1. What is a Health Home?
A Health Home provides a comprehensive system of care coordination for Medicaid members with chronic conditions. Health Home providers will coordinate all primary, acute, behavioral health and long-term services to support and treat the “whole person” across his/her lifespan. For more details regarding Health Homes, click here to visit the Centers for Medicare and Medicaid Services (CMS) website.
2. Why is the Bureau for Medical Services establishing Health Homes for Medicaid patients?
Health Homes have been shown to increase patient’s health and reduce medical costs. Since the focus is on the whole patient, all of the health care providers a patient sees are part of his/her treatment team.
Take for example, an individual suffering from bipolar disorder and hepatitis B and/or C. His/her medical doctor has prescribed medication for hepatitis treatment. His/her psychiatrist has also prescribed a mood stabilizer but makes a change at his/her next visit. The patient fails to inform his/her medical doctor and the new mood stabilizer reacts with the hepatitis medication resulting in him/her visiting the local emergency room then being admitted to the hospital.
Had he/she been enrolled in a Health Home, the medical doctor and the psychiatrist would have been working together and both known all of the medications the patient was taking and thus could have taken preventive action to prevent an extended hospital stay. This would have resulted in better treatment of the patient and would have saved costs.
Another example would be and individual with diabetes with depression. Some antipsychotics used to treat depression can actually worsen diabetes complications because how they influence an individual’s metabolism. The medical provider and behavioral health specialist would work together under the umbrella of the Health Home in order to identify the most effective treatment to treat the individual’s diabetes and depression, along with any other health issues he/she may have.
3. What Health Home opportunities are in WV?
Currently, the State has two types of Health Homes. The first Health Home is a Behavioral Health Health Home for eligible Medicaid members who have a diagnosis of bipolar disorder and has or is at risk of having hepatitis B and/or C. This Health Home was expanded from a six (6) county region to statewide on April 1, 2017. The second Health Home is a Diabetes Health Home for eligible Medicaid members who have a diagnosis of diabetes, pre-diabetes, and/or obesity and who have or at risk of having anxiety and/or depression. This Health Home began services on April 1, 2017, in 14 West Virginia counties: Boone, Cabell, Fayette, Kanawha, Lincoln, Logan, Mason, McDowell, Mercer, Mingo, Putnam, Raleigh, Wayne and Wyoming. The target population is within these counties, but enrollment with a Health Home provider is not restricted to Medicaid members residing in these counties; they can reside in border counties as long as the provider is located within the target counties.
4. Why are the available Health Homes just for bipolar disorder or diabetes and not for other mental or health conditions?
The decision was made to limit the Health Home programs to bipolar disorder or diabetes for several reasons:
1) West Virginia has a high rate of Medicaid members with bipolar disorder as well as those with pre-diabetes, diabetes and/or obesity that can benefit from targeted case management from a Health Home provider.
2) Individuals who experience bipolar disorder are more likely to have hepatitis B and/or C than the general public.
3) Individuals with bipolar disorder are more likely to have substance abuse issues.
4) Individuals with bipolar disorder or diabetes have different treatment needs than those with other severe mental illnesses or medical health issues.
5) Individuals with bipolar disorder or diabetes are more likely than those with other severe mental illnesses or physical diagnoses to require intense, proactive medical care.
6) Individuals with pre-diabetes, diabetes and/or obesity may need more intense treatment to manage the progression of the disease.
7) Individuals with pre-diabetes, diabetes and/or obesity are more likely to have additional chronic medical conditions.
5. Why did West Virginia include hepatitis B and C in the Behavioral Health Health Home and no other chronic mental illnesses?
Several factors contributed to why hepatitis B and C were selected as a focus including those mentioned above for bipolar disorder:
1) Hepatitis B and C drugs can exceed $32,000 a month and treatment is typically one year ($32,000 * 12= $384,000/year).
2) The cost for non-treatment is even more costly:
--Hepatitis C is the cause of about one-third of all the liver transplants in the U.S.
--The average cost of a liver transplant & associated hospital costs in 2011 was $577,000 according to Transplant Living.
--The transplant recipient has to take anti-rejection drugs at an annual cost of about $23,000 for the rest of his/her life.
3) The cost for education on prevention, spreading and living with hepatitis is minimal when compared with the cost of treatment.
4) Many people, especially those with bipolar disorder, are unaware they’re infected with the virus until serious health issues start. If caught in the early stages, individuals who are coached on healthy living and avoiding drugs and alcohol have lower lifetime medical costs and longer, healthier lives.
5) Because of the costs associated with hepatitis B and C, this was determined to be a good opportunity for West Virginia to show significant cost savings and health outcomes in the State Medicaid program.
6. Why did West Virginia choose pre-diabetes, diabetes and obesity rather than other medical health issues for the second Health Home?
1) Published evidence indicates that individuals with pre-diabetes, diabetes and obesity represent a patient population at high risk for anxiety and/or depression.
2) Statistically individuals with these diagnoses have high mortality rates compared to the general medical population.
3) Individuals with these diagnoses develop comorbid medical diseases because of lifestyle, substance abuse and/or other physical and mental diagnoses.
4) Individuals with these diagnoses have a pattern of poor treatment compliance.
5) The diagnosis of diabetes increases the member’s risk of developing many other serious health problems including:
--Skin complications including wound healing
--Eye complications and deteriorating vision
--Neuropathy
--Foot complications including numbness, burning, stinging and weakness
--Kidney disease
--High blood pressure, stroke and/or other cardiovascular diseases
--Hyperosmolar Hyperglycemic Nonketotic Syndrome (HNNS)
--Gastroparesis
--Effects on pregnancy and members overall mental health
--Prescription medication costs for individuals with pre-diabetes, diabetes and obesity in West Virginia average approximately $3,000 per year, per member
--For Medicaid members who concurrently suffer from anxiety and/or depression and receive the most current treatment, yearly prescription and medical costs can be significantly higher. For example, about 25% of West Virginia Medicaid’s antipsychotics, antidepressants, and/or antianxiety medications are attributed to this population. Overall medical cost for this population can easily exceed $30,000 per individual, per year.
--An estimated 10% of the total West Virginia Medicaid population is diagnosed with pre-diabetes, diabetes and/or obesity. However, there is reason to believe that diabetes is severely underdiagnosed in West Virginia due to members not receiving routine health care. Additionally, the average person living with diabetes is estimated to have had diabetes five years or more before they are diagnosed.
7. Why is the Diabetes Health Home Program limited to 14 counties and why those 14?
The 14 counties that were selected to be included in the Diabetes Health Home Program are: Boone, Cabell, Fayette, Kanawha, Lincoln, Logan, Mason, McDowell, Mercer, Mingo, Putnam, Raleigh, Wayne and Wyoming. This region was selected because of the high rate of Medicaid members already being diagnosed with pre-diabetes, diabetes or obesity and the accessibility to health care providers.