Chronic Health Homes DRAFT Criteria

1. Chronic Health HomesDRAFT Criteria Opioid Maintenance Therapy Providers Webinar December 5, 2012 1:30-3:30pm

2. Agenda • Program Objectives • Review Draft Health Home Criteria • Participant Eligibility • Health Home Services • Provider Qualifications • HIT Linkages • Payment Methodology • Evaluation • Next Steps • Questions/Discussion

3. Chronic Health Home Objectives Chronic Health Homes aim to: • Further integration of behavioral and somatic care through improved care coordination; • Improve patient outcomes, experience of care, and health care costs among individuals with chronic conditions; and • Enable Health Homes to act as locus of coordination for SPMI and OMT populations through provision of additional care coordination services.

4. Participant Eligibility Criteria • The individual has been diagnosed with: • a serious and persistent mental illness in combination with meeting the medical necessity criteria for PRP services, OR • an opioid substance use disorder that is being treated with methadone, AND one other qualifying chronic condition.

5. Participant Eligibility Criteria:Qualifying Chronic Conditions • Eligible chronic conditions among OMT population: • Mental health condition • Substance use disorder • Asthma • Diabetes • Heart disease • Overweight (BMI> 25) • Hypertension • Infectious disease (HIV/AIDS, Viral Hepatitis)

6. Health Home Assignment • Assignment to Health Home based on current provider • OMT providers must confirm and report qualifying chronic condition during intake • Provider may add new HH consumers as they initiate care after initial enrollment • Potentially-eligible consumers in hospital or ED notified of Health Home based on provider history, county of residence

7. Health Home Services • Comprehensive Care Management • Care Coordination • Health Promotion • Comprehensive Transitional Care • Individual and Family Support • Referral to Community and Social Support

8. Health Home Services: Comprehensive Care Management • Comprehensive assessment of preliminary service needs, including screening for co-occurring behavioral and somatic health needs • Development of consumer-centered ITPs • Development of treatment guidelines • Monitoring of individual and population health status and service use to determine adherence to treatment guidelines • Reporting of progress toward outcomes for consumer satisfaction, health status, service delivery, and costs

9. Health Home Services: Care Coordination Implementation of the consumer-centered ITP, including: • appointment scheduling; • conducting referrals and follow-up monitoring, including long-term services and peer-based support; • participating in hospital discharge processes; and • communicating with other providers and consumers/family members, as appropriate.

10. Health Home Services: Health Promotion • Health education, specific to chronic conditions • Development and follow-up of self-management plans emphasizing person-centered empowerment • Education regarding immunizations and screenings • Health promoting lifestyle interventions, such as: • Substance use prevention  • Tobacco prevention and cessation; • Nutritional counseling, obesity reduction and prevention; and • Physical activity.

11. Health Home Services: Comprehensive Transitional Care Comprehensive transitional care services aim to: • streamline plans of care; • ease the transition to long-term services and supports; and • reduce hospital admissions and interrupt patterns of frequent hospital emergency department use. The Health Home Team will: • collaborate with clinical, therapeutic, rehabilitative, and other providers to implement the treatment plan; • increase consumers’ and family members’ ability to manage care and live safely in the community; and • emphasize proactive health promotion and self-management.

12. Health Home Services: Independent & Family Support • Advocacy for individuals and families • Assistance with medication & treatment adherence • Identification of resources to support reaching the highest possible level of health and functioning, including transportation to medically-necessary services • Health literacy improvement • Support for the ability to self-manage care • Facilitation of consumer and family participation in ongoing revisions of care/treatment plan.

13. Health Home Services: Referral to Community & Social Supports • Health Homes will provide assistance for consumers to obtain and maintain eligibility for: • health care services, • disability benefits, • housing, • personal needs, and • legal services, as examples.

14. Provider Qualifications:Provider Types • Licensed as a Psychiatric Rehab Provider OR • Licensed as a Outpatient Methadone Treatment Provider AND • Be an enrolled Maryland Medicaid Provider • Be accredited as a Health Home by CARF • Provisional designation as Health Home for providers in-process of accreditation

15. Provider Qualifications: CARF Accreditation • Health Home accreditation under CARF’s Behavioral Health standards manual • Must complete sections 1 &2 of BH standards manual and Health Home supplemental survey • Cost • $995 initial application fee • $1475 per surveyor/per day • Average survey requires 2 surveyors, 2 days

16. Provider Qualifications: Initial and Ongoing Requirements • Cost-effective Health Home delivery model • Substantial % of existing consumers MA beneficiaries • Ability to provide 24/7 coverage • Ability to meet reporting requirements • Enrollment with CRISP, pharmacy data access • Ability to maintain required staffing

17. Provider Qualifications:Provider Staffing Ratios • Nurse Care Manager: .5 full-time equivalent (FTE) per 125 Health Home enrollees • Health Home Director: .5 FTE per 125 Health Home enrollees • Physician or Nurse Practitioner: 1 or 2 hours per Health Home enrollee per 12 month period • Administrative Support Staff: .25 FTE per 125 Health Home enrollees

18. HIT Linkages • eMedicaid online portal • Providers submit initial intake and monthly report of Health Home services provided and relevant participant outcomes • Will ultimately populate with individual participant claims data • CRISP notification of hospital encounters • Real-time pharmacy data • Provider HIT system capabilities

19. Payment Methodology • Flat per member/per month (PMPM) rate based on cost, actuarial soundness • Comparable to other states’ rates at $75-100 PMPM • Dependent on compliance with ongoing requirements • Maintain staffing, accreditation, compliance with all requirements and regulations • Documentation of minimum monthly HH service(s) per participant

20. Evaluation • Evaluation will be based on provider reports; claims, hospital, and pharmacy data; and participant surveys. • This includes, but is not limited to, a review of: • hospital admissions; • chronic disease management; • coordination of care; • program implementation; • processes and lessons learned; • quality improvements & clinical outcomes; and • cost savings.

21. Evaluation: Quality Measures • Examples of quality measures include: • avoidable hospital readmissions; • medication compliance; • preventive care delivery; • patient experience of care; and • medical outcomes specific to participants’ targeted chronic conditions.

22. Next Steps • DHMH consultation with SAMHSA • Continued stakeholder outreach • Finalize state plan amendment (SPA), set go-live date • Provider outreach, training & enrollment • Participant enrollment • SPA goes into effect, service provision begins • Ongoing participant outreach & enrollment • Continued development of eMedicaid

23. Points to Consider Start-Up/Training Costs Ongoing ability to deliver mandated services with continuous improvement Data Collection/Reporting Health IT Sustainability/Economies of Scale

24. Questions You may send additional questions to dhmh.bhintegration@maryland.gov