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By Athena Mandros

This year is the five-year anniversary of the implementation of the health home model in Missouri and Rhode Island – the states that were the earliest adopters. As these models hit the five-year mark, I think there are four key questions:

  1. How do you measure the success of the model?
  2. Do health homes actually work?
  3. What types of consumers are enrolled in health homes?
  4. Is there an “average” reimbursement rate for health home services?

The answer to each of these questions is like many elements in the U.S. health care system – it depends.

When it comes to health home performance, a comprehensive assessment is still a little ways off, as the first health home evaluation report isn’t due due to Congress until 2017. But at the state level, some preliminary results about health home outcomes are available now. Between 2012 and 2015, Missouri’s community mental health center (CMHC) health homes for consumers with serious mental illness met six of the nine benchmark goals set by the program. Under the program, the average number of hospitalizations has been reduced 14%, average emergency room visits decreased 19%, and the percentage of consumers with diabetes who had controlled blood glucose levels increased from 18% to 61% (see Missouri Coalition For Community Behavioral Healthcare: Healthcare Homes Progress Report 2012-2015). Washington state also has some preliminary assessments available.  The state has a managed fee-for-service (FFS) dual eligible demonstration with the Centers for Medicare & Medicaid Services (CMS), which utilizes health homes to coordinate care. The first year of the model resulted in six percent savings for the Medicare program – savings to the Medicaid program and the net cost of the health homes has not yet been made available. The savings to Medicare resulted in Washington continuing the health home model, which the state had previously planned to end (see First Year Of Washington State Managed FFS Duals Demonstration Shows 6% In Medicare Savings).

We do know more about the populations that are enrolled in health homes. As of May 2016, there are 20 states with health homes, which enroll about 1.25 million consumers. This is an increase of 25% over the one million consumers enrolled in May, 2015. The health homes in these 20 states serve three populations – consumers with chronic medical conditions only; consumers with serious mental illness (SMI), serious emotional disturbance (SED) or substance use disorder (SUD) only; or consumers with chronic medical conditions and/or SMI/SED. The majority of health homes serve consumers with chronic medical conditions only (56%), followed by consumers with SMI and chronic conditions (36%), and consumers with SMI, SED, and SUD (8%).

With regard to health home reimbursement rates, there is no standard. The market is still in the phase of “when you’ve seen one, you’ve seen one.” Rates range from $0 per member per month (PMPM) in North Carolina, to a high of $442 PMPM in Rhode Island. Currently no health home programs are factoring performance into rate setting. There are three states, however, that plan to include performance in health home rates in the near future – Iowa, Tennessee, and Rhode Island. Of these states, Rhode Island has discussed some of the performance measures they plan to use, including employment rate of health home consumers, discharges for non-treatment adherence, and annual physical or wellness exams with a primary care provider.

The bottom line is that five year’s in, there are still a lot of questions to be answered – and as more states begin their health home programs, the questions will continue to grow. For more answers, and to learn about the trends driving health homes, check out U.S. Medicaid Health Home Market: The 2016 OPEN MINDS Update. For every state, we have gathered current information on the populations served, the contracting model, eligible health home provider types, and the reimbursement rate. The report is organized into five key sections to give readers all the latest information on health home contracting models, reimbursement models, and pay-for-performance initiatives:

  1. Overview of the Medicaid health home model
  2. Number of states with health homes and enrollment
  3. Health home contracting and reimbursement models
  4. States planning to implement Medicaid health homes
  5. State-by-state guide to Medicaid health homes

For even more on health homes, check out How Are States Managing Medicaid Health Homes?: An OPEN MINDS Market Intelligence Report and What Accreditation Options Are Available For Medical Homes & Health Homes?: An OPEN MINDS Market Intelligence Report.


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