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SIX MONTH REVIEW CMHC Healthcare Homes

SIX MONTH REVIEW CMHC Healthcare Homes. CMHC Healthcare Homes. 29 CMHC Healthcare Homes 17,882 individuals auto-enrolled 3203 children and youth (18%) CMHC consumers with at least $10,000 Medicaid costs Average Medicaid cost $26,000+ annually Effective January 1, 2012.

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SIX MONTH REVIEW CMHC Healthcare Homes

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  1. SIX MONTH REVIEW CMHC Healthcare Homes

  2. CMHC Healthcare Homes • 29 CMHC Healthcare Homes • 17,882 individuals auto-enrolled • 3203 children and youth (18%) • CMHC consumers with at least $10,000 Medicaid costs • Average Medicaid cost $26,000+ annually • Effective January 1, 2012

  3. CMHC Healthcare HomesTarget Population • Clients eligible for a CMHC healthcare home must meet one of the following three conditions (identified by patient health history): • A serious and persistent mental illness • CPR eligible adults, and kids with SED • A mental health condition and substance use disorder • A mental health condition and/or substance use disorder and one other chronic health condition

  4. CMHC Healthcare Homes Target Population • Chronic health conditions include: • Diabetes • Cardiovascular disease • Chronic obstructive pulmonary disease (COPD) • Asthma • Chronic bronchitis • Emphysema • Overweight (BMI >25) • Tobacco use • Developmental disability

  5. CMHC Healthcare Homes • We are inventing health homes for individuals with serious mental illness • Adjusting expectations to realities • Continuing to understand and clarify • Helping staff acquire new skills • Creating health homes and adopting a whole person approach means transformation • Who we were in January, 2012 is not who we will be in January, 2014

  6. Six Month ReviewPurpose • Assure that HCHs are making appropriate progress in developing health home functionality • Meeting staffing standards • Participating in required training • Submitting required reports • Using the Care Management tools and reports • Engaging PCP for enrollees • Following up on hospitalizations • Transforming the organization

  7. Six Month Report Program Size

  8. Six Month Report Enrollment • Auto-enrollment versus engagement • Auto-enrolled in November: 17,882 • Engaged in service in January: 15,051 • Significant variability across HCHs • Enrollment January to June • Statewide : 2% growth to 15,419 • Significant variability across HCHs

  9. % Change by HCH in # of EnrolleesAuto-enrollment to Engagement

  10. % Change in HCH Enrollment by HCHJanuary to June

  11. Six Month Report Population Characteristics • Adults, Children and Youth • Historic Medicaid Expenditures • Serious Mental Illness and Serious Emotional Disturbances • Chronic Diseases • COPD/Asthma • Diabetes • Congestive Heart Failure (CHF) • Coronary Artery Disease (CAD) • Hypertension • Substance Abuse • Developmental Disabilities • Body Mass Index >25 • Tobacco Use • Medicare/Medicaid Dual Eligibles • Managed Care Enrollees

  12. Six Month Report % Children and Youth HCH Enrollees

  13. Six Month Report Medicaid Costs for HCH Adults

  14. Six Month Report Medicaid Costs for HCH Children and Youth

  15. Six Month Report Population Characteristics • 89% of enrollees have CPR eligible diagnoses • Depression: 36% • Schizophrenia: 30% • Bi-Polar Disorder: 28% • PTSD: 17% • Anxiety Disorder: 14% • Personality Disorder: 8% • Psychotic NOS: 4%

  16. Six Month Report % HCH Enrollees with COPD/Asthma Based on CMT Disease Management Report

  17. Six Month Report % HCH Enrollees with Diabetes Based on CMT Disease Management Report

  18. Six Month Report % HCH Enrollees with a History ofSubstance Abuse Based on Metabolic Screening Reports

  19. Six Month Report % HCH Enrollees with Hypertension Based on CMT Disease Management Report

  20. Six Month Report Population Characteristics • Congestive Heart Failure: 3% • Coronary Artery Disease: 6% • Developmental Disabilities: 16% • Children and youth: 28% • Adults: 14% • BMI >25: 79% • Report Smoking: 50%

  21. Six Month Report % Dual Eligible HCH Enrollees

  22. Six Month Report % HCH Enrollees in MC+

  23. Six Month Report Staffing Standards • Administration (1:500) • All HCHs have a Director and Clerical Staff • Some HCHs with less than 500 enrollees have committed to a fulltime Director • A few HCHs needed to increase staffing commensurate with enrollment • As HCH enrollment grows, other CMHCs may need to increase staffing • Nurse Care Managers (1:250) • HCHs have maintained appropriate NCM coverage though turnover has been an issue for some HCHs

  24. Six Month Report Staffing Standards • Primary Care Physician Consultants • 1 hour per enrollee • After a slow recruitment period most HCHs now meet this staffing standard • Statewide HCHs are at 86% of this standard • DMH will be working with sites to assure compliance with the 85% staffing standard

  25. Six Month Report % HCH Metabolic Screening CompletedJanuary to June

  26. Six Month Report Care Management Tools • CMT Care Management Reports • Limitations • Based on paid Medicaid claims data • Does not include Medicare or procedures/meds that are provided free, paid by the consumer, or for which no claim was submitted • Ability to note “false positives’ coming by January, 2013 • Includes the following reports which are updated monthly • Behavioral Pharmacy Management (BPM) • Medication Adherence • Disease Management

  27. Six Month Report Care Management Tools • Behavioral Pharmacy Management Report • Includes a series of Quality Indicators™ to identify prescriptions that deviate from Best Practice Guidelines • Inappropriate polypharmacy • Doses that are higher or lower than recommended • Multiple prescribers of similar medications • Sent to prescribing physician with Clinical Considerations™ that includes Best Practice Guidelines and recommendations • Sent to CMHC for all their consumers and includes information for all physicians, regardless of whether they are employed by the CMHC • May be most appropriately reviewed by the CMHC Medical Director

  28. Six Month Report Care Management Tools • Medication Adherence Report • Based on Medicaid pharmacy claims • Includes three classes of prescriptions • Anti-psychotic medications • Cardiovascular medications • Diabetes medications • Enables CMHCs to identify all prescriptions that have been filled by consumers and determine Medication Possession Ratios • A Medication Possession Ratio of .8 means that the prescription was filled for 80% of the quarter being reviewed. • Helps identify individuals who are having difficulty in taking their medications regularly

  29. Six Month Report Care Management Tools • Disease Management Report • Based on Medicaid claims and Metabolic Screening data • Identifies individuals with specific diagnoses/conditions who are not meeting specific indicators • Currently being revised to • Include separate measures for adults and children • Identify individuals based on not meeting specific test values (e.g. A1C, BP, and LDL levels) rather than not having specific tests performed • Add measures regarding BMI control and tobacco use • Provide a mechanism to identify false positives

  30. Six Month ReportHospital Admissions • HCHs receive daily e-mails regarding planned hospital admissions • HCH members discharged from the hospital must have a contact within 72 hours of discharge • This contact may be made by the individual’s CSS, case manager, or NCM • Nurse Care Managers must complete a medication reconciliation on HCH members discharged from the hospital • Information regarding the enrollees medications may be collected by the individual’s CSS or case manager for review by the NCM

  31. Six Month Report Hospital Follow Up is Complicated • False Positives and Missing Data • Late notification • Appealing denials • Dual Eligibles • Working with multiple hospitals • Barnes Hospital had admissions from half of the HCHs • Pathways had admissions to 38 hospitals • BJC and Crider each had admissions to 17 hospitals

  32. Six Month Report Hospital Follow Up Results • Average admissions per month: 675 • About 4% of HCH enrollees • 54% were contacted during the first four months • Each month several HCHs contacted 100% • Of the individuals contacted • Contacted within 72 hours following discharge: 71% • Medication reconciliation completed: 78% • Medication reconciliation completed within 72 hours: 73%

  33. Six Month Report HCH Enrollees with PCPs

  34. Six Month Report PCP Contacted

  35. Six Month Report % of HCH Adults w/o a CsMgr

  36. Six Month Report % of HCH Children w/o a CsMgr

  37. Six Month Report Training and Technical Assistance • Introduction and Orientation • Healthcare Home Implementation • Access to Care • Healthcare Home Administration • Data and Care Management Reports • Physicians Institute • Disease Management and Clinical Training • Introduction to Disease Management • Motivational Interviewing • TEAMcare • Wellness Coaching

  38. Six Month Report Training and Technical Assistance

  39. Six Month ReviewConclusion During the first six months of the CMHC Healthcare Home initiative, CMHCs made adequate progress toward developing health home functionality, but continue to face several challenges.

  40. Six Month ReviewChallenges • Assuring that consumers have effective clinical relationships ,and the HCH has an effective, collaborative relationship, with the consumers’ PCPs • Improving the percentage of HCH enrollees who are contacted following a hospitalization • Improving the percentage of HCH enrollees for whom metabolic screening data has been submitted to the statewide database • Helping staff learn more about chronic diseases health and wellness, and how to assist individuals in managing chronic disease and improving health status

  41. Six Month ReviewChallenges • Learning how to make the best use of Care Management tools and reports • How to identify what is most important from the wealth of data available • How to proactively manage the health status of populations (e.g. all individuals with diabetes, or asthma, or who are significantly overweight) in addition to responding to individual needs • How to routinely use the available data to monitor progress and make clinical decisions.

  42. Six Month ReviewSystem Challenges • Assessing what works best, especially for cohorts of enrollees with specific chronic diseases , and making necessary adjustments to program requirements, training and technical assistance • Evaluating whether CMHC Healthcare Homes are appropriately structured to best meet the needs of children and youth, and increasing training and technical assistance to improve the ability of HCHs to meet the needs of children and youth

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