Missouri Health Homes Launched January 1, 2012
OPEN MINDS January 9, 2012
Developed by OPEN MINDS, 163 York Street, Gettysburg PA 17325, www.openminds.com. All rights reserved.
Beginning January 1, 2012, Missouri Medicaid will be providing “Health Homes” for Medicaid eligible children and adults with chronic illnesses, including those with serious mental illnesses (SMI). The Health Homes will use health information technology to link services; provide comprehensive care management; care coordination and health promotion; comprehensive transitional care between inpatient and other settings; patient and family support; and referrals to community and support services. Medicaid beneficiaries enrolled in managed care (MO HealthNet) and beneficiaries that are dually enrolled in Medicaid and Medicare are also eligible for Health Home services.
The Missouri Department of Social Services and the Department of Mental Health is providing two types of Health Homes-Community Mental Health Center (CMHC) Homes and Primary Care Chronic Conditions Healthcare Homes. The Health Home provider organizations were selected following an application review. At least 25% of each Health Home provider organizations’ patient base must consist of Medicaid patients and/or uninsured patients. More than 30,000 eligible consumers have already been auto-enrolled based on their history of receiving services at a Health Home provider organization for a qualifying condition. Individuals with qualifying conditions who are not currently receiving services from a Health Home provider organization may request to join a Health Home. Additionally, potentially eligible individuals receiving services in a hospital emergency department or as an inpatient will be notified about eligible Health Homes and referred to one based on their choice of provider organization.
Community Mental Health Center (CMHC) Homes
The CMHC Health homes are provided by 27 CMHCs and CMHC affiliates. In order to participate in the program, the selected CMHCs will be required to obtain Health Home certification through nationally recognized Health Home accrediting organizations. Medicaid individuals that have been diagnosed with a serious mental illness or addiction disorder will be auto-enrolled in a CMHC Healthcare Home. The CMHC Healthcare Homes will be the state’s designated provider organization for an estimated 6,757 individuals of any age with the following conditions:
- Serious and persistent mental health condition
- Serious and persistent mental health condition and one of the targeted chronic health conditions
- Addiction disorder
- Co-morbid mental health condition and addiction disorder
- Addiction disorder and one of the targeted chronic health conditions
- A mental health or addiction disorder and tobacco use, which is considered as an at-risk behavior for chronic health conditions such as asthma and cardiovascular disease
Additional details about the CMHC Health Homes are as follows:
- How staffed-The CMHC Healthcare Homes will be physician led; the health teams will include a Health Home director, a primary care physician consultant, a nurse care manager, and an administrative support staff member. Optional health team members can include the individual’s treating primary care physician, psychiatrist, and mental health case manager, as well as a nutritionist/dietitian, pharmacist, peer recovery specialist, grade school personnel, and other educational, employment, or housing representatives.
- How paid-The CMHC Healthcare Homes will receive $78.74 per member per month (PMPM) to provide all needed care coordination services specified by the individual’s person-centered plan; the PMPM reimbursement is not intended to cover the cost of services covered by Medicaid. The PMPM reimbursement is calculated as a sub-PMPM for each team member that assumes specific tasks will be provided for a pre-specified number of patients. For example, the $78.74 total PMPM includes $35.00 for a nurse care manager who coordinates care via 12 tasks for up to 250 enrollees, $12.50 for a primary care physician consultant who devotes one hour per enrollee per year to provide four services, $19.17 for a Health Home director who oversees care for 500 enrollees through five activities, and $12.07 for one administrative support staff person who handles seven administration tasks related to 500 enrollees. All Health Home payments, including those for beneficiaries enrolled in managed care will be made directly from MO HealthNet, the state Medicaid plan, to the Health Home provider organization.
- Anticipated savings to state-16% reduction in PMPM health care costs within three years as compared to usual care. Usual care PMPM costs are are expected to reach $1,815.81 PMPM based on existing cost trends.
- Bonus payments-Not specified in the SPA, but DMH staff indicated in a June 2011 presentation about the Health Home implementation titled “Paving the Way,” that CMHC Health Homes will receive additional funding based on their improvement on performance measure outcomes.
- Performance measures-The SPA lists specific goal-based performance measures intended to measure improvements in health care quality, patient outcomes, and care coordination. In July 2011, each CMHC was given its benchmark data for certain measures; the SPA lists the goals for each measure. Performance measure outcomes will be derived from Medicaid claims data, pharmacy claims data, required reports filed by the Health Home provider organizations, patient surveys, patient engagement with Missouri’s Cyber Access personal health record, disease registry data.
Primary Care Chronic Conditions Healthcare Homes
The Primary Care Chronic Conditions Healthcare Homes are comprised of federally qualified health centers (FQHC’s), rural health centers (RHC’s), and physician practices. Primary care practices will be required to obtain NCQA (National Committee for Quality Assurance) Health Home certification. Enrollment for primary care practices are targeted at persons with two chronic health conditions; or those diagnosed with one chronic condition who are at risk of developing another. An estimated 25,372 individuals eligible for Healthcare Home services will be auto-assigned to a Health Home provider organization based on their qualifying conditions. The following chronic conditions are targeted for Primary Care Chronic Conditions Healthcare Homes services:
- Cardiovascular disease, including hypertension
- Overweight, defined as a body mass index of 25 or more
- Developmental disabilities
- Smoking or diabetes qualifies a person with one qualifying condition as being at-risk of having a second chronic condition.
Additional details about the Primary Care Chronic Condition Health Homes are as follows:
- How staffed-The Primary Care Chronic Conditions Healthcare Homes will also be physician led; the health teams will include a primary care physician or nurse practitioner, a licensed nurse or medical assistant, behavioral health consultant, a nurse care manager, and the practice administrator or office manager. Optional health team members can include a nutritionist, diabetes educator, public school personnel, and others as appropriate and available.
- How paid-The Primary Care Chronic Conditions Healthcare Homes will receive $58.87 PMPM. The PMPM reimbursement for each team member assumes specific tasks and a target workload, similar to the tasks and targets for the CMHC Health Home team members. All Health Home payments, including those for beneficiaries enrolled in managed care will be made directly from MO HealthNet, the state Medicaid plan, to the Health Home provider organization
- Anticipated savings to state-1.89% net savings in annual aggregate enrollee health care costs as compared to pre-Health Home estimated costs of $136 million
- Bonus payments-Not specified in the SPA
- Performance measures-The SPA lists specific goal-based performance measures intended to measure improvements in health care quality, patient outcomes, and care coordination for this population. The SPA lists goals for each measure. Performance measure outcomes will be derived from Medicaid claims data, pharmacy claims data, required reports filed by the Health Home provider organizations, patient surveys, patient engagement with Missouri’s Cyber Access personal health record, disease registry data,
A link to the full text of “Missouri Medicaid CMHC Health Homes State Plan Amendment” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/102111mhcdmocmhchealthhomesspa.htm.
A link to the full text of “Missouri Medicaid Health Homes State Plan Amendment” for primary care settings may be found in The OPEN MINDS Circle Library at www.openminds.com/library/110311mhcdmoprimcarehealthhomesspa.htm.
The “Paving the Way for Healthcare Home” presentation was also part of the documents discussed at the Missouri Coalition of Community Mental Health Centers 2011 Annual Meeting. The meeting topics covered multiple aspects of the Health Home implementation. A link to the full text of the annual meeting documents may be found in The OPEN MINDS Circle Library at www.openminds.com/library/062811mhcdmohcpresmddmhc.htm
For more information, contact: Bob Bax, Missouri Department of Mental Health, 1706 E. Elm Street, Post Office Box 687, Jefferson City, Missouri 65102; 573-751-4122; Fax: 573-751-8224; E-mail: firstname.lastname@example.org; Web site: http://dmh.mo.gov/about/chiefclinicalofficer/healthcarehome.htm; or Seth Bundy, Missouri Department of Social Services, Broadway State Office Building, Post Office Box 1527, Jefferson City, Missouri 65102-1527; 573-751-4815; Fax: 573-751-3203; E-mail: Seth.D.Bundy@dss.mo.gov; Web site: http://dss.mo.gov
Missouri Health Homes Launched January 1, 2012. (2012, January 9). OPEN MINDS Weekly News Wire.
Copyright 2011. OPEN MINDS