1. 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

2. 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

3. 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

4. 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

5. 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)

6. 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

7. 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

8. 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, (32.3% of SK members)
We have 146 practices in Level 1

9. 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