Medicaid Health Home Impacts And Implications: Chief Medical Officer

The Affordable Care Act of 2010 continues to have a significant impact on the health care industry itself. One area where that impact has been especially prominent is in the shift toward a Medicaid Health Home model.

The Medicaid Health Home — intended to operate under a “whole-person” care philosophy by integrating and coordinating care for people suffering from chronic conditions — requires significant operational adjustment at all levels of the care continuum.

As part of GSI Health’s continuing series examining the impacts and implications of the Medicaid Health Home model, today’s post focuses on the shifting roles, responsibilities and requirements faced by Chief Medical Officers (CMOs):

The Changing Role Of The CMO Under Medicaid Health Homes

One of the biggest challenges that most Chief Medical Officers face in the transition to a Medicaid Health Home model is leading a cultural shift within their organization, moving away from traditional care “silos” toward a more collaborative approach. That means facilitating care coordination and integrating care delivery services under a new collective accountability structure. Given the difficulties of restructuring and the likelihood that these transitions will improve patient outcomes (resulting in reduced Emergency Department visits and avoidable hospital readmissions), it’s in the CMO’s best interest to start this process sooner than later.

Key Steps:

  1. Establish and maintain provider network and relationships
  2. Establish and convey the importance of the interdisciplinary care teams
  3. Define clinical programs and performance metrics
  4. Identify best practices and evidence-based clinical protocols to support clinical programs
  5. Champion adoption of care coordination and population health IT tools
  6. Measure quality and performance of the care team
  7. Champion Health Home practice transformation

Care Continuum Realization Technology

While the responsibilities and key steps detailed above provide a solid foundation, they are by no means the only elements required for a Medicaid Health Home’s success. In addition to shifting roles such as the Chief Medical Officer, you need a health IT solution capable of providing unprecedented access to information that spans each patient’s entire continuum of care. You need a health information network that connects people not systems, one that helps you fill in the information and communication gap with easily accessible and actionable patient care knowledge.

Stay tuned to the GSI Health Blog for the next installment in this series on the impacts and implications of Medicaid Health Homes as we turn our attention to the role of the Chief Operating Officer or VP of Care Management.

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