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Title text here. Health Homes: The 4 th Long-Term Care Policy Summit September 5, 2012 Wendy Fox-Grage AARP Public Policy Institute. What is a Medical Home vs. a Health Home?. In 2007, four physician associations developed a set of joint principles for a “patient-centered” medical home

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  1. Title text here • Health Homes: • The 4th Long-Term Care Policy Summit • September 5, 2012 • Wendy Fox-Grage AARP Public Policy Institute

  2. What is a Medical Home vs. a Health Home? • In 2007, four physician associations developed a set of joint principles for a “patient-centered” medical home • Physician-Centered • Care Coordination • Patient Outcomes and Evidence-Based Care • Expanded Hours of Care • Payment • 23 states have medical home initiatives in Medicaid/CHIP programs

  3. What are Health Homes? • Option for Medicaid State Plans • Comprehensive system of care coordination for Medicaid enrollees with chronic conditions • Primary, acute, behavioral health, and long-term services and supports for “whole person” care

  4. What are the Goals for Health Homes? • Improved quality of care/outcomes for individuals • Improved experience of care for beneficiaries • Reduction in hospital admissions and readmissions • Reduction in emergency room use • Less reliance on nursing homes • Reduction in overall health care costs

  5. What are Key Features? • Comprehensive care management • Care coordination • Health promotion • Comprehensive transitional care • Patient and family support • Referral to community and social support services, if relevant • Encourages use of health information technology as feasible

  6. Which States have Approved Planning Requests? Alabama Arkansas Arizona California District of Columbia Idaho Maine Mississippi Nevada New Jersey New Mexico North Carolina Washington West Virginia Wisconsin

  7. Which States have Approved State Plan Amendments? States with Approved State Plan Amendments as of August 2012: • Missouri (two Approved SPAs) • Rhode Island (two Approved SPAs) • New York • Oregon • North Carolina • Iowa States with SPAs on the Clock: • Alabama • New York (3) • Ohio • Wisconsin Draft Proposals: Oklahoma, West Virginia, Maine, Idaho, Massachusetts

  8. Who can be in a Health Home? Medicaid eligible individual having: • two or more chronic conditions, • one condition and the risk of developing another, or • or at least one serious and persistent mental health condition

  9. What Chronic Conditions can be Included? The chronic conditions listed in statute: • mental health condition, • substance abuse disorder, • asthma, • diabetes, • heart disease, and • being overweight (a BMI of > 25). Through Secretarial authority, States may add other chronic conditions for approval by CMS.

  10. Who Can Be Health Home Providers? • Examples include Multiple Disciplines: • Physician and/or Group Practice • Rural Health Clinic • Community Health Center • Community Mental Health Center • Managed Care Organization • Home Health Agency • Hospital * States may include many other providers, subject to CMS approval

  11. Where is the Money? • 90% enhanced federal match for 1st 8 quarters for health home services for each enrollee • CMS will NOT reimburse for duplicative services • Health home needs to be in place before reimbursement can begin

  12. What are Some Models? • Building onto existing medical home and primary care case management program or vs. a new model • Interdisciplinary team • Geographic coverage • Training and IT infrastructure • Payment

  13. What are the Data Requirements? Providers: Report quality measures to the State to receive payment State : Collect utilization, expenditure, and quality data for an interim survey and an independent evaluation CMS Reports to Congress : Survey of States & Interim Report to Congress in 2014; and Independent Evaluation & Report to Congress in 2017

  14. What Core Data do Health Home Providers have to Collect? Adult BMI Assessment Ambulatory Care-Sensitive Condition Admission Care Transition – Transition Record Transmitted to Health care Professional Follow-Up After Hospitalization for Mental Illness Plan- All Cause Readmission Screening for Clinical Depression and Follow-up Plan Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

  15. What are Other Data Reporting Requirements? Service Utilization Institutional Admissions Emergency Room Visits Cost Savings Use of Health Information Technology Quality and Outcomes

  16. What are the Big Challenges? Health Information Technology: Electronic medical records and data requirements Conflict Free Case Management Financial Sustainability: Only 8-quarters of enhanced Medicaid match

  17. Where to Go for More Info and Help? Health Homes State Medicaid Director Letter Health Homes information on Medicaid.govhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Integrating-Care/Health-Homes/Health-Homes.html Integrated Care Resource Center (TA contractor) www.integratedcareresourcecenter.com

  18. Where to Go for More Info and Help? • Health Homes Mailbox at CMS healthhomes@cms.hhs.gov • Wendy Fox-Grage, AARP Public Policy Institute wfgrage@aarp.org; 202-434-3867

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