Missouri First to Launch “Health Homes”

Better coordination expected to produce better outcomes, lower costs

KANSAS CITY, Mo. –Tri-County Mental Health Services is located in a modern office building near a highway and Robbie-Joe Hughes’ space within it hardly looks homey, with bare walls and a printer in a cardboard box on the floor.

And yet on Jan. 1, this will become the “health home” for about 500 Tri-County Medicaid clients who have both a mental health (including substance abuse) problem and a chronic physical condition, such as diabetes.

As the new director of healthcare homes for Tri-County, Hughes said she was excited to be working on the cutting edge as Missouri becomes the first state to implement what she described as a “patient-centered approach” destined to improve outcomes and lower costs.

A registered nurse and former professor of nursing at William Jewell College, Hughes (and her staff) will be responsible for coordinating the care of 479 Medicaid patients initially identified by the state as meeting the criteria for the program, which is an outgrowth of the federal health reform law, the Affordable Care Act.

On Oct. 21, the federal Centers for Medicare and Medicaid Services announced that for two years it would fund 90 percent of the costs for coordination efforts like those at Tri-County and 26 other community mental health centers across Missouri. The 90 percent funding means a larger federal share of the Medicaid costs. Typically, the federal government covers about 60 percent of Medicaid costs, leaving the other 40 percent to the state.

As Hughes talked about her role in the coordination of care, she likened one of her outstretched hands to a patient’s mental well-being and the other to his or her physical well-being, and then clasped them together.

“With primary care and behavioral health, we have such a fragmented system of payments,” Hughes said. “The goal is to coordinate care in such a way that the health-care home becomes a catalyst for a person to receive holistic care.”

Coordinated care, she said, should reduce emergency room visits and hospital re-admissions while promoting wellness through education and counseling.

“These services – the coordination – were not traditionally paid for by Medicaid,” said Dr. William A. Pankey, chief medical officer at Kansas City’s Swope Health Services, which is also working to establish a “healthcare home” for dual-diagnosis clients.

“The providers will still bill for the same thing … the probable reimbursement rate (for providers) hasn’t changed at this time. … Swope will bill for coordination,” Pankey said.

Most Swope Health Services clients live in Jackson County, Mo., but the organization also has two clinics in Wyandotte County, Kan.

“Kansas has not identified through their Medicaid agency any (similar) plan,” to promote and pay for better coordination, Pankey said. “We’d love to be able to do this on both sides of the state line. That’s the federal expectation, but each state has to do its part.”

Kansas officials, led by Lt. Gov. Jeff Colyer, are preparing a Medicaid reform plan for release later this year. They have not yet released details of the plan but have said they want to improve coordination of care for Medicaid patients. At the same time, Gov. Sam Brownback, a Republican, has said his administration will not implement any part of the Affordable Care Act, which he refers to as Obamacare, until after the U.S. Supreme Court has ruled on the law’s constitutionality. That isn’t expected to happen for at least several months.

Hughes’ boss, Tri-County Chief Executive Tom Cranshaw, credited Joseph Parks, chief clinical officer for the Missouri Department of Mental Health, and Ian McCaslin, director of Missouri’s Medicaid agency, MO HealthNet, for taking the lead in establishing the Health Homes program in Missouri.

“Joe Parks has been evangelizing about the studies that show that people with mental illness die, on average, 25 years earlier of the same heart attacks, cancer and strokes you and I are likely to die from,” Cranshaw said. “It was his vision that if you use the health-care home concept, you could start carving away at that discrepancy.”

While Missouri is the first state to have its health home plan approved by CMS, Rhode Island and Oregon have also applied.

Cranshaw said his counterparts in Kansas have told him they, too, would like to establish health home programs, but that they see politics behind Kansas’ failure to yet seek approval.

“There is resistance in Topeka to give anything that comes out of the Affordable Care Act any legs,” Cranshaw said.

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