what is a health home and why should i know about them?
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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 ? - PowerPoint PPT PresentationTRANSCRIPT
What is a Health Homeand Why Should I Know about Them?
Western Region Behavioral Health Organization
Presentation- July 31, 2013
2
• 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
AGENDA
Health HomesWhat 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 HomesHow 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 HomesHealth 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
Individual & Care
Manager
Community Resources
Health Care Providers
Services Agencies
Education
Vocational Services
Housing
Health HomesHealth Home Purpose: •Improve health care and health outcomes•Lower Medicaid costs•Reduce preventable hospitalizations and ER visits•Avoid unnecessary care for Medicaid members
Health HomesWho 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 HomesWho 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 HomesWhat 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 Home – Vision….Maimonides Medical Center
TODAY’S CARE HEALTH HOME CAREMy patients are those who can make appointments to see me
Our patients are those who are registered in our health home
Patient’s chief complaints or reasons for visit determines care
We systematically assess all our patient’s health needs to plan care
Care is determined by today’s problem and time available today
Care is determined by proactive plan to meet patient needs w/o visits.
Care varies by scheduled time and memory or skill of the doctor
Care is standardized according to evidence-based guidelines
Patients are responsible for coordinating their own care
A prepared team of professionals coordinates all patients’ care
I know I deliver high quality care because I am well trained
We measure our quality and make rapid changes to improve it
Acute care is delivered in the next available appointment and walk-ins
Acute care is delivered by open access and non-visit contacts
It’s up to the patients to tell us what happened to them
We track tests & consultations, and follow up after ED & hospital stays
Clinic operations center on meeting the doctor’s needs
A multi-disciplinary team works at the top of our licenses to serve patients
Health HomesWhy 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 HomesHow 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
Option 1
Person has a
need & is
eligible
State reviews Medicaid claims & places person
on HH roster
Option 2
HH assigns person to Care Management Agency in network
HH Care Management Agency reaches out to
person, obtains consent and enrolls
HH obtains its Roster via the Health
Commerce System
Provider or other individual determines need for HH services exists and completes
HH Referral Form including consent
Referral form is sent to HH
HH Care Management Agency reaches out to
person, obtains consent and enrolls
HH assigns person to Care Management Agency in network
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:
Erie CountyHealth Home Name
Contact Phone Number
Email Address
Health Home Partners of WNY (Spectrum)
Christopher Hartnett
716-539-1794 [email protected]
Greater Buffalo United Accountable Healthcare Network (GBUAHN)
Kirsten Newby 716-247-5282, Ext. 218
Health Homes of Upstate New York (HHUNY)
Tracy Marchese 585-613-7642 [email protected]
Health Homes in Our Region:
Niagara CountyHealth Home Name
Contact Phone Number Email Address
Niagara Falls Memorial Medical Center
Vicki Landes 716-278-4647 [email protected]
Health Home Partners of WNY (Spectrum)
Christopher Hartnett
716-539-1794 [email protected]
Health Homes in Our Region:
Monroe CountyHealth Home Name
Contact Phone Number Email Address
Greater Rochester Health Home Network (GRHHN)
Deb Peartree 585-737-7522 [email protected]
Health Homes of Upstate New York (HHUNY)
Tracy Marchese
585-613-7642 [email protected]
Health Homes in Our Region:
Wyoming CountyHealth Home Name
Contact Phone Number Email Address
Health Home Partners of WNY (Spectrum)
Christopher Hartnett
716-539-1794 [email protected]
Health Homes in Our Region:
Allegany, Cattaraugus, Cayuga, Chautauqua, Chemung, Genesee, Livingston, Ontario, Orleans, Schuyler, Seneca, Steuben, Tioga, Tompkins, Wayne and Yates Counties
Health Home Name
Contact Phone Number Email Address
Health Homes of Upstate New York (HHUNY)
Tracy Marchese
585-613-7642 [email protected]
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.
Q And A