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What Matters In Making Health Homes Sustainable
By Monica Oss CEO Open Minds January 23, 2013
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I see “health homes” (and their likely successor, some model of behaviorally-lead medical home) as models in the real-time market test phase. We are just getting these constructs up and running on a large enough scale to look at both operating models and results. (For more on current adoptions of health homes, see An Executive Update On Integrated Care Models For Behavioral Health Systems premium members.)
Eventually, I think the "health home" construct will evolve in the market to mean the group of organizations that assume financial and service delivery risk for high-cost consumers with cognitive disorders. This is likely some hybrid of what we know now as health homes, medical homes, specialty carve-out/disease management programs, HCB waiver programs, and Medicare Advantage SNP models. And, whatever the market successor, I think this is a great repositioning option for organizations that have traditionally served high-needs consumers - adults or children.
But success in this new role will depend on an organization’s ability to develop some traditional "managed care" organizational competencies and the ability to manage costs created by external environmental factors. On the organizational competencies side, it’s the usual hit list for managing service delivery in a P4P or risk-based environment:
- Robust health record keeping and the ability to do health information exchange
- Organizational and contract performance metrics, and the use of metrics-based management to improve performance, and manage financial risk and unit cost
- Deployment of automated clinical decision support tools across all chronic disease states
- Infrastructure to locate and coordinate non-health social services
- Systematic approach to consumer engagement and improving the consumer experience
In addition to these organizational competencies, I was reminded of some of the external environmental challenges that could affect the "success" (both clinical and financial) of these models in our coverage of a recent analysis of chronic disease management in the New York system, New York's Chronic Illness Demonstration Project Analysis Reveals Six Lessons For Medicaid Health Homes premium members. The report reviewed the progress of the three-year New York Medicaid Chronic Illness Demonstration Project (CIDP) for beneficiaries with chronic physical and behavioral health needs and identified some challenges provider organization face providing the CIDP services.
As I read the analysis, I thought three of the environmental challenges should be considered by executive teams when developing these ‘health home’ types of models, payment rates, and performance expectations:
Difficulty sharing data - Data sharing to facilitate coordinated care models comes in two varieties. The first is more of a technical nature - having the EHR technology with the ability to exchange data between provider organizations. The second factor is a policy issue which gives me more concerns - the participation (or lack of participation) of behavioral health provider organizations in health information exchanges. One of the obstacles, the challenges posed by federal privacy rules, we have covered extensively (see 'Prohibited Disclosure' – Behavioral Health Locked Out Of HIEs all members and Do We Have The Tech For Behavioral Health Consent Management? all members). The absence of a solution to this issue may be a "deal breaker" for behavioral health organizations that want to move into a primary role in these emerging care coordination models.
Difficulty accessing appropriate services and coordinating care - To be successful, the long-planned collaborations between a group of local professionals and provider organizations actually have to work. These local collaborations will need to move beyond improved communication and goodwill to something more tangible in terms of service delivery if health home managers are going to achieve their required performance measures. (For more information, see information, see Positioning For Success In The New Era of Integrated Care all members and Thinking About Integration? Seven Measures To Create A Sustainable System all members.)
Difficulty securing appropriate housing - Much of the policy of CMS and state governments to "bend the cost" curve is dependent on moving consumers from institutional settings to home- and community-based service models. The availability of housing options and housing supports for specific populations should be a consideration in both service delivery system planning and projecting system performance cost. (For more on housing options in behavioral health, see 'Housing First' Models Gain Support all members and New York State Office of Mental Health Puts Out RFP For Supported Housing For 1000+ Adults premium members.)
If your organization is considering some expanded role in managing services for high-cost complex consumer populations, these are a few of the key considerations in developing your sustainable model.