagnosis there was a 17% reduction in inpatient admissions, and a 29% decrease for those with diabetes. Additionally, 87% of consumers reported improved health status and 94% that they were better able to manage their condition.

There were a couple of key points that both Merakey and Banner emphasized that are important to running community-based programs. The first is the staffing and culture of the program. Working in a community-based program is much different than working in an office-based setting. Staff have to be comfortable working in stressful situations and with a high degree of irregularity. If you spend 85% of your time in the community, every day can look different. Staff have to be comfortable with not knowing what is going to happen. Additionally, members of the team have to be careful about not becoming too attached to participants in the program. It is important that the team builds trust and can tell one another when it is time to take a step back.

Nancy Wexler

The second key point, was that follow-up after treatment was crucial. While both programs phased down after 12-18 months, they continued to check in with consumers after the program ended. The idea was to reinforce behaviors learned and to make sure they don’t need additional assistance.

Finally, Nancy Wexler, Program Manager, Healthcare Innovation, Banner University Health Plan, emphasized the importance of evaluating your program and being able to report outcomes. Banner began funding the HCTP program via an internal grant in 2014. Over the next couple of years, the HTCP program was able to test enrolling different populations and tweak the model. The ability to not be locked into a set program was also crucial. Ultimately, the evaluation was shown to be successful through careful outcome reporting and the health plan agreed to continue the program using a pay-for-performance contract.

Annie Medina

For her insight and takeaways on the session, I reached out to Ms. Medina, who noted:

Both of these programs highlight some of the best-practices that we know to be true in delivering home- and community-based services: collaborative, interdisciplinary teams; consumer-centric, personalized services; flexible service definitions and locations; and services designed to support integration and inclusion. The successes that Merakey and Banner shared really highlight the ability of innovative treatment models to meet the needs of some of our most complex and hard-to-reach consumers, while also showing a positive return on financial investment.

For more on trends in community-based program models, check out these resources in the OPEN MINDS Industry Library:

  1. The Nuts & Bolts Of Making A Health Home Sustainable
  2. How To Manage A Community-Based Workforce
  3. Innovative Community-Based Care Models For Consumers With Complex Conditions
  4. The Future Of Housing Support
  5. What’s Holding Up Community-Based I/DD Services?
  6. Under The Microscope: Issues For The Future Of Medicaid Home & Community Based Services
  7. Leveraging Medicaid To Address The Housing Issue
  8. The Long-Term Care Confusion
  9. Iowa Medicaid Health Plans Shift I/DD HCBS Waiver Reimbursements To Tiered Rates
  10. HCBS Enrollment Up 5%; Expenditures Per Participant Down 2%

To learn more about innovative programming, join Annie Medina in Long Beach, California on August 14 for the Designing & Implementing Innovative Treatment Programs: An OPEN MINDS Executive Summit & Showcase.


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