Last week at The 2016 OPEN MINDS Strategy & Innovation Institute, we explored health homes from every angle – from different states, different financing structures, different populations served, different care models…as we’ve seen over the past few years, every state has structured their health home system differently (see How Are Medicaid Health Homes Reimbursed For Services?).
To talk about these perspectives, we were happy to have a panel of payer organizations discussing the health home models within their state in the session, Are Health Homes Working? The Payer Perspective. From New York, we heard from a managed care plan that is managing health homes for the HIV population; from Iowa, we heard from a managed care organization that is managing health homes for children with mental health issues and adults with serious mental illness (SMI); and from Maryland, where the state directly contracts with health homes rather than contracting with a managed care organization, we discussed health homes for adults with SMI or opioid addiction. Three different states, with three different models, serving three different populations.
First, we heard from Alan Rice, LCSW, Population Health Specialist with VNSNY CHOICE – Select Health HIV SNP. VNS-CHOICE is a New York City-based Medicaid managed care plan specifically serving consumers with HIV/AIDS. The plan was developed in 2003 to address the special needs of this population, and currently has about 4,000 members. The HIV health home program currently has about 1,200 consumers enrolled in nine health homes – they are planning to grow this enrollment to 2,500. In New York, HIV is a single qualifying condition for health home enrollment because the state determined that if you have HIV, then you are at-risk for another chronic condition. Currently, health homes are paid a per member per month (PMPM) fee based on acuity, based on past member claims; but in September 2016, the state will shift to “high,” “medium,” and “low” PMPM based on assessment criteria. Mr. Rice expects that they will be able to start analyzing data and outcomes from health homes next year.
Next, we heard about Iowa and integrated health homes for children and adults from Deborah L. Heggie, Ph.D., Corporate Chief Clinical Officer, Magellan Health about the Iowa integrated health home model, which focused on children with mental health issues and adults with serious mental illness. Magellan was Iowa’s Medicaid managed care carve-out for beneficiaries with serious mental illness (SMI). Iowa started with five health homes as a pilot program in 2011, and expanded statewide in 2014-2015. Over 22,000 consumers (12,000 adults and 10,500 children) participated in the health home program throughout the state and 40 provider organizations became integrated health homes (IHHs). Dr. Heggie reported that the health home program has had positive results – emergency department visits and inpatient admissions for both mental health and medical reasons have decreased between 2012 and 2014.
Last, we heard from Alyssa Brown, J.D., Chief, Evaluation, Research, & Data Analytics Division, Planning Administration, Maryland Office of Health Care Financing. Maryland health homes are managed directly by the state and serve the SMI population and consumers with opioid addiction who are receiving methadone treatment. The Maryland system has 81 approved health home sites (eight of which are opioid treatment providers), with about 6,000 participants.
Maryland has conducted a preliminary review of their health homes and found that the initial results are mixed. Between 2013 and 2014, the health home population has seen an increase in emergency department and inpatient utilization; a slight decrease in length of stay and readmission rates; and after year one, no reduction in costs. Dr. Brown emphasized that these results are preliminary and are expected to improve over time. The state is committed to the program, and will be expanding their analysis in the fall to look at the data over two years.
For all the differences within these states, all three of our presenters noted some of the same things that are making health homes successful within their programs:
- The ability to track and report data and performance metrics is essential for organizations operating as health homes. Payers need both cost and performance data to be able to demonstrate the value of the health home model, and this is impossible without data. For those states where health homes are contracted through managed care organizations, there are requirements from the state Medicaid program that the plans need to report on themselves – this means they need the health home providers data to help them meet their requirements.
- The provider organizations that have been the most successful have been those with strong organizational leadership and a commitment to shift the culture towards more collaboration and a mindset of whole-person care. The consumers being served by health homes have complex needs and may not be engaged in their care – this requires additional training and workforce development on outreach, the role of a care manager, how to manage larger caseloads, etc. This is additional training necessary to avoid burnout and turnover and to build an effective care team that can successfully work with consumers.
- Communication, collaboration, and coordination are the name of the game. Whether health home provider organizations contract with the state or managed care organizations, the nature of health homes requires that provider organizations work closely with payers and other provider organization partners. We know that health homes are about promoting care coordination for the most complex consumers – but this is impossible without a clear plan, communication, and consistent collaboration to make the model work.
These three issues stand out to me as a theme that I’ve heard discussed by many people at the institute all week: the era of value-based care requires a population health approach to care and the ability to demonstrate your value – whether we’re talking about becoming a health home, or partnering with a large health system. For more on health homes, check out the OPEN MINDS Health Home Library and stay tuned for our continued coverage of The 2016 OPEN MINDS Strategy & Innovation Institute.