Care coordination for patients with high cost, chronic health conditions has been the foundation for the early success of Alabama Medicaid’s four pilot Patient Care Networks (PCNs). Now, federal approval of a new “health home” program will provide extra funding and support needed to improve patients’ health outcomes while reducing overall expenditures to the state.
The Centers for Medicare and Medicaid Services (CMS) notified the Agency on April 9 that it had approved the Agency’s request to implement comprehensive care management in the four networks, also known as health homes. Federal approval will allow the state to draw down 90 percent federal matching funds for a two-year period between July 1, 2012, and June 30, 2014.
“We know that a relatively small number of our patients account for a significant percentage of the cost,” said Medicaid Managed Care Division Director Nancy Headley. “This is in part because a disproportionate share of the Alabama population is more likely to have chronic health conditions such as diabetes or heart disease. With the health homes program, we will be able to focus on the patients with these health conditions and work intensively with them to improve the quality of care they receive.”
Qualifying Medicaid participants must have two chronic health conditions or one chronic health condition and be at risk of developing another condition. Approved conditions include asthma, diabetes, heart disease, cardiovascular disease, chronic obstructive pulmonary disease, cancer, HIV, mental health conditions, substance abuse disorder, sickle cell anemia and transplant patients.
“This is particularly important for patients with mental health conditions because they often have other chronic diseases that go untreated until their health situation becomes serious,” said Headley. “By identifying these patients and intervening with targeted case management, the quality of the health care they receive can be substantially improved.” The PCN’s are now required to have a behavioral health nurse that will serve as a liaison between Mental Health and the primary care physician.
The program will also financially support the efforts of two other state agencies: The Alabama Department of Public Health which will provide case management services and the Alabama Department of Mental Health which will provide targeted case management services. Physicians who oversee the medical care of participating patients will receive enhanced fees as well.
Patients will be identified monthly using claims data and referred for services. The effort also includes transitional care services so that patients are visited by a nurse prior to hospital discharge to help with medication reconciliation or other needs.