Health Homes in Maryland Lisa Hadley, MD, JD March 29,

Outline Program Background Health Home Objectives Health Home Criteria –Participant Eligibility –Health Home Services –Provider Qualifications –HIT Linkages –Payment Methodology –Evaluation Update 2

Background- Health Homes Medical Homes- evolving concept since SAMHSA Primary Care and Behavioral Health Care Integration (PBHCI) program Affordable Care Act, Section Health Homes for enrollees with SPMI or multiple chronic conditions –90%FMAP for 8 quarters Behavioral Health Integration effort in Maryland 3

Background- Target Population Increased risk of physical health problems among those with mental illness & substance use disorders Life expectancy of 56 years among the mentally ill, vs. US average of 78 years* Complexity of multiple providers & needs Lifestyle and social determinants of health Access to care * Heron MP, Hoyert DL, Murphy SL, Xu JQ, Kochanek KD, Tejada-Vera B. Deaths: Final data for National vital statistics reports; vol 57 no 14. Hyattsville, MD: National Center for Health Statistics

Health Home Objectives 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, SED and OTP populations through provision of additional care coordination services. 5

Participant Eligibility Criteria The individual has been diagnosed with: –a serious and persistent mental illness or serious emotional disturbance, in combination with receiving services in a Psychiatric Rehabilitation Program (PRP) or Mobile Treatment (MT) program, OR –an opioid substance use disorder that is being treated with methadone, AND at risk for an additional chronic condition due to current alcohol, tobacco or substance use, or historical dependence 6

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

Provider Qualifications: Provider Types 8 To become a Health Home, a provider must be licensed as a: -Psychiatric Rehabilitation Program, -Mobile Treatment Program, or -Opioid Treatment Program. Additionally, all providers must: -Be an enrolled Maryland Medicaid Provider, and -Be accredited by, or pursuing accreditation from, an approved accrediting body (CARF, The Joint Commission)

HIT Linkages eMedicaid online portal –Providers submit initial intake and monthly report of Health Home services provided and relevant participant outcomes –Allows for data entry and review, as well as reports- generating CRISP real-time notification of hospital encounters, pharmacy data Provider HIT system capabilities 9

Payment Methodology Flat per member/per month (PMPM) rate of $98.87 based on employment cost Patient panel billed once monthly to MMIS One-time initial intake fee at same rate Dependent on compliance with ongoing requirements –Maintain staffing, accreditation, compliance with all requirements and regulations –Documentation of minimum of 2 monthly HH services per participant 10

Implementation Maryland health Homes State Plan Amendment approved by CMS October, 2013 Program go-live October 1, 2013 New provider applications continue to be accepted Ongoing support, outreach, analysis Ongoing training and technical assistance Health Home Advisory Committee 11

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. 12

13 As of Dec 31, 2014 there are currently 70 approved Health Home sites throughout Maryland. In 21 participating counties, over 4,708 participants are enrolled in the Health Homes program. 70 Approved  56 Psychiatric Rehabilitation Programs  10 Mobile Treatment Providers  4 Opiod Treatment Programs 8 Pending 13 Denied 91 Applications Received 4,332 Adult Participants 367 Youth Participants 4,708 Total Participants

Additional Information homes.aspx 14