Transcript Health Home - Community Connections of New York

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?
• 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
2
Health Homes
What 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 Homes
How 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 Homes
Health 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
Health Care Providers
Community Resources
Education
Individual
& Care
Manager
Vocational Services
Services Agencies
Housing
Health Homes
Health Home Purpose:
• Improve health care and health outcomes
• Lower Medicaid costs
• Reduce preventable hospitalizations and ER
visits
• Avoid unnecessary care for Medicaid members
Health Homes
Who 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 Homes
Who 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 Homes
What 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 CARE
My 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 Homes
Why 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 Homes
How 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
State reviews Medicaid
claims & places person
on HH roster
HH obtains its Roster
via the Health
Commerce System
HH assigns person to
Care Management
Agency in network
HH Care Management
Agency reaches out to
person, obtains
consent and enrolls
Person
has a
need &
is
eligible
Option 2
Provider or other
individual determines
need for HH services
exists and completes
HH Referral Form
including consent
Referral form is sent to
HH
HH assigns person to
Care Management
Agency in network
HH Care Management
Agency reaches out to
person, obtains
consent and enrolls
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 County
Health Home
Name
Contact
Phone
Number
Email Address
Health Home
Partners of WNY
(Spectrum)
Christopher
Hartnett
716-539-1794
[email protected]
716-247-5282,
Ext. 218
[email protected]
Tracy Marchese 585-613-7642
Tracy.marchese@beaconhs
.com
Greater Buffalo
Kirsten Newby
United Accountable
Healthcare Network
(GBUAHN)
Health Homes of
Upstate New York
(HHUNY)
Health Homes in Our Region:
Niagara County
Health 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 County
Health 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
Tracy.marchese@beacon
hs.com
Health Homes in Our Region:
Wyoming County
Health 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
Tracy.marchese@beacon
hs.com
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