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Spring 2013, Volume 21, Number 2

A male patient tells the doctor about his health

Health Homes: A Strategy to Improve Care

What is a "health home"? Despite its name, a health home is not a physical place. Instead, it's a strategy for helping people with multiple chronic conditions manage those conditions better.

Adults and children with several chronic conditions typically see multiple specialists or require services from multiple providers, and those providers often do not know what the others are doing. With health homes, a single health-care provider or team becomes responsible for coordinating all the care an individual receives.

Because health homes have the potential to improve people's health and save money, learning more about the health home concept is one goal of the Affordable Care Act.

The Affordable Care Act gives states the option of creating health homes for Medicaid beneficiaries with at least two chronic conditions, such as a mental health condition, substance use disorder, asthma, diabetes, heart disease, or overweight; one chronic condition and high risk of developing another; or a serious, persistent mental health condition. Focused on the highest-need, highest-cost adults and children, health homes exemplify "person-centered" care by integrating and coordinating primary, behavioral, and acute care and providing long-term services and support. "Behavioral health conditions can exacerbate existing physical health conditions," said Suzanne C. Fields, M.S.W., L.I.C.S.W., SAMHSA's Senior Advisor to the Administrator for Health Care Financing. "If someone is actively using substances or experiencing mental health problems, it can make it difficult for them to take care of their own health." In addition, said Ms. Fields, having a chronic physical condition increases the likelihood of depression, anxiety, and self-medication with substances. Plus, she said, chronic conditions typically require coordination with social and other community supports -- something that's especially important for children with complex behavioral health needs.

"Health homes provide an opportunity to coordinate care, intervene earlier, and either stabilize or even potentially reduce costs," said Ms. Fields.

Developing a Plan

Those potential benefits, plus a 90 percent federal financial match to states for health home services in the first two years, are proving attractive.

Many states have expressed interest in modifying their Medicaid state plans—the contract with the federal government in which states lay out their Medicaid program details—to add a health home option. The Centers for Medicare and Medicaid Services (CMS) has already approved 10 Medicaid health home state plan amendments in eight states: Idaho, Iowa, Missouri, Ohio, New York, North Carolina, Oregon, and Rhode Island.

Three of these programs—Ohio, one of Missouri's, and one of Rhode Island's—focus exclusively on individuals with serious mental illness. Three—New York, Iowa, and Oregon—include mental health conditions and substance use disorders among their list of targeted chronic conditions. Idaho's program and Rhode Island's other program include mental health conditions but not substance use disorders, while North Carolina and Missouri's other program include neither.

To ensure that plans adequately address behavioral health, CMS requires states to consult with SAMHSA as they develop their health home state plan amendments, even if their proposed programs won't focus on behavioral health as a specific chronic condition.

"To be successful, regardless of what conditions they target, state plan amendments have to account for the needs of behavioral health clients effectively," said David Shillcutt, J.D., a public health advisor in SAMHSA's Office of Policy, Planning, and Innovation.

State Medicaid Agencies can email to set up an informal consultation. A team of six to 10 SAMHSA experts will provide feedback and recommendations for states. They can also put states in touch with helpful resources, such as SAMHSA's Center for Financing Reform and Innovations Information Resource Center and the Center for Integrated Health Solutions, which is jointly sponsored by SAMHSA and the Health Resources and Services Administration.

See the sidebars on Missouri, Ohio, and Iowa for examples of state health home programs.

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