黑料正能量 Note: Thanks to an agreement with Open Minds, 黑料正能量 has been able to share a regular stream of timely guidance from this nationally acclaimed organization that provides 鈥渄aily market intelligence, industry analysis, and management solutions for executives in behavioral health, mental health, and social services.鈥
黑料正能量 is pleased to announce that Open Minds CEO Monica Oss will be a featured keynote panelist and workshop presenter at our April 25-6 Executive Seminar: look for an enews posting later this week with full program and online registration details.
听
What Matters In Making Health Homes Sustainable
By Monica Oss听 CEO Open Minds听 January 23, 2013
Developed by OPEN MINDS, 163 York Street, Gettysburg PA 17325, .听 All rights reserved.
听
I see 鈥渉ealth homes鈥 (and their likely successor, some model of behaviorally-lead medical home) as models in the real-time market test phase. We are just getting these constructs up and running on a large enough scale to look at both operating models and results. (For more on current adoptions of health homes, see premium members.)
听
Eventually, I think the “health home” construct will evolve in the market to mean the group of organizations that assume financial and service delivery risk for high-cost consumers with cognitive disorders. This is likely some hybrid of what we know now as health homes, medical homes, specialty carve-out/disease management programs, HCB waiver programs, and Medicare Advantage SNP models. And, whatever the market successor, I think this is a great repositioning option for organizations that have traditionally served high-needs consumers – adults or children.
听
But success in this new role will depend on an organization鈥檚 ability to develop some traditional “managed care” organizational competencies and the ability to manage costs created by external environmental factors. On the organizational competencies side, it鈥檚 the usual hit list for managing service delivery in a P4P or risk-based environment:
- Robust health record keeping and the ability to do health information exchange
- Organizational and contract performance metrics, and the use of metrics-based management to improve performance, and manage financial risk and unit cost
- Deployment of automated clinical decision support tools across all chronic disease states
- Infrastructure to locate and coordinate non-health social services
- Systematic approach to consumer engagement and improving the consumer experience
听
In addition to these organizational competencies, I was reminded of some of the external environmental challenges that could affect the “success” (both clinical and financial) of these models in our coverage of a recent analysis of chronic disease management in the 黑料正能量 system, premium members. The report reviewed the progress of the three-year 黑料正能量 Medicaid Chronic Illness Demonstration Project (CIDP) for beneficiaries with chronic physical and behavioral health needs and identified some challenges provider organization face providing the CIDP services.
听
As I read the analysis, I thought three of the environmental challenges should be considered by executive teams when developing these 鈥榟ealth home鈥 types of models, payment rates, and performance expectations:
Difficulty sharing data – Data sharing to facilitate coordinated care models comes in two varieties. The first is more of a technical nature – having the EHR technology with the ability to exchange data between provider organizations. The second factor is a policy issue which gives me more concerns – the participation (or lack of participation) of behavioral health provider organizations in health information exchanges. One of the obstacles, the challenges posed by federal privacy rules, we have covered extensively (see all members and all members). The absence of a solution to this issue may be a “deal breaker” for behavioral health organizations that want to move into a primary role in these emerging care coordination models.
Difficulty accessing appropriate services and coordinating care – To be successful, the long-planned collaborations between a group of local professionals and provider organizations actually have to work. These local collaborations will need to move beyond improved communication and goodwill to something more tangible in terms of service delivery if health home managers are going to achieve their required performance measures. (For more information, see information, see all members and all members.)
Difficulty securing appropriate housing – Much of the policy of CMS and state governments to “bend the cost” curve is dependent on moving consumers from institutional settings to home- and community-based service models. The availability of housing options and housing supports for specific populations should be a consideration in both service delivery system planning and projecting system performance cost. (For more on housing options in behavioral health, see all members and premium members.)
听
If your organization is considering some expanded role in managing services for high-cost complex consumer populations, these are a few of the key considerations in developing your sustainable model.
听