Previously, I discussed what home health programs (HHP) are. In this blog I analyze the major players in the HHP.
State Authority & Participation
The Center for Medicare Services (CMS) oversees the Health Home Program, but each state has a Health Home Authority that creates and manages its HHP. States are required to follow the core principle of HHP and treat each participant under a “whole person” philosophy, but states can create a program that best fits its participants’ needs.
The Health Home Authority also has the freedom to decide which conditions are included, the criteria that is used to select providers, how payment will be managed, and what reports and metrics are to be included in the program. Thus, it has a significant impact on what data and reporting are required to support the program.
According to CMS, as of March 2019, 23 states and the District of Columbia have a total of 38 approved Medicaid Health Home models.
The Major Players
Managed Care Plans (i.e., payers) who have Medicaid members play a role in Health Home Programs. Payers define which providers can be part of their HHP network. Generally, providers will include primary care providers, community health centers, social workers, mental health practitioners, home health agencies, and possibly case managers that work for the managed care health plan. Not only do payers contract service providers to be part of their HHP network, but they are responsible for gathering and reporting clinical and operational data, communicating with providers about key events, and administering reimbursement to the HHP provider.
Providers are on the HHP front line since they choose who will be part of the delivery team. They decide what activities will be involved in outreach and enrollment of participants, coordinate medical and non-medical care, and provide support for the individual and family members.
This guide provides an overview of the Health Home Program and presents five common challenges payers will face when creating a successful program. To learn more, you can click here or submit the form below.