KHI: MO, KS Health Home Programs Deemed Successful

'Health Home' Initiative Shows $4.2M Savings In First Year

Savings were in hospital and emergency room Medicaid costs of 19,000 Missouri patients

By Mike Sherry KHI News Service June 25, 2013


Missouri’s efforts to coordinate medical and behavioral health care for high-cost Medicaid patients appear to be working, according to a preliminary analysis of the project. And a similar program for Kansas is in development.

Figures from the first year of the program indicate the “health home” initiative with community mental health centers (CMHCs) saved about $4.2 million in hospital and emergency room Medicaid costs last year, according to Dorn Schuffman, the consultant coordinating the effort for the Missouri Department of Mental Health.


Schuffman, a former head of the department, also said about a quarter of the program participants required at least one hospitalization last year. About 19,000 patients were involved in the program.


Compared with the patients’ histories for the previous two years, that was about a 3 percent decrease in hospitalizations, he said, an apparent reversal of an upward trend.


But Schuffman said it would take more than one year’s experience to draw firm conclusions about the program’s results.


He presented the findings last week at a forum organized by the Metropolitan Mental Health Stakeholders.

Coming to Kansas next year


Angela Hagen of the Kansas Department for Aging and Disability Services described similar efforts in Kansas that will be undertaken as part of KanCare, the state’s Medicaid overhaul launched in January. The goal is to initiate health homes by the first of next year, she said.


According to officials at the Kansas Department of Health and Environment, savings from health homes already have been included in the more than $1 billion in projected Medicaid cost cuts over the next five years.


The local stakeholders group is holding a series of meetings to discuss ways to better integrate medical and behavioral health services.


There has been research indicating that persons with serious mental illness die 25 years earlier than the rest of the population largely because they tend to have treatable conditions such as diabetes and cardiovascular disease that go unmanaged.


As a provision of the Affordable Care Act, the Centers for Medicare and Medicaid Services will pay an enhanced federal match for the first two years to states with approved health home programs.


Missouri was the first state in the country to gain approval of its health home plan in October 2011, with an effective date of January 2012.


Missouri’s Medicaid program cost about $6.6 billion in fiscal year 2011, according to the Missouri Foundation for Health, and as of about three years ago, it covered nearly 900,000 Missourians.


The Kansas Medicaid program covers about 380,000 people at an annual cost of about $3.2 billion.


Starting before ACA

Missouri was experimenting with health homes prior to the federal health reform law. Schuffman said officials learned from that experience that coordination among providers was more important than, say, putting a primary care clinic within a community mental health center.


“Integrating turned out to be not as important as collaborating between the (mental health center) and the (health clinic),” he said.


Department officials learned that it was inefficient to place a primary care physician at a mental health site because managing chronic diseases did not require as many consultations as it did to control the mental illness, Schuffman said.


However, the department discovered it helped to embed a mental health professional in a primary care setting and officials have integrated that into the health-home program.


In Kansas, with financial assistance from the Sunflower Foundation, safety-net providers are piloting health homes around the state.


Connie Hubbell is involved with the pilot as director of governmental affairs for the Kansas Association for the Medically Underserved. She said both models work, whether it’s having a mental health provider at a primary clinic or the other way around.


There is still a stigma surrounding mental illness, Hubbell said, and for that reason having a mental health specialist at a primary care site can bring practical results.


“In small communities, people don’t want to drive their car to the mental health center, people know them, and they see their car sitting out front,” she said. “But if they see it at the primary care clinic, they don’t think much about it.”


Details still being worked out


In Kansas, under KanCare, the state has contracted with three managed care companies to provide care to the Medicaid population.


Hagen said many of the details of incorporating health homes into KanCare are still being worked out. She said state officials had put together a 70-member task force, including outside groups, to help craft a proposal to present to CMS.


The state’s KanCare website has a health homes section, which includes information on the second public forum on the health homes initiative, which is scheduled for July 23 at the Capitol Plaza Hotel in Topeka.


According to an overview of the health home initiative completed last month, Kansas anticipates beginning the program by enrolling persons with serious mental illness.


“Additional target groups will follow closely,” the document said, “including individuals with chronic conditions such as diabetes.”


According to the Kansas Department of Health and Environment, the state Medicaid program has about 35,000 beneficiaries with serious mental illness and about 36,000 beneficiaries with diabetes.


According to the document, the state still needs to refine explanations for the core services it intends to provide through health homes and also need to decide upon provider qualifications, quality goals and measures and payment methodology.


The goal is to submit the application to the federal government as early as October.