Also known as the patient-centered medical home, the Person-Centered Healthcare Home is a relatively new model gaining momentum throughout the country for its potential to advance both quality health care and cost-effectiveness. Many states are implementing health homes for persons with complex chronic conditions, including serious mental illness and behavioral health issues, as a strategy to improve the patient experience and health care outcomes as well as reduce costs. By wrapping health and social services around medically complex Medicaid/Medicaid beneficiaries and improving care coordination, states, health plans and provider systems intend to demonstrate reduced hospitalizations, emergency room use and avoidable admissions.
In 2007, several medical associations issued the Joint Principles of Patient-Centered Medical Homes which set forth standards governing these new organizations, including: on-going client relationship with a personal physician; physician-directed multi-disciplinary team to provide services; whole person orientation; coordinated care; outcomes-oriented and evidenced-based treatment; enhanced access to treatment; and reimbursement commensurate with the services offered. In 2008, The Commonwealth Fund, in concert with other organizations, initiated a five-year demonstration project to help primary care safety net sites become high-performing patient-centered medical homes.
Additional information can be found at the NCQA Patient-Centered Medical Home and the Patient Centered Medical Home Resource Center websites. Missouri’s Primary Care Practice Health Homes website provides descriptions, flow charts, MOU’s and other valuable information. The Integrated Care Resource Center provides technical assistance to state Medicaid agencies that seek to amend their Medicaid plan to implement Health Homes for chronic conditions. Their resource library contains much useful information health home design and implementation.
As the 2013 IBHP paper “Health Reform and Transformation of the Delivery of Care” points out, while there is considerable information available on the subject of health reform, widespread transmission of it is vitally needed. IBHP’s survey of 590 physical and behavioral health providers and students found that over half had “limited” or “no knowledge” of important aspects of health reform such as patient eligibility, population health management and performance incentives.
The State of California has submitted an application to CMH to develop a 2703 Health Home pilot, an innovation of the Affordable Care Act. California seeks to tie the health home pilot initiative together with its Center for Medicaid and Medicare-funded State Innovation Plan. Click here to access the Califiornia Department of Health Care Services planning documents. Other documents related to the State’s application can be found here.
Systems integration is being achieved in some localities by focusing on health neighborhoods. Communities are defining and implementing health neighborhoods differently around the country. They can be defined by geography, population or a virtual approach using data systems to aggregate information. In seeking to address whole health needs, public systems are particularly seeking new approaches for individuals and communities with high incidence of co-occurring medical, mental health and/or substance abuse issues. Addressing adverse social factors is critical to improving outcomes for these high need individuals, and thus the integration of social services, housing and health is very important.
Agency for Healthcare Research and Quality’s (AHRQ) paper on “Coordinating Care in the Medical Neighborhood” describes the concept, key features, desired outcomes, operations, barriers to overcome and tools for planning a health neighborhood. The California Endowment launched its statewide “Building Healthy Communities Initiative” to address the social determinants of health in 14 communities throughout California. This initiative is committed to achieving “4 Big Results”: creating health homes for all children; reversing the childhood obesity epidemic; increasing school attendance; and reducing youth violence.
Los Angeles County has become a hot bed of health neighborhood planning. The County is pursuing a Health Neighborhood pilot to develop health neighborhoods in 5-7 locations in 2015. The Blue Shield Foundation has awarded LA Care Health Plan a planning grant to develop a Health Neighborhood Joint Planning Collaborative that will complement Los Angeles County’s pilots. IBHP, this website’s host, has been selected as the facilitator for this planning project.
Listed below are just a few of the myriad papers and reports centering on healthcare homes:
- “State Multi-Payer Medical Home Initiatives and Medicare’s Advanced Primary Care Demonstration“, State Health Policy Briefing, February, 2010
- “America Awakens to the Patient Centered Medical Home“, Paul Grundy et al., Medical Home News, Vol 1, #10, October, 2009
- “Initial Lessons from the First National Demonstration Project on Practice Transformation to a Patient Centered Medical Home“, Paul Nutting MD et al., Ann Fam Med, 2009
- “Health Coverage in the Safety Net: How California’s Coverage Initiative is Providing a Medical Home to Low Income Uninsured Adults in Ten Counties, Interim Findings“, Nadereh Pourat et al., UCLA Policy Brief, June, 2009
- “Summary of National Demonstration Projects and Recommendations for the Patient Centered Medical Home“, Benjamin Crabtree, Ph.D, et al., Ann Fam Med, Vol 8, 2010
- “Strategies to Improve Care Management for Beneficiaries with Complex Needs“, Alice Lind, Center for Health Strategies, June 2009
- “Cliff Notes to Emerging Outcomes from Demonstration Projects of Patient-Centered Medical Homes and the Transformation of Primary Care“, annotated by Justis and Wall, Washington Patient Centered Medical Home Collaborative, January, 2010
- “Payment Options and Learning Collaborative Work in Support of Primary Care Medical Homes“, Washington State Health Care Authority, December, 2008
- “Standards and Measures for Patient Centered Primary Care Homes, Office for Oregon Health Policy and Research“, February, 2010
- “Maine Patient Centered Medical Home Pilot Update“, January, 2009
- “Medical Home Gains Traction on [California’s] North Coast“, California Healthline, July, 2010
- “Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of Evidence from Prospective Evaluation Studies in the United States”, Kevin Grumbach and Paul Grundy, UCSF Center for Excellence in Primary Care, November, 2010
- “Patient Centered Medical Home, Building Evidence and Momentum; A Compilation of PCMH Pilot and Demonstration Projects“, Patient Centered Primary Care Collaborative, 2008
- “How Medical Homes Can Advance Health Equity“, California Pan-Ethnic Health Network, November, 2010
- SAMHSA’s Powerpoint defining healthcare home concepts
- How Are Health Homes Different From Patient Centered-Medical Homes? (chart)
- A description of the patient-centered medical home model at all Veterans Health Administration sites, referred to as Patient Aligned Care Teams (PACT)
- “Better to Best: Value-Driving Elements of the Patient-Centered Medical Home and Accountable Care Organizations“, 2011, Health2Resources
- “Recommended Core Measures for Evaluating the Patient-Centered Medical Homes: Cost, Unitlization, and Clinical Quality” the Commonwealth Foundation, May, 2012
- “Effects of Patient-Centered Medical Home Attributes on Patients’ Perception of Quality In Federaly-Supported Health Centers“, Lebrun-Harris et al. Annals of Family Medicine. 2013; 11:6; 508-516.
- “Effect of a Multipayer Patient-Centered Medical Home in Health Care Utilization and Quality”, Rosenthal, M. et al., JAMA 2013 Vo. 173
- “The Patient-Centered Home’s Impact on Cost and Quality“, Nielson, M. et al., January, 2014
- Population Management in Community Health Center Based Health Homes“, Center for Integrated Health Solutions, 2014
- Guide to Medicaid Health Home Design and Implementation, Centers for Medicare and Medicaid
- Health Home Resource Center, Centers for Medicare and Medicaid
- Opportunities for Whole Person Care in California, 2014, California Association of Public Hospitals and Health Systems
Integrating Mental Health Into The Healthcare Home / Behavioral Health Organizations
- The Excellence in Mental Health Act (S. 257), legislation introduced in March, 2012 in Congress, would provide federal recognition and support for community behavioral health organizations that meet the criteria to become Federally Qualified Community Behavioral Health Centers.
- Missouri’s Community Mental Health Center Health Homes
- “Early Evidence on the Patient-Centered Medical Home“, Agency for Healthcare Research and Quality, February, 2012
- “Integrating Mental Health Treatment into the Patient-Centered Medical Home“, prepared for the Healthcare Research and Quality Dept., U.S. Dept. of Health and Human Services, July, 2010
- “Behavioral Health/Primary Care Integration and the Person Centered Healthcare Home“, Barbara Mauer, March, 2009
- “A New Kind of Homelessness for Individuals with Serious Mental Illness? The Need for a ‘Mental Health Home‘” by Thomas Smith et al., Psychiatric Services, April 2009
- “Medical Homes and the Integration of Mental Health”, Bazelon Center for Mental Health Law
- “Serving the Needs of Medicaid Enrollees with Integrated Behavioral Health Services in Safety Net Primary Care Settings“, National Association of State Medicaid Directors, April, 2008
- “Specialty Care Medical Homes for People with Severe, Persistent Mental Disorders“, V. Alakeson et al.,Health Affairs, 29, 2010
- “Behavioral Health/Primary Care Integration and the Person Centered Healthcare Home“, National Council for Community Behavioral Healthcare, 2009
- “The Primary Care, Mental Health and Substance Use Disorder Provider Readiness Assessment”,prepared by Dale Jarvis for IBHP and CiMH, 2011
- “The Case for Treating the Whole Person in the Age of Health Care Reform: Lessons Learned from the Integrated Behavioral Health Project“, IBHP, 2011
- Health Homes and Primary Care / Behavioral Health Integration, Center for Integrated Health Solutions
- “Mental Health and Substance Use Provider Readiness Assessment: What is Needed to Succeed in the New Healthcare Ecosystem”, prepared by Dale Jarvis for the National Council, 2011
- Financing and Policy Considerations for Medicaid Health Homes for Individuals with Behavioral Health Conditions, Center for Integrated Health Solutions, 2013
- BHOs of Today, BHOs Of Tomorrow: Influencing The Behavioral Health Carve-Out Models, Monica Oss, 2012
- “Behavioral Health Homes for People with Mental Health and Substance Abuse Conditions: The Core Clinical Features“, SAMHSA-HRSA Center for Integrated Health Solutions, 2012
- “Value-Based Financially Sustainable Behavioral Health Components in Patient-Centered Medical Homes“, R. Kathol et al., Annals of Family Medicine, Vol 12, No. 2, 2014
- “Development of Joint Principles: Integrating Behavioral Health Care into the Patient-Centered Medical Home“, Annals of Family Medicine, 183, 2014
- “SAMHSA’s Center for Integrated Health Solutions lists dozens of resources for creating and maintaining health homes, with an emphasis on behavioral health.
- “Advancing Behavioral Health Integration within NCQA Recognized Patient-Centered Medical Homes“, SAMHSA-HRSA Center for Integrated Health Solutions, 2014
- Developing Health Homes for Children with Serious Emotional Disturbances: Considerations and Opportunities, Home Health Resource Center, 2014
- “Designing Medicaid Health Homes for Individuals with Opiod Dependency: Considerations for States“, Centers for Medicare and Medicaid, 2015
- “Health Homes for Patients with Complex Needs“, California Department of Health Services”, 2014