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OM: 27 States Serve Over 1m in Medicaid Health Homes

by troyweb

NYAPRS Note: One critical aspect of health home implementation is its success in relation to other ACA policy opportunities for states. New York is one of a few that have taken new possibilities and planned sweeping reforms in coordination with the Federal government. Health homes as a piece of that delivery system change model is fraught with implementation issues the more opportunities a state takes advantage of; members of the health home population cross-cut over multiple recipient groups, creating implementation gaps and considerations across transitions (re. BH and LTC into managed care). And within health homes, there is great variation in quality care and what is meant by active “enrollment”.

 

In the chart below, NY is listed as having enrolled over 150,000 individuals in health homes. This number must reflect potential enrollees, however, as the number based on a year of practice is actually 50,000 in active care management. If health homes are going to keep pace with other transformation efforts, we need to take a critical look at best practice strategies across states that go beyond policy memes. For example, the comparative chart below indicates that 14 other implementation states have a far greater proportional base of provider organizations. Increasing numbers and types of organizations offering care management may be difficult to manage, but it could also reduce caseload sizes and create more service and cultural receptivity within outreach and engagement. Analyses of health homes should also not just look back at initial implementation, but forward: are the rates offered for care management currently adequate? How will the rate be structured given the various population members enrolled when the 90-10% federal match is dissolved in six months? What best practices within quality health homes should be standardized and expected in a value based system? And what practices are unacceptable that should be met with consequences for an individual provider or overreaching policy?

 

States Serve Over 1m in Medicaid Health Homes

OPEN Minds NEWS REPORT | MAY 4, 2014

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As of March 2014, 27 states were operating or planning to launch Medicaid health homes. The 27 includes 15 states with one or more approved health home state plan amendments (SPAs), and another 12 states (11 states plus the District of Columbia) with an approved health home planning request. The 15 states have 22 approved SPAs, and have enrolled more than 1 million Medicaid beneficiaries with chronic health problems.

The first health homes launched in October 2011. States can implement Medicaid health homes for broad populations with chronic health problems, or for specific populations such as individuals with serious mental illness (SMI), serious and persistent mental illness (SPMI), or serious emotional disturbance (SED). Iowa, Missouri, and Rhode Island have health homes focused on individuals with mental health disorders. In these three states, health homes for individuals with mental health disorders are typically operated by behavioral health provider organizations, such as community mental health centers (CMHCs). Health home provider organizations receive a monthly payment to provide six core services: comprehensive care management, care coordination and health promotion, comprehensive transitional care from inpatient to other settings, individual and family support, referral to community and social support services, and use of health information technology to link services.

 

Medicaid Health Home Enrollee & Provider Organization Estimates, March 2014

State (& Date of First SPA Approved)

Number Of Approved SPAs

Enrollees

Number & Type Of Provider Organizations

Alabama April 2013

1

70,206

186 provider organizations

Idaho November 2012

1

9,179

28 provider organizations with 55 service locations

Iowa July 2012, July 2013

2

4,396 in primary care health homes

16,825 in SMI/SED health homes

Primary care includes 32 provider organizations (with 71 locations & 609 practitioners)

SMI/SED includes 1 lead provider organization (Magellan) with 11 community facilities in 5 counties

Maine January 2013

1

42,958

165 health home practices in partnership with 10 Community Care teams

Maryland September 2013

1

2,516

58 provider organizations

Missouri January 2012

2

15,382 in primary care health homes19,631 in CMHC health homes

Primary care includes 18 federally qualified health centers, 6 hospitals, 14 clinics & 14 rural health clinics28 CMHCs with 120 clinic/outreach offices

New York January, April, July 2012

3

158,460

32 health home lead provider organizations operating 48 health homes in 58 counties

North Carolina October 2011

1

559,839

1,838 provider organizations

Ohio September 2012

1

10,312

6 provider organizations

Oregon October 2011

1

93,253

198 provider organizations

Rhode Island October 2011

3

2,855 in broad focus health homes6,772 in SMI health homes2,340 in opioid dependency health homes

4 comprehensive evaluation, evaluation, diagnosis, assessment, referral & reevaluation centers8 provider organizations (6 CMHCs + 2 other mental health clinics5 provider organizations with 11 statewide locations

South Dakota November 2013

1

5,655

112 health homes in 117 locations with 545 provider organizations

Vermont March 2014

1

2,949

5 hub providers and 57 spoke providers

Washington June, December 2013

2

22,792

8 qualified health homes with 30 subcontracted Care Coordination Organizations

Wisconsin October 2012

1

188

1: AIDS Resource Center for Wisconsin

Total

22 approved SPAs

1,046,508

Not Summed

 

The status of Medicaid health home adoption by the states was reported by CMS in “State Health Home CMS Proposal Status (Effective March 2014).” The document lists health home adoption status for each state. For the states that have launched one or more Medicaid health home initiatives, the document lists total estimated enrollment and the estimated number of health home provider organizations. Additional details about states’ health home plans are as follows:

  • Seven of the 15 states with an approved SPA also have another approved planning request. These states are Alabama, Idaho, Maine, Maryland, North Carolina, Washington, and Wisconsin.
  • Four states with an approved health home SPA have submitted another proposed SPA to implement another health home initiative; these states are Iowa, Maine, Ohio, and Wisconsin.
  • The 12 states with an approved health home planning request are Arizona, Arkansas, California, District of Columbia, Kansas, Kentucky, Minnesota, Mississippi, Nevada, New Jersey, New Mexico, and West Virginia.
  • The remaining 24 states, although they may be planning a Medicaid health home initiative, have not submitted a proposed SPA to the federal Centers for Medicare and Medicaid Services (CMS). These states are Alaska, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Louisiana, Massachusetts, Michigan, Montana, Nebraska, New Hampshire, North Dakota, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, and Wyoming.

To help more states implement Medicaid health homes, in March 2014, the Center for Health Care Strategies released “Seizing the Opportunity: Early Medicaid Health Home Lessons” by Kathy Moses and Brianna Ensslin. With the support of the New York State Health Foundation and the Missouri Foundation for Health, the authors reviewed the experiences of six early health home adopter states to outline elements critical to implementation and sustainability. The early adopter states are Iowa, Missouri, New York, North Carolina, Oregon, and Rhode Island; as of early 2014collectively these states have enrolled more than 875,000 beneficiaries in health homes. The six states estimate their current health home penetration rate at 20% to 40% of the eligible Medicaid population. The key lessons for other states seeking to implement sustainable health homes are as follows:

  • Use flexibilities within the health home option to advance state policy goals
  • Define health home target populations and the health home option to achieve the greatest impact on outcomes
  • Align payment models with policy goals to drive payment modernization
  • Use experience with complex populations to drive the definition of health home services
  • Support health home provider organizations to achieve culture change
  • Invest in access to real-time data to support effective care coordination

A link to the full text of “State Health Home CMS Proposal Status (Effective March 2014)” may be found in The OPEN MINDS Circle Library at www.openminds.com/market-intelligence/resources/state-health-home-cms-proposal-status-effective-march-2014.htm.

A link to the full text of “State Health Home CMS Proposal Status (Effective February 2014)” may be found in The OPEN MINDS Circle Library at www.openminds.com/market-intelligence/resources/state-health-home-cms-proposal-status-effective-february-2014.htm.

A link to the full text of “Seizing the Opportunity: Early Medicaid Health Home Lessons” can be viewed online at http://www.chcs.org/publications3960/publications_show.htm?doc_id=1261636&inactive=1#.UzHFPMRDvmc&utm_source=Seizing+the+Opportunity%3A+Early+Medicaid+Health+Home+Lessons+&utm_campaign=Health+Homes&utm_medium=email(accessed April 24, 2014).

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