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What is a Health Home and Why Should I Know about Them?. Western Region Behavioral Health Organization Presentation- July 31, 2013. AGENDA . What is a Health Home ? How is Health Home Care Management work done and what services are provided? Who qualifies ?
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What is a Health Homeand Why Should I Know about Them? Western Region Behavioral Health Organization Presentation- July 31, 2013
AGENDA • What is a Health Home ? • How is Health Home Care Management work done and what services are provided? • Who qualifies? • Who is providing Health Home Care Management? • What makes this care management different? • Why should Health Homes be important to you? • How is someone linked to a Health Home & How do I make a referral? • How is the WRBHO helping with the Health Home roll out? • Questions 2
Health Homes What is a Health Home? • It is a program that provides Care Management to High Need Medicaid Recipients • All of the professionals involved in a member’s care communicate with one another so that all needs are addressed in a comprehensive manner. • Medical, behavioral health and social service needs are to be addressed
Health Homes How is the work done? • Work is done through a care manager who oversees and coordinates access to all of the services a member requires, including those being covered by Managed Care Organizations • Care manager ensures that the member receives everything necessary to stay healthy. • All the services and partners are considered collectively as the “Health Home.”
Health Homes Health Home Provides: • Comprehensive care management • Care coordination: clinical and non-clinical health care • Health promotion • Comprehensive transitional care (ex- inpatient discharge) • Patient and family support • Referral to community and social support services such as: housing, legal assistance, food • Uses Health Information Technology to link services
Health Home System Health Care Providers Community Resources Education Individual & Care Manager Vocational Services Services Agencies Housing
Health Homes Health Home Purpose: • Improve health care and health outcomes • Lower Medicaid costs • Reduce preventable hospitalizations and ER visits • Avoid unnecessary care for Medicaid members
Health Homes Who qualifies? • Medicaid recipient: • May be a Medicaid Managed Care Member or receiving services on a FFS basis. • May have both Medicaid and Medicare • Must have one of the following: • Two or more chronic health conditions (such as asthma, diabetes, heart disease, BMI> 25, SUD, mental health condition) • SMI, or • HIV/AIDS
Health Homes Program Size: • Approximately one million Medicaid recipients (out of 5 million) meet the federal criteria for Health Homes • Target enrollment for NYS: • 2013-2014= 151,000 • 2014-2015= 225,000
Health Homes Who Is Providing Health Home Care Management? • Targeted Case Management Slots are being converted to Health Home Care Management • COBRA Care Management slots are being converted as well. • New agencies have agreed to provide Health Home Care Management to expand capacity • Capacity will be driven by need, not limited to a specific number of approved slots
Health Homes What makes this care management different? • Access is not limited to those in the Mental Health system. Those with SU needs are eligible • Slot capacity is not capped. Capacity will be driven by need • Shorter application and simpler process than used for SPOA submissions • Access is much timelier. Referral does not need to be processed through County SPOA process, although the county may be asked for input concerning the most appropriate care management agency for the individual. • Care managers are encouraged to visit the individual if hospitalized and to work closely with the hospital /facility to support a successful discharge to after care.
Health Homes Why should Health Homes be Important to You? • Offers another partner (another resource) in supporting the needs of complex, hard to serve Medicaid clients • Important resource for discharge planners • Improves provider communication • Helps make certain that social needs of individual are met • Assists in avoiding unnecessary re-admissions • Assists in avoiding unnecessary Emergency Department visits • Partner in reducing health system costs
Health Homes How is someone linked to a Health Home? • Medicaid recipients are being placed on lists by NYS OMH and the Health Homes are reaching out to those on these lists. • Referrals may be made by anyone in the community to any Health Home operating in their County. • Health Homes will refer individuals to downstream care management providers based upon the needs of the individual
Linking to a Health Home Person has a need & is eligible Option 2 Option 1 State reviews Medicaid claims & places person on HH roster Provider or other individual determines need for HH services exists and completes HH Referral Form including consent HH obtains its Roster via the Health Commerce System Referral form is sent to HH HH assigns person to Care Management Agency in network HH assigns person to Care Management Agency in network HH Care Management Agency reaches out to person, obtains consent and enrolls HH Care Management Agency reaches out to person, obtains consent and enrolls
Health Homes How do I make a referral? • Make a call using the contact information on the following slides • Collect and keep the referral forms handy
Health Homes in Our Region:Allegany, Cattaraugus, Cayuga, Chautauqua, Chemung, Genesee, Livingston, Ontario, Orleans, Schuyler, Seneca, Steuben, Tioga, Tompkins, Wayne and Yates Counties
How is the WRBHO Helping with the Health Home Roll Out? • Notifies inpatient provider when a case we are reviewing is already engaged with a Health Home to encourage follow up • Recommends referral to Health Homes when appropriate in conjunction with the review of discharge plans
Health Homes Conclusion: Health Home care management should be seen as a resource to help all of us support our high need, high risk Medicaid clients better.
