Understanding Medicaid Health Home Impacts And Implications

The Affordable Care Act of 2010 introduced a lot of new ideas about health care in the United States. With those new ideas came the promise of exciting new opportunities for health care providers, payers and patients to work together to improve care and lower costs.  The focus on this blog post is on one particular area of The Affordable Care Act that promises to have a big impact on state Medicaid programs….

Medicaid Health Homes: A Definition

As an optional Medicaid State Plan benefit, Medicaid Health Homes are intended to operate under a “whole-person” care philosophy by integrating and coordinating care for people suffering from chronic conditions such as substance abuse, asthma, diabetes, mental health issues, heart disease and obesity.  A Health Home is not just a Medicaid Benefit nor a Program or Team.  It is a system and organizational transformation.

Promise & Potential

By coordinating medical, behavioral and social care into a cohesive accountable care organization, the potential for Medicaid Health Homes to improve overall patient care quality while lowering both the short and long-term cost of care is significant.  In addition, by utilizing the latest health information technology, these Accountable Care Organizations (ACOs) receive readily accessible insight into aspects of individual patient histories and risk factors that would have previously been all but invisible.

In addition to the valuable clinical perspectives, this level of care coordination allows care team managers to more effectively adjust and manage patient care by organizing care providers and referrals in a more efficient manner.

As a result of this improved collaboration and management approach, high-risk patients with chronic conditions receive a higher level of care, the benefits of which include:

  • Care Coordination
  • Health Promotion
  • Comprehensive Transitional Care & Follow-Up
  • Patient & Family Support
  • Community & Social Support Service Referrals

The anticipated results are:

  • Improved patient outcomes and health status
  • Improved coordination of primary care, behavioral health and social services
  • Reduced inappropriate ED utilization
  • Reduced avoidable inpatient utilization
  • Enhanced use of community resources
  • Reduction in health care costs

With the rising cost of healthcare, providers and payers need to find new ways to collaborate to improve patient outcomes in order to thrive in the new health care environment. The formation of Medicaid Health Homes suggests a promise to help them accomplish just that.

The Path To Realization

There are a number of things that need to happen in order to turn the promise and potential of Medicaid Health Homes into a viable reality. From strategic changes in the care delivery model to more tactical and logistical adjustments, individuals at every level of your care network need to work together. That means, among other things, integrating new elements such as behavioral health and social services into the traditional care model. While the details will undoubtedly differ for each new program, the key changes required are in the areas of care payment and delivery.

Stay tuned to this page … Over the course of the next few posts, we’ll provide a high level overview of some key operational adjustments to individual roles and responsibilities that the shift toward a Medicaid Health Home model requires.

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