Only half of a new Medicaid-funded program to integrate medical, behavioral health and social services launched statewide this week – much to the surprise of health care providers.
On Monday, a day before the planned launch date, providers were notified by the state that the portion of the Health Homes program that would integrate services for those with serious mental illness would begin on July 1.
However, the program for those with chronic conditions, such as asthma and diabetes, would be “launched at a later date.”
“There’s a lot of money that’s going to be lost by several clinics that have already hired staff,” said Katrina McGivern, communications coordinator for the Kansas Association for the Medically Underserved, which represents safety net clinics across the state.
“It leads to trust issues. Is it going to move forward?”
The goal of Health Homes is to improve health outcomes for those with chronic conditions, to reduce the number of people who are unnecessarily admitted to the hospital and to reduce emergency room visits, said Becky Ross, Medicaid initiatives coordinator for the Kansas Department of Health and Environment.
Not all Medicaid’s roughly 426,360 recipients are assigned to Health Homes. Assignments are made by managed-care companies contracted by the state, and they base the assignments on claims data that show the Medicaid recipients are frequent visitors to hospital emergency room or other data that show better coordinated services are needed.
On Tuesday, managed-care companies began sending letters to Medicaid recipients who are eligible to participate in the mental illness Health Homes program. For those who don’t opt out, services are set to begin in August.
The mental illness Health Homes program will include about 36,000 people, Ross said, and an estimated 38,000 people will be a part of the chronic conditions Health Home program when it launches.
“We’re essentially targeting folks that are the highest cost and who can benefit from much closer care coordination,” Ross said.
There are several services that Health Homes must provide under federal and state regulations. They include care management and coordination, health promotion, patient and family support, referrals for social services and help transitioning from one provider to another.
State officials did not feel the network for providers was adequate statewide to launch the chronic conditions Health Home program this month, so the state will re-evaluate a launch date for that program in January, Ross said.
“We will continue to engage those providers that would like to be involved in the chronic conditions Health Home and continue to help them understand what it is so that hopefully once we hit Jan. 1, we can feel like an adequate network is there,” said Sara Belfry, spokeswoman for the Kansas health department.
Originally, the entire Health Homes program was scheduled to start on Jan. 1, 2014.
But the state decided to postpone it to July to maximize $250,000 in federal funds for electronic health records and eliminate confusion over open enrollment for KanCare, which takes place in January, officials said earlier this year.
Several providers said they wished the state would have launched the chronic conditions Health Homes program, in part because they already have hired additional staff members to manage the patients who were expected to participate.
The delay has been frustrating and confusing, said Teresa Lovelady, CEO of the Center for Health and Wellness. The clinic had signed up to be a Health Homes provider for both the mentally ill and those with chronic conditions, but now she’s not sure whether those dealing with mental illnesses will still be assigned to the clinic since the chronic conditions program has been delayed.
“I feel like this is a last minute deal that will have a huge financial impact on the clinic,” Lovelady wrote in an e-mail.
She estimates the clinic could lose up $330,750 in anticipated revenue because of the delay. The clinic had also already committed more than $150,000 to hire additional staff members to deal with the Health Homes program.
“Can I afford to wait until January 1 for a re-evaluation or should I cut my losses now and not participate in this process?” she wrote. “Can (the clinic) afford to sustain until the state is ready? Can (the clinic) not afford to comply with such last minute critical decisions that hit the bottom line of the clinic either way? How should I plan moving forward? Can I trust this process?”
Carolyn Gaughan, executive director for the Kansas Academy of Family Physicians, said, “It’s probably a smart idea to wait” on the chronic conditions portion of the program.
So far, she said, it has been similar to last year’s bumpy rollout of KanCare, the state’s privatized Medicaid program. Not enough providers had contracted with managed-care companies to make the program work.
State officials did not say how many providers had been contracted with so far.
There are still many questions about how Health Homes will work, providers say.
“It’s far more involved than anything any of us in the silos of medical, behavioral health or social work have done before,” said Dave Sanford, CEO at GraceMed, a safety net clinic.
The three managed-care companies that oversee KanCare – UnitedHealthCare, Amerigroup and Sunflower, a subsidiary of Centene – are all approaching Health Homes differently, Sanford said.
For example, Sanford said that one of the managed-care organizations expects that GraceMed will do all of the work to provide the core services defined for Health Homes under the plan, while another organization plans to hire its own care coordinators to provide those services.
“It’s still very confusing. The three MCOs haven’t finalized all the guidelines and payment policies,” Sanford said. “It’s been a short window of time, so many things that need to be signed, sealed and delivered just haven’t been.”
GraceMed is in the process of hiring its own care coordinator and care coordinator manager, Sanford said.
“We want to start out slow and make sure we understand the expectations of the MCOs,” he said.
Kevin Fish, executive director of ARC of Sedgwick County, which offers services and programs to those with physical and intellectual disabilities, said ARC will serve as a case management provider to Health Homes for the mentally ill and developmentally disabled.
“There’s going to be a bit of a learning curve for us,” Fish said.
At this point, ARC plans to have two case managers who will handle about 35 cases each.
“Ultimately, we’re hoping that the individual will have a greater level of support by having all these teams pooled together. The potential could be very good for this to benefit our clients,” he said
Even though services for the mentally ill are supposed to start in a month, it’s not clear whether ARC will bill through the managed-care companies or through the Health Home providers directly, Fish said.
Health Homes is part of the Affordable Care Act, and the federal government gives a 90 percent match to states for the first two years of the program. After that, the match drops to about 56 percent.
The net cost to the state for the program is $13 million after the first two years, Ross said.
The program requires the state to pay the managed-care companies, who then pay providers for services.
The average monthly per-member rate the state will pay the managed-care companies for those with serious mental illness is $171.79.
The rates that providers will receive from the managed-care companies will vary and are not publicly available.