Last year, The Centers for Medicare & Medicaid Services (CMS) announced plans to launch Medicaid health homes to provide care coordination for children with medically complex or chronic conditions, with more information and additional guidance expected in October (see CMS To Launch Health Homes For Children With Medically Complex Conditions). In the meantime, what we have seen is most of the activity in this space is happening in New York, where the health home initiative launched in 2012, and expanded to include children in 2016. (For a deep dive into that system, check out our recent session with Carl M. Coyle, MSW, chief executive officer of Liberty Resources, Inc., Children’s Health Homes. Coming To A State Near You?).
The takeaway from that news is that eventually, health homes are coming to your state, and will include coverage of medically complex children. And like any new market opportunity, there are some additional “excellence” requirements for any organization that wants to make the leap from specialty provider organization to a health home. Meeting the new demands—integrated care coordination, value-based contracting, and data analytics in all its forms—was the focus of this year’s summit, The OPEN MINDS Children’s Services Executive Summit: Emerging Models For Children’s Health Homes. The event included case study presentations and an Open Forum On Innovations In Children’s Services, featuring Josh Boynton, vice president at Aetna; Kathy Szafran, executive director of Mountain Health Promise at Aetna; Elizabeth Wendel, business project program manager at Aetna; Kevin Campbell, model author family finding at the Center for Youth Connectedness; Sonni Vierling, vice president at PACE Center For Children’s Services, Community-Based Services, Orchard Place; and Carl M. Coyle, chief executive officer at Liberty Resources, Inc.
A big part of this conversation was the payer perspective and what health plans want. In short, health plans want provider organizations that are “prepared,” meaning they should stack up on four key elements—performance measures, network development, social determinants of health, and whole-person culture building.
Ability to measure a wide array of system performance measures—Some of the performance measures will be mandated, depending on the state or the contract, while others must be identified by the executive team, using a systematic plan and process. The key is to remember that health homes are built on an integration philosophy, and the performance measures need to reflect this, as well as refocus on measures that reflect improved consumer experiences and quality of living. Ms. Vierling explained, “For us, measures were mandated, so we look at driving the data around those. In addition to mandated measures, we look with the senior management team at integration across branches for what we want to see. Data literacy is one of the competencies for our staff.”
Mr. Boynton noted, “We strongly believe that we have to start measuring the things that actually matter. Look at the hierarchy of need. Are you as the consumer living the life you want to live? As we start looking at outcomes around kids and families, are we helping you build a network of people who aren’t paid to be in your life?”
Options to deliver services—As a health home, will you handle all services in-house, or will you build a network of other provider organizations that will deliver those services, but in turn will need to be coordinated, monitored, and managed? Having a clear answer to this question is important, as each approach takes different skill sets. Mr. Coyle explained the balancing act, “For us, we are so diversified we can turn to our own resources. But when you refer out to other organizations, you have differentiated levels of quality. And there may be limited choice. You have to be purposefully selective on who you would send consumers to.”
Broader coverage through social determinants of health—For specialty provider organizations, addressing the health barriers that consumers face has traditionally meant focusing on a very specific slice of their health care—mental and physical—and the occasional social service. Operating as a health home and truly rethinking how outcomes are defined means broadening care coordination to include social determinants of health. This is especially important for child populations who often age out of the system, into communities where they have little or no social support. Mr. Campbell explained, “This points out the weakness in the delivery system. We take a capabilities approach, not a needs approach. With a needs-based approach, people become objects and we exist to deliver services. We use technology to empower them and to build community around themselves and then think about services as complementary to that.”
Building a “whole person” culture—Managing to a “whole person” model, whether for adults or children, takes more than your average team. In addition to the key professional competencies necessary to deliver and coordinate behavioral health care, medical care, and social supports, there is an elevated need for relationship management, data management expertise, and value-based reimbursement management. And on top of all this, the staff needs to think in terms of integrated care and care coordination. Ms. Vierling explained the importance of training and building champions. She noted, “We have a core team of about 30 people that ranged between senior management to front line, and they were ‘equal’ in the five-day training around the core concepts. That was the stakeholder group that trained the rest of the organization to embed this plan. We still do this, with reminders and training. It’s critical to have those champions.”
Ms. Szafran added the importance of culture building outside the organization, as the success or failure of a health home often hinges on an organization’s ability to manage and coordinate with other entities. She explained: “We looked at some of our key relationships and asked what made this work. We’ve done that at every layer, including parents, kids, and leadership folks.”
Services for children with complex health and social support needs are shifting to health homes for children. This specialty market, while still “under development,” is realigning along the same referral, reimbursement, and service delivery models as adult health homes. And as out-of-industry competition grows for all behavioral health services, children’s health homes represent one more niche market for specialty provider organizations looking for post-crisis survival and sustainability options.
Health homes offer great potential to improve outcomes for children with complex needs and to reduce their use of other, more expensive health care resources. The right child-serving provider organizations can use this model to increase their impact and expand their service lines—if they are willing (and able) to work in and/or manage a collaborative service approach.
For more, be sure to check out our recordings and session slides from the entire summit:
- The Current Service & Financing Trends Affecting Children, Families & Provider Organizations
- It Takes A Provider Village To Help A Child With Complex Needs: How Iowa’s Pediatric Integrated Health Home Team-Based Approach Improves Outcomes
- The Promise Of Mountain Health: The West Virginia Case Study
- Children’s Health Homes In New York State: A Systems Perspective
- Open Forum On How To Develop Health Home & Care Coordination Programs With OPEN MINDS Senior Associates Sean Klutinoty, Joseph P. Naughton-Travers, Paul Neitman & George Braunstein
- Open Forum On Innovations In Children’s Services With Josh Boynton, Vice President, Aetna; Kathy Szafran, Executive Director, Mountain Health Promise, Aetna; Elizabeth Wendell, Business Project Program Manager, Aetna; Kevin Campbell, Model Author Family Finding, Center for Youth Connectedness; Sonni Vierling, Vice President, PACE Center For Children’s Services, Community-Based Services, Orchard Place & Carl M. Coyle, Chief Executive Officer, Liberty Resources, Inc.
And for more on integration, join me on August 26 at The 2020 OPEN MINDS Management Best Practices Institute for the keynote address, “Integrating Behavioral Health In A Fragmented World,” by MaryAnne Lindeblad, State Medicaid Director, Washington State Health Care Authority.