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Medicaid 'health homes' not built
Schenectady, Saratoga counties await state action as networks begin to end fee-for-service care
By CATHLEEN F. CROWLEY Staff writer
Published 10:20 p.m., Wednesday, October 26, 2011

On Jan. 1, the state's Medicaid system will start moving into a new model of care. But as one Department of Health official said, describing it is like trying to explain a world inside Dungeons and Dragons: It doesn't really exist.

Schenectady and Saratoga counties are among the first counties that, starting Jan. 1, are supposed to enroll Medicaid patients into "health homes," or networks that will manage the care of a Medicaid patient. The state has yet to designate the counties' health homes, or set details of how they will run.

Many providers are overwhelmed by how fast the state is changing policies, and fear that patients will slip through the cracks. Organizations are scrambling to partner and form health homes. Even though the start date is Jan. 1, state officials said it will be an evolving process that will take years and enrollment will happen gradually as health homes get up and running.

Health homes are not brick-and-mortar structures, but networks of local providers that will share the responsibility of caring for each Medicaid patient they enroll, including physical, mental health and addiction needs. Most networks will be led by a hospital, a community health organization or an insurance company.

For example, the Visiting Nurses Association of Schenectady and Saratoga Counties is the lead agency in a proposed network that includes Ellis Medicine, Hometown Health Centers, CDPHP and MVP Healthcare.

State leaders believe that coordinated care will be cheaper and better compared to the scattered fee-for service care Medicaid patients currently receive.

"There are probably a bunch of people here mourning the loss of fee-for-service," said Michael Hogan, commissioner of the state Office of Mental Health, referring to the previously dominant model. "But get over that. We are not going back there."........................>>>>....................>>>>.....................Read more: http://www.timesunion.com/local/article/Medicaid-health-homes-not-built-2238351.php#ixzz1byVsNXyr

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1. The State reserves the right to assign beneficiaries to a specific health home.


2. The State reserves the right to cancel a Health Home provider’s approved status based on upon failure of the provider to provide health home services in accordance with the NYS Health Home Provider Qualification Standards, provide quality health home services to its clients, or upon other significant findings determined by the State.


3. The State reserves the right to cancel the program at any time for lack of funding, and/or if, after evaluation of the program, desired results in quality, efficiency and decreased costs are not shown, or any other reason determined by the State.

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Health Homes for Medicaid Enrollees with Chronic Conditions

New York's Medicaid program serves over 5 million enrollees with a broad array of health care needs and challenges. While the majority of Medicaid enrollees is relatively healthy and only requires access to primary care practitioners to obtain episodic and preventive health care, the Medicaid program also has several population groups who have complex medical, behavioral, and long term care needs that drive a high volume of high cost services including inpatient and long term institutional care.

Navigating the current health care system can be difficult for relatively healthy Medicaid recipients and even more so for enrollees who have high-cost and complex chronic conditions that drive a high volume of high cost inpatient episodes. A significant percentage of Medicaid expenditures are utilized by this subset of the Medicaid population. Appropriately accessing and managing these services, through improved care coordination and service integration, is essential in controlling future health care costs and improving health outcomes for this population.

A Health Home is a care management service model whereby all of an individual's caregivers communicate with one another so that all of a patient's needs are addressed in a comprehensive manner. This is done primarily through a "care manager" who oversees and provides access to all of the services an individual needs to assure that they receive everything necessary to stay healthy, out of the emergency room and out of the hospital. Health records are shared (either electronically or paper) among providers so that services are not duplicated or neglected. The health home services are provided through a network of organizations – providers, health plans and community-based organizations. When all the services are considered collectively they become a virtual"Health Home."

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Fast Facts:

Created as a new option under federal health care reform (Affordable Care Act)
NY State Department of Health (DOH) is currently soliciting providers to become Medicaid health homes
The NY State DOH initiative is targeting Medicaid utilization among people with serious mental illness and people with multiple chronic medical conditions
People with intellectual and developmental disabilities are excluded from participation in NY’s current health homes initiative.
Background:

New provisions in the federal health care reform law allow for the establishment of health homes as a new Medicaid State Plan Option and increased federal financial participation for the provision of certain services under health home auspice.  A health home is a provider (or network of providers) that is designated as a health home by the state by virtue of their capacity to deliver coordinated and integrated care to enrollees who have multiple chronic conditions.  Aggressive care management, the promotion of preventive health strategies, care delivered by a strong clinical team across health care settings, and the application of health information technology are expected to result in better health outcomes at a reduced cost to government.

NY State DOH is currently soliciting proposals from Medicaid providers who want to be designated as a health home.  DOH expects to have a statewide network of health homes established this fall and will begin to enroll people in health homes soon thereafter.   One of NY’s first health home initiatives will focus on enrollees with behavioral health and/or chronic medical conditions.  This population includes those with a serious and persistent mental health condition, those with two or more chronic medical conditions, and those with one chronic medical condition but at risk for a second chronic condition.  Chronic conditions include:  asthma, diabetes, heart disease, hypertension, and HIV/AIDS.  NY State’s filing with the federal government explicitly excludes those with intellectual disabilities.  DOH has explained that they will exclude anyone in receipt of a Medicaid funded service under the auspice of OPWDD.  More information on this initiative can be found on the NY State DOH website:

http://www.health.state.ny.us/health_care/medicaid/program/medicaid_health_homes/index.htm

Implications for the OPWDD 1115 Waiver:

The analysis that was done by the NY State DOH in support of its health home application to the federal government identified a large number of people with intellectual and developmental disabilities as among the populations who drive high Medicaid costs related to their utilization of multiple Medicaid funded services across health and long term care settings.  Specifically, DOH identified 52,000 people with i/dd and 2 or more chronic medical conditions.  While the i/dd population is not the current focus, it is reasonable to expect that the State will seek ways to better manage cost and utilization for this population either through similar strategies that are ultimately included in the OPWDD 1115 waiver or through later inclusion of this population in Medicaid Health Homes.  The program elements in health homes have strong parallels to some of the objectives in the 1115 waiver concept paper (e.g., strong care management, coordination of care across multiple settings, breaking down barriers between acute health care and long term care systems).  The developmental disabilities field would do well to closely monitor the implementation of Medicaid Health Homes.  It may provide us with insight as to the benefits and pitfalls of this kind of an approach to coordinated supports and services.