Thursday, February 23, 2012
Updates
Health Homes for Medicaid Members with Chronic Conditions
Under the Affordable Care Action Section 2703, the Centers for Medicare and Medicaid Services (CMS) is offering states an option to provide health homes for members with chronic conditions, with enhanced federal support. This option covers the enhanced integration and coordination of primary, acute, behavioral health, and long-term services and supports for persons across the lifespan with chronic illness. It provides an opportunity to build a person-centered system of care that achieves improved outcomes for beneficiaries and better services and value for State Medicaid programs. This provision supports CMS’s overarching approach to improving health care through the simultaneous pursuit of three goals: improving the experience of care; improving the health of populations; and reducing per capita costs of health care (without any harm whatsoever to individuals, families, or communities). To take advantage of this opportunity, states must submit a Medicaid State Plan Amendment (SPA).
BMS has been soliciting input on various aspects of the SPA through several mechanisms. Work groups on specific topics were set up at the time of project launch and each met several times during the early planning stages. More recently, webcasts have been conducted for any interested stakeholders and each has provided an opportunity to ask questions and provide comments on the progress of the SPA to date. Slides from each of these stakeholder meetings are posted in the presentations area of the Health Homes work space. The most current copy of the SPA draft can be accessed by clicking here.

Stakeholder Advisory Group
Stakeholder Advisory Group
  • Identify and rank care coordination needs of members targeted for health homes SPA.
  • Identify community resources that should be incorporated into a community‐based model.
  • Identify best approaches for adapting a health home/care coordination model to your area and specialty.
  • Identify performance and outcome measures.
  • Identify most effective means of engaging members and providers in health home development.
The presentations from the update calls can be found in the Presentations section of the Health Homes work space.

Original Work Groups
Original Work Groups

Health Homes Work Group

  • Identify qualified provider standards. 
  • Pinpoint most effective provider infrastructure supports. 
  • Analyze CMS provider requirements and health home functions. 
  • Obtain feedback from existing “medical home” providers.

Community Care Coordination Work Group

  • Analyze target populations’ needs.
  • Assess existing member experience with coordinated care.
  • Map community resources and their potential integration.
  • Evaluate merits of other states’ models.
  • Propose model(s) to accomplish 6 CMS‐defined functions.
  • Formulate adaptable models that comply with CMS requirements and health home functions.
  • Develop behavioral health integration options. Assess potential HIT role and integration.

Measures and Outcomes Work Group

  • Identify measures to assess program impact that conform to CMS requirements.
  • Study CMS standards and measures and propose data reporting and collection mechanics.
  • Define each measure’s numerator and denominator.
  • Propose provider reporting requirements for both health homes and care coordination teams.

Member Engagement Work Group

  • Identify an effective means to obtain initial and ongoing member and family input.
  • Prepare a communications plan for SPA development and implementation.
  • Develop a proposed methodology for matching members with providers.
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