Iowa’s Section 2703 Health Home

DevelopmentOctober 04, 2011

Presentation to:24th Annual State Health Policy Conference

Show Me…New Directions in State Health PolicyWestin Crown CenterKansas City, Missouri

Iowa Department of Human Services

Presentation Overview

1. Iowa Health Home Program2. Other Iowa Medical Home Pilots 3. Lessons Learned

2Department of Human Services

ACA Section 2703 Health Homes

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High level Concept:• Following the 7 principles of a Patient Centered

Medical Home (PCMH) with added flexibility around the location which care coordination is provided.

• Focusing on Members with Chronic Conditions• Starting mid 2012• Iowa is predominantly a FFS environment with a

mental health managed care carve out

ACA Section 2703 Health Homes

– Limited to practices with at least one of the following provider types:

• MD/DO• ARNP

– May include, not limited to entities enrolled as:• Physician Clinic• Community Mental Health Centers• Federally Qualified Health Centers • Rural Health Centers

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ACA Section 2703 Health Homes

• Certification/Recognition:• Health Homes will have to meet PCMH standards specified

in IDPH rules. Those rules require NCQA or other national accreditation.

• Practices may enroll as a health home by:– Signing an agreement delineating responsibilities of a health

home,– Completing a TransforMed self-assessment (if not already PCMH

recognized),– Achieve PCMH recognition within first year of operation.

(providers that have submitted application with first 12 months and are pending a decision will have an extension)

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ACA Section 2703 Health Homes

Payment Methodology• Fee-For-Service payments (standard)• Per-member-per-month (PMPM) care

coordination health home payment: – Targeted only for persons with defined chronic

disease – PMPM Tiered payment Levels 1 to 4 – Depending on the acuity/risk of the enrollee the

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ACA Section 2703 Health Home

Payment Methodology• Performance payment tied to achievement of

quality/performance benchmarks: – Annually, starting in year two correlating with state

fiscal year– Measures align with, meaningful use, national quality

programs, and other payer initiatives – Providers will track progress of measures through a

tool provided by the State Health Information Network (HIN)

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ACA Section 2703 Health HomesEligible Individuals• Diagnosed with at least one serious and persistent mental health

condition, or;• Has at least two chronic conditions or ;• Has one chronic condition and is at risk for a second chronic condition

from the following list of categories:– Mental Health Condition– Substance Use Disorder– Asthma– Diabetes– Heart Disease– Obesity (overweight, as evidenced by a BMI over 25)– Hypertension

• Individual Opts –in to the program through the engagement of the provider

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Serious and Persistent Mental Health Condition

• Defined by Iowa as a population with Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED)

• The ACA language has emphasis on this group and so Iowa is working to establish an Integrated Health Home to provide whole person, care coordinated services for those with SMI or SED

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Integrated Health Home (IHH)

• An IHH ensures quality management of both physical and behavioral health care needs through a partnership of behavioral and physical health care providers, coordination of a broad set of services and supports, and measurable improvement in health outcomes.

• Magellan Health Services is both managing and providing program level support to IHHs established in Iowa.

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Why Integrate Behavioral Health and Physical Health Care?

• People with serious mental illness often have chronic physical health conditions.

• Many people with serious mental illness often do not receive the preventive or physical health care services they need.

• Integrating services to treat both can provide the best outcomes for individuals being served.

• Health care reform encourages integrated care.

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IHH – Key Elements

• Co-location of medical services with behavioral health providers

• Comprehensive care coordination and health promotion

• Member engagement, peer support and family support

• Referral to community resources and social support

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Iowa Care Program - History

• IowaCare program operates under an 1115 Waiver and provides a limited set of benefits to members otherwise uninsured.

• Program started in 2005 with only two providers in the network.

• Members had to travel great distances to receive medical care and typically wait months before being seen by a specialist.

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Iowa Care Medical Home Program

• On October 1, 2010, the IowaCare network expanded to include 2 FQHCs and the implementation of a Medical Home model for IowaCare members.

• Upon completion of the expansion in 2012, 6 FQHCs and 2 participating hospitals will provide medical home services for over 50,000 IowaCare members.

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IowaCare Population in 2014• It is expected that in 2014, most of the IowaCare

population will be full Medicaid Eligible. • The primary care services this population is

receiving now through the IowaCare Medical Home program is managing the population before they enter into full Medicaid Benefits.

• The same IowaCare Medical Home providers will likely be Health Home providers for the Medicaid Population.

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IowaCare Medical Home Progress ReportOverall, the IowaCare medical homes are managing patients

with diabetes better than the general Medicaid population. As of June 30th, 2011:

• 2,580 Patients with Diabetes have been seen in an IowaCare Medical Home

• 82% of medical home members seeking care have had an A1c in the last twelve months

• Overall Medicaid population with diabetes is reported that 44% of have had an A1c in the last 12 months

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IowaCare Progress Report

• Access has increased for IowaCare patients in a medical home

• In the first 6 months – 18,717 same day visits for emergent care

needs through a primary care office – 49,137 patient encounters occurred at a

primary care office – Average .91 encounters per member

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IowaCare Progress Report

• Non-emergent care wait times vary from medical home to medical home, using the standard measurement of the 3 rd next available appointment, wait times varies from 1 week to 11 weeks.

• Referral tracking continues to be a problem within the Medical Home network. Access to referral data has been challenging.– Interpretations of HIPPA regulations– The lack of stable or well established HIT connections between the

medical homes and participating hospitals hinders communication for referrals, discharges and transfers of care data

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IowaCare - Other Lessons• More work needs to be done to ready a practice for

an assigned mass of members needing care all on the same day

• Attention is needed to understand the higher medical needs of this population before rolling out to other practices

• Referral protocols and communication lines should be pre-established and understood

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