OM: Lessons Learned from the NYS Health Home Trenches

NYAPRS Note: Here’s another timely piece by one of the nation’s most sought after behavioral healthcare management consultants, Open Minds’ Monica Oss. Monica will be a featured speaker at NYAPRS’ April 25-6 Annual Executive Seminar in Albany. For program details, please go to To register, please go to

Lessons Learned From The Health Home Trenches

by Monica E. Oss Chief Executive Officer, OPEN MINDS February 26, 2013

Developed by OPEN MINDS, 163 York Street, Gettysburg PA 17325, All rights reserved

Health homes (and medical homes) are so new that it is rare to find someone who has been managing them long enough to give us "lessons learned." But we got just that at The 2013 OPEN MINDS Performance Management Institute. One of our keynote addresses featured a presentation by Michael Mittleman, Ph.D., Senior Vice President of Corporate Compliance of PSCH - an organization managing health homes in the New York market (see Using Technology To Succeed With Accountable Care Organizations & Health Homes premium members).

PSCH (Promoting Specialized Care and Health) is a 501(c)(3), human service agency for people with developmental, psychological and behavioral disabilities, and serving 8,500 individuals in NYC's five boroughs, Long Island, Westchester, and New Jersey. Traditionally, PSCH has offered day treatment, residential, therapeutic, rehabilitation, educational, vocational and social services. (For more on PSCH, see Netsmart Launches New York Health Home TA Initiative With PSCH premium members.)

New York's health home initiative began in February of last year after the federal Centers for Medicare and Medicaid Services (CMS) approved New York's Medicaid state plan amendment. The first of three enrollment waves began on January 1, 2012 with phased-in enrollment of about 700,000 people with mental health and/or addiction disorders and chronic medical illnesses (see New York Medicaid Health Home Initiative Underway premium members).

After operating operating for the past year within this system, Dr. Mittleman had some great advice for our attendees to consider as they establish health homes within their own regions:

  1. Communicate - There is no way to overcommunicate. Organizations need to do this, and do this often, at all steps of organizing a health home.
  2. Build consensus - In any health home there are many members with many votes. Consensus building can be a slow, but important process in decisionmaking.
  3. Provide latitude - Work committees need a lot of room to develop the ideas that boards need to consider before moving forward with implementation.
  4. Be agile or perish - With extreme regulatory volatility ruling the day in the market, organizations need to be able to change with changing requirements.
  5. Hire legal counsel - The legal environment surrounding health homes is also volatile, with little or no case law for guidance. This complexity demands legal professionals.
  6. Define IT needs internally, and outsource the solution - The competitive pressures within the industry mean that member organizations cannot expect to provide tech solutions without incurring possible distrust from other member organizations.
  7. Acquire outside money - At startup, per member per month costs will not cover costs.
  8. Hire full-time staff - Using existing staff alone also won't cut it. Hiring both full-time health home employees, as well as full-time IT staffs are a must to meet the staffing demands of health homes.

For a complete recap of our coverage of the 2013 OPEN MINDS Performance Management Institute, check out our official wrap-up.