1 / 24

Chronic Health Homes DRAFT Criteria

Chronic Health Homes DRAFT Criteria. Opioid Maintenance Therapy Providers Webinar December 5, 2012 1:30-3:30pm. Agenda. Program Objectives Review Draft Health Home Criteria Participant Eligibility Health Home Services Provider Qualifications HIT Linkages Payment Methodology Evaluation

everley
Download Presentation

Chronic Health Homes DRAFT Criteria

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Chronic Health HomesDRAFT Criteria Opioid Maintenance Therapy Providers Webinar December 5, 2012 1:30-3:30pm

  2. Agenda • Program Objectives • Review Draft Health Home Criteria • Participant Eligibility • Health Home Services • Provider Qualifications • HIT Linkages • Payment Methodology • Evaluation • Next Steps • Questions/Discussion

  3. Chronic Health Home Objectives Chronic Health Homes aim to: • Further integration of behavioral and somatic care through improved care coordination; • Improve patient outcomes, experience of care, and health care costs among individuals with chronic conditions; and • Enable Health Homes to act as locus of coordination for SPMI and OMT populations through provision of additional care coordination services.

  4. Participant Eligibility Criteria • The individual has been diagnosed with: • a serious and persistent mental illness in combination with meeting the medical necessity criteria for PRP services, OR • an opioid substance use disorder that is being treated with methadone, AND one other qualifying chronic condition.

  5. Participant Eligibility Criteria:Qualifying Chronic Conditions • Eligible chronic conditions among OMT population: • Mental health condition • Substance use disorder • Asthma • Diabetes • Heart disease • Overweight (BMI> 25) • Hypertension • Infectious disease (HIV/AIDS, Viral Hepatitis)

  6. Health Home Assignment • Assignment to Health Home based on current provider • OMT providers must confirm and report qualifying chronic condition during intake • Provider may add new HH consumers as they initiate care after initial enrollment • Potentially-eligible consumers in hospital or ED notified of Health Home based on provider history, county of residence

  7. Health Home Services • Comprehensive Care Management • Care Coordination • Health Promotion • Comprehensive Transitional Care • Individual and Family Support • Referral to Community and Social Support

  8. Health Home Services: Comprehensive Care Management • Comprehensive assessment of preliminary service needs, including screening for co-occurring behavioral and somatic health needs • Development of consumer-centered ITPs • Development of treatment guidelines • Monitoring of individual and population health status and service use to determine adherence to treatment guidelines • Reporting of progress toward outcomes for consumer satisfaction, health status, service delivery, and costs

  9. Health Home Services: Care Coordination Implementation of the consumer-centered ITP, including: • appointment scheduling; • conducting referrals and follow-up monitoring, including long-term services and peer-based support; • participating in hospital discharge processes; and • communicating with other providers and consumers/family members, as appropriate.

  10. Health Home Services: Health Promotion • Health education, specific to chronic conditions • Development and follow-up of self-management plans emphasizing person-centered empowerment • Education regarding immunizations and screenings • Health promoting lifestyle interventions, such as: • Substance use prevention  • Tobacco prevention and cessation; • Nutritional counseling, obesity reduction and prevention; and • Physical activity.

  11. Health Home Services: Comprehensive Transitional Care Comprehensive transitional care services aim to: • streamline plans of care; • ease the transition to long-term services and supports; and • reduce hospital admissions and interrupt patterns of frequent hospital emergency department use. The Health Home Team will: • collaborate with clinical, therapeutic, rehabilitative, and other providers to implement the treatment plan; • increase consumers’ and family members’ ability to manage care and live safely in the community; and • emphasize proactive health promotion and self-management.

  12. Health Home Services: Independent & Family Support • Advocacy for individuals and families • Assistance with medication & treatment adherence • Identification of resources to support reaching the highest possible level of health and functioning, including transportation to medically-necessary services • Health literacy improvement • Support for the ability to self-manage care • Facilitation of consumer and family participation in ongoing revisions of care/treatment plan.

  13. Health Home Services: Referral to Community & Social Supports • Health Homes will provide assistance for consumers to obtain and maintain eligibility for: • health care services, • disability benefits, • housing, • personal needs, and • legal services, as examples.

  14. Provider Qualifications:Provider Types • Licensed as a Psychiatric Rehab Provider OR • Licensed as a Outpatient Methadone Treatment Provider AND • Be an enrolled Maryland Medicaid Provider • Be accredited as a Health Home by CARF • Provisional designation as Health Home for providers in-process of accreditation

  15. Provider Qualifications: CARF Accreditation • Health Home accreditation under CARF’s Behavioral Health standards manual • Must complete sections 1 &2 of BH standards manual and Health Home supplemental survey • Cost • $995 initial application fee • $1475 per surveyor/per day • Average survey requires 2 surveyors, 2 days

  16. Provider Qualifications: Initial and Ongoing Requirements • Cost-effective Health Home delivery model • Substantial % of existing consumers MA beneficiaries • Ability to provide 24/7 coverage • Ability to meet reporting requirements • Enrollment with CRISP, pharmacy data access • Ability to maintain required staffing

  17. Provider Qualifications:Provider Staffing Ratios • Nurse Care Manager: .5 full-time equivalent (FTE) per 125 Health Home enrollees • Health Home Director: .5 FTE per 125 Health Home enrollees • Physician or Nurse Practitioner: 1 or 2 hours per Health Home enrollee per 12 month period • Administrative Support Staff: .25 FTE per 125 Health Home enrollees

  18. HIT Linkages • eMedicaid online portal • Providers submit initial intake and monthly report of Health Home services provided and relevant participant outcomes • Will ultimately populate with individual participant claims data • CRISP notification of hospital encounters • Real-time pharmacy data • Provider HIT system capabilities

  19. Payment Methodology • Flat per member/per month (PMPM) rate based on cost, actuarial soundness • Comparable to other states’ rates at $75-100 PMPM • Dependent on compliance with ongoing requirements • Maintain staffing, accreditation, compliance with all requirements and regulations • Documentation of minimum monthly HH service(s) per participant

  20. Evaluation • Evaluation will be based on provider reports; claims, hospital, and pharmacy data; and participant surveys. • This includes, but is not limited to, a review of: • hospital admissions; • chronic disease management; • coordination of care; • program implementation; • processes and lessons learned; • quality improvements & clinical outcomes; and • cost savings.

  21. Evaluation: Quality Measures • Examples of quality measures include: • avoidable hospital readmissions; • medication compliance; • preventive care delivery; • patient experience of care; and • medical outcomes specific to participants’ targeted chronic conditions.

  22. Next Steps • DHMH consultation with SAMHSA • Continued stakeholder outreach • Finalize state plan amendment (SPA), set go-live date • Provider outreach, training & enrollment • Participant enrollment • SPA goes into effect, service provision begins • Ongoing participant outreach & enrollment • Continued development of eMedicaid

  23. Points to Consider Start-Up/Training Costs Ongoing ability to deliver mandated services with continuous improvement Data Collection/Reporting Health IT Sustainability/Economies of Scale

  24. Questions You may send additional questions to dhmh.bhintegration@maryland.gov

More Related