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By Monica E. Oss

Last week, we reported on the New York State Department of Health (DOH) launch of health homes for children in the New York Medicaid plan (see New York Medicaid Launches Children’s Health Homes). This is a relatively rare development in the world of health homes — while 20 state Medicaid programs currently have health home programs, only four have programs for children. (For more detail on health home programs, check our market intelligence report, U.S. Medicaid Health Home Market: The 2016 OPEN MINDS Update.)

My immediate question: What does this model mean for children and for child-serving provider organizations in the state of New York (or any of the four other states with health homes for children)? To answer that question, I reached out to OPEN MINDS Senior Associates Howard Shiffman and Paul Neitman.

Howard Shiffman-newsletter_250x250_web
Mr. Shiffman

Howard Shiffman noted that the competencies needed by provider organizations to be successful at health homes have been a part of the larger market for years. He wrote:

This is an interesting development, and if implemented correctly by New York, this could serve to be a model of other states. I think this is a win for children in New York that meet health home criteria and a win for provider organizations that have been preparing for more integrated, coordinated models of care over the past few years.

If your organization is in a position to become a health home or medical home that manages care for children, there are a few things you need to do to prepare:

  1. Focus on managing and tracking performance – In a coordinated, managed care environment, provider organizations working with children need to pay attention to outcomes, safety, and permanency.
  2. Use information technology effectively – In a health home, provider organizations need electronic records that can share information with payers and other provider organizations. Health homes also require organizations to be able to use data analytics to deliver services in a cost efficient manner and to support clinical and administrative decision making.
  3. Form partnerships with other provider organizations – Understanding and possessing the competencies necessary to work with mental health, addiction treatment, and physical health care provider organizations is a necessary component of making the health home model work. This will mean working more collaboratively with other organizations to serve children in the best way possible.
  4. Develop new services and programs that fit into the health home model – Children in this health home system will need preventive services and aftercare plans that are designed to keep them out of emergency rooms and children’s hospitals. This means developing more short-term acute care services, such as shorter lengths of stay for evaluations (three – four days), expedient medication evaluations, and immediate crisis intervention.

In a health home model, children will get integrated care, which will be more clinically holistic and their families will have less redundant contacts with professionals and less trauma dealing with multiple service provider organizations. This is a positive development.

Paul Neitman
Mr. Neitman

Paul Neitman explained that the need for care coordination will offer provider organizations capable of collaboration more market opportunities. He wrote:

Hopefully, this new program improves physical and behavioral health care for children in foster care and certain juvenile justice youth. Often times, for children in the child welfare system, the responsibility for managing and coordinating health and behavioral health care was left to the foster parent. Children in foster care and juvenile justice system often have complex support needs, are often moved around to different placements, and in some cases are required to move in and out of Medicaid when in residential care. Overall, the main issue is lack of care coordination and a common “health record” for a very special group of children with very complex needs. For provider organizations, the health home model provides a new market opportunity with a clear funding source if they are willing and able to work in a collaborative service environment.

Health homes offer the potential to improve outcomes for children and families with complex needs and to reduce their use of expensive health care resources. And, they are an opportunity for child-serving provider organizations to increase their impact and their service lines.

Be sure to register to join me on February 15 in Clearwater Beach, Florida, for The 2017 OPEN MINDS Next Generation Forum On Children’s Services Annual Summit, where we will identify the challenges and opportunities faced by children’s services providers, as well as the strategies to overcome those challenges.

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