Mary Dale Peterson, MD, MSHCA Implementation of the Medical Home Model for Children with Special Needs April 2018 Mary Dale Peterson, MD, MSHCA Fred McCurdy, MD, PhD, MBA Carmen Rocco, MD Maria Mata, RN

Disclosures and Objectives Have a better understanding of how to operationalize the health home concept in their own practice, especially for patients with chronic illness or disability List three benefits that accrue to a primary care practice when a service coordinator is “embedded” in that practice Describe the model of interaction between the service coordinator, the primary care physician, and the managed care organization   Disclosures- None

DHP HEALTH HOME MODEL for STAR Kids Three tiers Parallels NCQA/URAC Standards for PCMH Physician payments E&M codes paid at higher than Medicaid fee schedule THSteps paid at Medicaid fee schedule Home visits paid at higher rates All existing incentives for STAR Medicaid remain in place $xx/ISP during 1st 6 months and $xx/ISP after May 2016 Management payments monthly for each level of Health Home Yearly gain sharing incentive for total cost of care

LEVEL 1 HEALTH HOME Patient centered access Team-based care Maintain current members Open panel for first 3 months after roll out Same day appointments for sick STAR Kids members Team-based care Get all parties to “YES” for ISP Collaborate with DHP on service coordination

LEVEL 2 HEALTH HOME Prerequisites Accept new STAR Kids members Meet or exceed 70% of LOC 1 quarterly visits Measurable improvement in care delivery (table on next slide)

LEVEL 2 HEALTH HOME (cont’d) MEASURABLE IMPROVEMENT: From the two (2) lists below, choose (3) items – two (2) from the PROCESS column and one (1) from the BETTER OUTCOMES/CQI PROJECTS column PROCESS BETTER OUTCOMES/CQI PROJECTS Home visits Asthma Customized appointments Diabetes Co-located LPC Behavioral health Co-located dietician/nutritionist Decreased ED visits Create/maintain parent support group Decreased hospital admissions Other (make a proposal to DHP for approval) Decreased hospital re-admissions  

LEVEL 3 HEALTH HOME Prerequisite Achieve 2 of the following 3 items Employ case coordinator in the practice Achieve 2 of the following 3 items Fully implement EHR Employ enhanced reporting Facilitate electronic member engagement

Practices by Location – Active or Pending Level 2 and 3 Health Homes Practices by Location – Active or Pending SK Members Brownsville (5) 516 Harlingen (2) 417 Laredo (6) 453 Corpus Christi (5) 1,658 Beeville (1) 53 McAllen (1) 290 TOTAL 3,387 (32.3% of SK members) We have 146 practices in Level 1

Lessons Learned from Assigned Service Coordinators Level 2 and 3 health homes qualify for an assigned Service Coordinator (SC) so long as they have their own health home champion within the practice Experience to date: Physicians report learning a lot from SCs about the program and how it works Physicians report learning a lot more about the information required of them to facilitate authorization for in-home services Physicians report the close collaboration, especially on LOC1 cases, by having the SC on site regularly assists them in coordinating services for these complex members Physicians want something similar to this for their STAR and CHIP members Service Coordinators report easier communication with members and more ability to get all parties on the same page Service Coordinators report better ability to get EHR documentation to assist with service coordination efforts and authorizations