Integrated Health Homes For Iowa Plan Members
Magellan Behavioral Care of Iowa
August 2013
Format For Webinar
• Olmstead Task Force and Magellan have partnered together to bring
information to those interested, with a focus on delivering
information to the consumer and family members who would like
more information about the goals and design of the IHH program
• Overview presentation of the integrated health home program
including the Who, What When, Where and Why’s? - Kelley
Pennington, Integrated Health Home Director (approx 30 minutes)
• Q &A with assistance from Geoff Lauer, Olmstead Task Force
(approx 30 minutes
• Questions may be typed throughout the course of the presentation
What Is Magellan Behavioral Health of Iowa
What is Magellan’s Role?
• Magellan Behavioral Care of Iowa is a managed care organization
charged with managing the Iowa Plan for Behavioral Health
• The Iowa Plan is Iowa’s managed care program for certain publicly
funded mental health and substance abuse services
• Magellan has been the State’s contractor since 1995
• Significant expertise in behavioral health care
• In partnership with the Iowa Department of Human Services ,
Magellan is providing the direction for the development and
management of the Integrated Health Home Program
HOW is this program made possible?
Affordable Care Act
• Supports the development of health homes
• Section 2703
• Allows for expansion of Medicaid services
• 90 percent FMAP for health home-related services for first 8 quarters
• Alternative payment models
• Incentive grants
Iowa Legislature
Iowa Department of Human Services/Iowa Medicaid Enterprise
What
Is a “Health Home?”
A health home is a team-based health care delivery model that
provides
comprehensive,
continuous care to people with the goal of obtaining
maximized health outcomes
Patient-centered medical homes (PCMH) have been developing
in primary care world for decades
WHAT is an Integrated Health Home (IHH), Then?
The term Integrated Health Home is the name
given for the health home program that is
specifically designed for people with serious
mental illnesses (SMI) and children/youth with
serious emotional disturbances (SED)
Say It Again?
Very simply stated, the integrated health home is a TEAM OF PEOPLE with
unique skills, such as nurses, social workers and peer/family support
specialists, solely positioned to provide much needed
 care coordination
 education
 direction
for people with mental health challenges and their families
The goal is BETTER HEALTH
IHH TEAM FOCUS
This team’s entire focus is to help people
connect with information, services and
other resources with the goal of
improving all realms of one’s health –
mental, physical, social….
WHO CAN ARGUE WITH THAT?
WHAT an integrated health home is NOT
An integrated health home is NOT…
• a house
• a residential setting
• a PMIC
• a group care placement
• a hospital
• a building
• A nursing home
NO, NO, NO, NO!!! Not even close….
Why call it HOME?
• The health home/medical home term has been
around a long time
• The Affordable Care Act refers to health homes
• The term HOME is generally intended to have a
positive connotation of somewhere where people
know you, care for you, have your best interest in
mind…You know the phrase…HOME SWEET HOME
Why develop integrated health homes?
People with chronic mental illness die 25 to 30
years earlier than their peers who do not have
a mental health condition, often due to
unaddressed physical conditions.
Much of this is preventable.
2006. National Association of State Mental Health Program Directors. “Morbidity and Mortality in People with Serious Mental Illness.”
Alexandria, VA.
http://www.nasmhpd.org/general_files/publications/med_directors_pubs/Technical%20Report%20on%20Morbidity%20and%20Mortaility%
20-%20Final%2011-06.pdf.
The drastically reduced lifespan for people with SMI and
SMI/SUD is comparable with Sub-Saharan Africa
BUT WE ALREADY HAVE SERVICES, CASE MANGEMENT
ETC…
PEOPLE ARE DYING.
WE NEED TO DO MORE.
WE CAN DO MORE.
WHO is the Integrated Health Home Designed For?
Iowa Plan* members (Medicaid) who have a
Adults with serious and persistent mental
illness (SPMI)
Children/youth with serious emotional
disturbances (SED)
* Includes approximately 411,000 members; most all Medicaid members are eligible
for the Iowa Plan
Diagnostic Criteria for IHH Membership
The SMI diagnosis is defined by the
following diagnosis categories:
Serious emotional disturbance (SED)
means:
• Psychotic disorders
• A diagnosable mental, behavioral or
emotional disorder of sufficient
duration to meet DSM diagnostic
criteria
• Schizophrenia
• Schizoaffective disorder
• Major depression
• Bipolar disorder
• Delusional disorder
• Obsessive-compulsive disorder
• Other MH diagnosis with significant
functional impairment
• Results in functional impairment
Attributed Medicaid Member Population
• Identified through Magellan claims
information
–30,000 SPMI adults statewide
–16,000 SED children and youth
statewide
Can people on waivers be in IHH?
YES – Children on CMH waiver are included
YES - Children and adults receiving Habilitation Services
___________________________________________________________
NO – ID waiver, PD waiver, HD waiver, BI waiver, Elderly waiver, HIV waiver
Is IHH Membership Optional?
YES, this is an optional program.
Members have choice and can always exercise the choice to
opt in,
opt out,
move to different IHH provider in community
Because it is available to offer additional help with care
coordination, resources, education about health and wellness,
peer support etc, the hope is that members do not opt out
But the choice is always with the member’s!
Do I have to change doctors, therapists etc?
NO!!!
• Being assigned to IHH gives you an additional service of having access to
the Care Coordination teams
• You can keep seeing your providers
– Primary care
– Psychiatrist
– Therapist
– BHIS
– Habilitation provider
– Etc
NONE OF YOUR PROVIDERS WILL CHANGE BECAUSE OF IHH UNLESS
YOU WISH FOR A CHANGE
What You Need to Know About Opting Out of IHH
CMH waiver – Currently requires case management as part of CMH waiver.
The IHH will be provider for the case management service portion of the
CMH waiver so if child is opted out of IHH, there is no case management
service available and therefore the waiver services will be unable to be
accessed.*
Habilitation Services – Currently requires case management as part of
Habilitation Services. The IHH will be provider for the case management
service portion of Hab so if child/adult is opted out of IHH, there is no case
management service available and therefore the waiver services will be
unable to be accessed.*
*Targeted Case Management will not be an available option for people who
meet IHH criteria. The State has determined that IHH will provide the case
management for those with SMI/SED.
WHO are the IHH providers?
 Behavioral health providers that are the
community experts for serving people with
mental health needs
 Have willingness and support to think
differently in terms of serving health care
 Meet standards outlined
 Not all willing and able will be IHH
IHH Provider Qualifications
• Accredited/licensed mental health provider of good standing in the Iowa
Plan
• Capacity to serve a significant number of the targeted population
• Demonstrated capacity to use HIT to measure outcomes
• Commitment from highest levels of leadership to lead transformational
change according to the IHH program principles
• Demonstrated readiness to complete the change transformation curriculum
in a year
• Demonstrated capacity to manage quality improvement processes
• Ability to staff the program with the necessary teams to manage
• Meet specific qualifications outlined in state plan amendment
HOW can I be a part of a IHH?
• Meet criteria for membership
• Assigned membership will be automatically enrolled to health home in area
– Should receive a letter informing you of enrollment
– IHH provider will reach out to you
• If you are not automatically assigned,
– Call IHH provider directly to enroll
– Call Magellan directly for local IHH
• Cannot be assigned to both physical health home and specialized
integrated health home
IHH Is a Team Approach
Magellan
• Selects IHH providers
• Provides care management support
through
 Claims-based reporting to identify
gaps in care
 Risk analysis
 Development of online tools
to support daily service delivery and
population management needs
Community IHH Provider
• Develops care teams to work with
members
• Uses data and technology to oversee
and intervene in the total care of the
member
• Works with community services and
supports to address member/family
needs
• Develops whole-health approaches for
care
IHH Community Provider Teams
• Care coordination teams integrated within IHH sites
• Enhanced staffing for TCM members moving to IHH (50:1)
• Ratio-based positions dependent on number of members
– Nurse (RN) - 400:1
– Care Coordinator (BS/BA) 250:1 adults; 200:1 children
– Peer or Family Support Specialist (certified) 250:1 adults; 200:1
children
• Non-ratio-based positions
– Program Director
– Supervisor
WHAT can IHH do?
 Comprehensive care management
 Care coordination
 Health promotion
 Comprehensive transitional care
 Individual and family support services
 Referral to community and social support
services
GREAT things
are done by a
series of small
things brought
TOGETHER.
Patient-Centered Focus
New Attitude
• Patient-centered – Focus is on mobilizing
services and supports based solely on the
individual’s health and wellness needs
• Integration of physical, behavioral, and
other social supports
• Proactive, preventative efforts to
improve/maintain health
• Access to services available
• Information and guidance
• Plants and lamps campaign – creating
warm, inviting places for health care
delivery
• It is a privilege to serve this population
Old Attitude
• Practice-centered - Patient needs to fit into
available service array
• Silo approach to care, lack of integrative
efforts
• Reactive efforts to manage crisis, illness
• Waiting lists, poor access, missed
appointments
• Confusion within system, no designed
guidance
• Sterile, low focus on environmental setting
• Population should feel privileged to be
served
Using Data to Manage Member Population
• A move from thinking of health care as a series of isolated, reactive, crisistype encounters, to a big-picture approach that anticipates needs and
improves outcomes
• A process of scanning large groups of patients and asking, “What are the
pressing health needs of this population, and how can we best satisfy or
even pre-empt those?”
• A “population” is a group of people with a shared condition, such as
diabetes, schizophrenia or asthma
• Use data, such as claims or encounters, to inform areas of intervention
needed to improve or maintain health status
• Example: Diabetic patients may need annual eye exam, foot exam, HbA1c
testing, medication management, etc.
Using Information Technology
• Allows for immediate health information access
• Electronic Medical Records (EMRs)
– Allow for improved internal information-sharing
– Allow critical patient medical information to move to outside providers
quickly
• Continuity of Care Document (CCD) - electronic document exchange
standard for sharing patient summary information
• Create tools to inform next steps within practice:
– Look across practice patient population
– Sort and group patients by common traits
– Make informed choices about where dollars and energy are best spent
– Measure progress in real time
Let’s Talk About Wellness for a Change…
Health promotion includes use of
• self-management tools
• fitness
• nutrition
• health education
• other innovative approaches
IHH Sites: Practice Transformation Coaching
• Practice transformation coaches will be routinely onsite to instruct and
assist practices with quality improvement efforts to transform site to
patient-centered practice
• Ongoing technical assistance for 2 years
• Tools to assess readiness and transformation progress
• Learning Collaboratives to learn from others, share best practices
• Adult IHH – HealthTeamWorks will be providing coaching expertise
• Child IHH – University of Iowa will be providing coaching expertise
IHH Sites: Quality Outcomes Expectation
• Demonstrated effectiveness is critical
• Quality measures will be monitored related to
health status, improvement in function, etc.
• Financial incentives available to sites for
meeting health measures
IHH Sites: Flexible Payment Methodology
• Health homes services paid on a per member per month (PMPM) basis
• Blended rate of high-need to low-need member costs of care
• Allows for flexibility in delivery of care
• Concentration of efforts can be given where needed with less cost concern
• Fee-for-service remains in place for traditional services available (e.g.,
therapies, medication management, BHIS, etc.)
• Large primary care sites will be paid lower PMPM to participate in care
coordination, communication for common members
IHH Sites: Systems of Care Approach for
Child IHH
Child sites will function using Systems of Care model
• Child- and family-centered
• Strengths-based approach
• Family team meetings
• Wraparound process
• Community engagement
• Use of natural supports
Habilitation Services and IHH
• Medicaid members who receive Hab services are attributed to IHH sites
(currently phase 1 only)
• Anyone starting Hab will also be attributed to an IHH site when IHH is
available
• IHH is required for anyone on Hab (as long as IHH is available)
• Exception: Members who are on waivers other than CMH waiver will not be
attributed to IHH (i.e. Elderly, ID, HIV, PD, HD, BI)
Phased Statewide Roll-Out
PHASE 1:
July 2013
Dubuque (pediatric
only); Linn, Polk,
Warren and
Woodbury counties
PHASE 2:
April 2014
PHASE 3:
July 2014
30 counties
64 counties
For More Information:
www.MagellanofIowa.com
Kelley Pennington, IHH Director
Kmpennington@Magellanhealth.com
Cheryl Holt, Assoc. Director, IHH Adult Program
CAHolt@MagellanHealth.com
Dave Klinkenborg, Assoc. Director, IHH Child Director
DRKlinkenborg@MagellanHealth.com