Last summer, word came from The Centers for Medicare & Medicaid Services (CMS) for plans to launch Medicaid health homes to provide care coordination for children with medically complex or chronic conditions, with detailed plans coming later this year and funding available in 2022 (see CMS To Launch Health Homes For Children With Medically Complex Conditions). The reason I think this is an important development is two-fold. First, the health homes for adults in the original Patient Protection and Affordable Care Act (PPACA) significantly changed payer and health plan thinking about the best models for managing the needs for complex consumers. And the original Medicaid-funded initiatives were soon followed with broadscale adoption by health plans (see The Changing Face Of Medicaid Health Homes—The 2017 Update and Health Homes, Specialty Health Plans, CCBHCs. Oh My!).
The second is that the proposed health home models will cause far-reaching integration of provider organization services since the health homes are designed for children with serious, long-term physical, mental, or developmental disabilities, or diseases such as cerebral palsy; cystic fibrosis; HIV/AIDS; blood diseases, such as anemia or sickle cell disease; muscular dystrophy; spinal bifida; epilepsy; severe autism spectrum disorder; and serious emotional disturbances or serious mental health disorders. This will cause an unprecedented realignment of service referrals and expand the scope of services needed for those provider organizations to remain relevant.
This pending realignment of referral patterns and service delivery models in the children’s services field was a reason for the focus of this year’s summit, The OPEN MINDS Children’s Services Executive Summit: Emerging Models For Children’s Health Homes. While 2022 may seem far off, our previous experience working with provider organizations in the design, development, and marketing of health homes is that this is an 18-month undertaking—so the time is now if your executive team is thinking about moving in this direction.
And, we got a strategic wake-up call (and a great history lesson) during the Summit session, Children’s Health Homes In New York State: A Systems Perspective, from Carl M. Coyle, MSW, chief executive officer of Liberty Resources, Inc.—a member of the Children’s Health Home of Upstate NY (CHHUNY) since 2016. Adult health homes launched in New York State in 2012, followed by several iterations of system changes, and then children’s health homes in 2016. In 2019, six 1915c home and community-based services (HCBS) case management waivers transitioned to the New York health homes model. Performance expectations for the health homes include reductions in preventable inpatient stays; reduced preventable emergency room visits; improved outcomes for children with serious emotional disturbance/mental illness; improved care for chronic conditions; and more preventive care.
CHHUNY is a network of 90 child welfare agencies and safety net behavioral health provider organizations—providing children’s care coordination services for New York Medicaid health plans and serving 10,600 children across 54 counties. The network provides a single care coordination and service delivery system for children—including early intervention behavioral health treatment, educational services, stable housing, alternatives to hospital emergency room use, referral and linkage to community organizations, assistance with social services, preventive services and chronic disease management, and appointment scheduling. Liberty Resources, and the other member provider organizations, provide Medicaid-covered children’s services through CHHUNY.
To achieve success with children’s health homes, Mr. Coyle suggested organizations must deliver, or support, three system competencies—data-driven assessments, a comprehensive plan for care coordination, and a multidisciplinary team.
Data-driven assessments: Understanding the needs of each individual child is a key element to success in children’s health homes—to know all the “health barriers” facing consumers, including mental, physical, social, and social determinants of health. To do this requires pulling data from various systems (and possibly pulling it differently), including electronic health records (EHRs), hospitals, and other sources into a care management platform to set up real-time analytics for decision support.
Comprehensive plan for care coordination: Using assessment data is key to developing a comprehensive goal-focused, person-centered care management plan for all of a child’s social, behavioral, and physical health goals. The plan needs to go beyond traditional case management focused on a particular issue.
A multidisciplinary team: For success with managing the “whole child,” provider organizations leading children’s health home programs need to have or have access to a wide range of key professional competencies, from behavioral health care, to medical care, to social supports. And the concept of multi-disciplinary goes beyond a clinical focus with relationship management, data management expertise, and value-based reimbursement management.
Ten years later, the competition among specialty provider organizations for adult care coordination contracts with health plans is brisk. I expect the same in the children’s service field. Now is the time for executive teams to decide if they want to pursue this role—or not. For more on the changes in the field, check out our recent coverage of some of the big news in the children’s health and human service market:
- New Mexico Agrees To Create Trauma-Responsive System For Children In Foster Care
- 5% Of Medicaid Children Have High Reliance On Urgent Care Centers, Lower Rates Of Primary Care Visits
- Children With I/DD Have Double The Health Care Costs Of Children Without I/DD
- Rate Of Uninsured Young Children Rose Significantly In 13 States From 2016 To 2018
- Seven States To Launch Value-Based Medicaid Children’s Integrated Care Model
- 65% Of American Parents Of Children Under 18 Cite Social Determinants As Barrier To Healthy Living
- One In Three U.S. Children Have An Adverse Childhood Experience
- Families Of Children With Special Health Care Needs More Likely To Have Housing Instability
- Between 8% & 19% Of Children With Intensive Behavioral Needs Placed In Treatment Foster Care
- 1 Per 1,000 Children Aged 3 To 17 Had Intellectual Disability Between 2009 & 2016
The market challenges for serving children are increasing, including an increased prevalence of serious child mental health and behavioral issues, autism, limited community-based services, and added pressures from trends like the ongoing opioid epidemic. To stay ahead of the trends, customize your market intelligence through your email preferences—exclusively focused on OPEN MINDS’ coverage of the children’s service market.
And for more on integration, join me on August 26 at The 2020 OPEN MINDS Management Best Practices Institute in Newport Beach, California for the keynote address, “Integrating Behavioral Health In A Fragmented World,” by MaryAnne Lindeblad, State Medical Director, Washington State Health Care Authority.