Transcript Health Homes – Mady Chalk - UCLA Integrated Substance Abuse

TREATMENT RESEARCH INSTITUTE
Applying Science to Transform Lives
Coordinated Care and Health
Homes
Mady Chalk, Ph.D
Treatment Research Institute
CADPAAC Conference
May, 2011
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Health Homes Defined
• Health home models are intended to encourage
a population-based, proactive and planned
approach to care, including chronic care, that is
coordinated across providers.
• Health homes models are intended to provide a
single point of coordination for all health care,
including specialty care, hospitals, and postacute care.
• Health homes provide patient self-management
support.
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Health Homes Defined
• Health homes are centrally managed, generally
by a primary care physician or non-physician
administrator.
• Health homes receive supplemental payments
to support operations expected of a medical
home.
• Health home models rely on use of data systems
to enhance safety and reliability.
• The rationale is to reduce fragmentation in ways
that lower costs and lead to better outcomes.
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Medical Societies’ Joint Principles
• In 2007, four Medical Societies approved Joint
Principles of the Patient-centered Medical Home
• The joint principles originate from two distinct
conceptual frameworks, the primary care model
and the chronic care model, each of which was
developed for different purposes.
• The primary care model focuses on all patients
in a practice and emphasizes whole-person care
over time, rather than single disease-oriented
care.
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Medical Societies’ Joint Principles
• The chronic care model focuses on “system
changes intended to guide quality improvement
and disease management activities” for chronic
illness.
• The chronic care model assumes that before
implementation of a medical or health home
every chronically ill person has a primary care
team that organizes and coordinates their care.
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Statement of Joint Principles
“To deliver patient-centered primary care,
practitioners have to restructure their practices so
that they are more accessible, promote prevention
and wellness more effectively, proactively support
patients with chronic illness rather than treat the
symptoms of those illnesses, and, proactively
support patients in self-management and decisionmaking.”
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Summary of Joint Principles
• Ongoing Relationship with Personal Physician
• Team Approach at the practice level with
collective responsibility for ongoing care
• Whole Person Approach including responsibility
for providing, arranging for, and staying informed
about all care
• Coordination and Integration of Care facilitated
by information technology
• Quality and Safety are hallmarks - advocacy,
evidence-base, continuous quality improvement
• Expanded Access To Care
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Patients Need to Know
• Patients need to know which practice serves as
their health home so they know who to count on
to coordinate and manage their overall care.
• In addition, patients need to be aware of what
the health home will provide if they are to work
closely with the health home and change the
way they use care.
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Behavioral Health in the Health Home
• While physicians have input into which patients
they serve, in many cases, they may not be
aware of other physicians, non-physician
clinicians, and treatment programs their patients
see, especially in the areas of behavioral health.
• We know that about two-thirds of primary care
visits have a psychosocial component (Robinson and Reiter,
2007) and about 25% of general healthcare patients
report that they have a co-morbid substance use
condition (NSDUH, 2005).
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Behavioral Health in the Health Home
• Patients who receive integrated services during
treatment have been shown to have almost
twice the odds of abstinence; receipt of primary
care by patients with substance use disorders
(2-10 visits) during and following treatment is
predictive of remission at 5 years Mertens, Risher et al., 2008).
(
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Incentives for Behavioral Health
To improve the possibility for inclusion of
behavioral health in the health homes, behavioral
health incentives can be used:
• Monthly stipends to help programs with
developing initial administrative functions
• Monthly care coordination payments
• Short-term monthly stipends to provide IT
assistance for the program
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Planning Ahead
• States and Counties with existing or planned
health home initiatives need to compare what
they are intending to do to the Definition of
Health Home.
• There is no single model of a health home.
• States and Counties need to inventory programs
and decide which ones can be aligned with
health home services.
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Questions to Ask
Focus for States and Counties:
• Patient Population: What Medicaid beneficiaries
are eligible for services and how many patients
will receive services?
• Geographic Area: Where are services provided,
e.g., in specific regions? Statewide?
• Delivery Model: In what delivery system are
services provided (e.g., through health plans, in
fee-for-service, etc.)
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Questions to Ask
Focus for States and Counties:
• Provider Network: Who is delivering the services
and how many providers are there?
• Provider Eligibility and Standards: Who is
eligible to provide services? What standards
must they meet?
• Quality Measures Reporting: What performance
measures will be used to assess quality
improvement, utilization, costs, etc.? What
performance information is being shared with
service providers?
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Questions to Ask
Services: What are the specific services provided
to patients?
1. Comprehensive care management
2. Care coordination and health promotion
3. Transition care and support (from inpatient, nursing
home, residential care, etc.)
4. Individual and family support
5. Referrals to community and social support services
6. Use of HIT to link services
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Questions to Ask
Focus for States and Counties:
• Information Exchange: How will clinical
information be exchanged with patients and
providers outside of the health home? What
explicit agreements between the patient and
health home need to be reached to assist with
exchange of information?
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Questions to Ask
Focus for States and Counties:
• Funding: How will services be funded? What do
you know now about what will be the average
cost per beneficiary?
• Oversight: How will the state and/or county
oversee the program?
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Challenges
• Capital and courage to start
• Reliance on Electronic Health Records (EHRs)
for most health home models and for most
treatment programs will require new investments
in hardware and software as well as time to
learn how to use and maintain EHRs.
• Team-based care may require cultural changes
in the way that care has traditionally been
delivered.
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Challenges
• Educating patients on their roles within the
health home and teaching them new skills and
pathways to become informed and active in their
health care will likely be necessary.
• Patients putting all of their information eggs in
one health home basket; patients fearing that
health home will serve as a gatekeeper they
don’t want.
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Challenges
• As challenging as the medical home-patient
exchange of information is, the medical homespecialist exchange may be more so.
• Need for supports to primary care clinics and
practices to provide and manage medications for
treatment of substance use and co-morbid
mental disorders.
• Funding for supports to primary care clinics.
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For more information
Contact
Mady Chalk, Ph.D.
Treatment Research Institute
[email protected]
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