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Missouri is first to implement 'health homes' for patients with chronic illnesses

This article first appeared in the St. Louis Beacon, Oct. 24, 2011 - Beginning next year, Missouri will take a new approach to serving residents with mental health, substance abuse and other chronic conditions. These residents will all be served through what's known as a "health home" model. It means providers -- ranging from primary-care doctors to counselors -- will be able to share the same data on each patient and provide better coordinated care.

The Center for Medicare & Medicaid Services announced Missouri's new approach in a conference with reporters last week. The agency said Missouri would be the first state in the nation to move to the health home model. Cindy Mann, a center official, provided no information about the number of Missourians that would be served by the new program or the costs.

She expressed confidence that the approach would save money, citing research showing patients tend to get better care and more coordinated care at a lower cost through health home. She also noted that state would have to put up less money. Typically, states are required to contribute a 40 percent match for Medicaid services. But this program requires Missouri to spend only 10 percent of its money, with the federal government providing 90 percent. The match only covers certain services, however.

Routine care, "such as sitting down with a therapist, is paid for through Medicaid in a normal way," Mann said. "The additional funding is for all the care coordination services, linking people with services."

She says the funds could cover transportation to make sure people make their medical appointments, follow-up care by case workers and visiting people's homes to make sure they are following their care coordination plan.

"We don't know exactly how many (will be served). How much we will spend on mental-health services will really depend on how many people enroll and what's medically necessary for those individuals. We hope it's robust because we want to see a lot of people moving into health homes."

The reason, she says, is that "this kind of care coordination really does deliver better care, more friendly care, more robust care at lower cost."

The health-home model has emerged in part from data showing that health could be improved and cost lowered if patients kept appointments and followed the doctor's orders. That explains the program's focus on helping people get and keep appointments, follow through with treatment, take their medications and alter lifestyles that might affect their health.

The federal agency said Rhode Island and Oregon also are seeking to set up a health-home plan similar to Missouri's.

Local Initiative Funds Physician Training

By coincidence, the Missouri Foundation for Health also announced funding for a health-home initiative Friday afternoon. It will spend $560,000 to underwrite training to help 80 doctors' practices become "medical homes." That's another name for the health-home model, which emphasizes coordinated care as a way to improve patient health.

The training will start in December for medical practices in federally qualified health centers, rural health centers, hospital clinics, community mental health centers and private practices. The focus also will be on using electronic medical record technology for improved tracking of patient needs and care.

"A medical home creates durable and meaningful relationships among patients, families, and their doctors' care teams," says Dr. James R. Kimmey, MFH president and CEO. "The care is accessible, continuous and compassionate, and patients can become empowered and ultimately make healthier lifestyle decisions."

Core elements, he says, include "engaging the patient in managing his or her medical conditions, being proactive in making sure patients get needed care, suggesting appropriate and compassionate treatment options, answering questions about illnesses, and coordinating the care ordered by specialists."

In addition to training underwritten by MFH, the practices will get supplemental payments from Missouri's Medicaid program and from Anthem Blue Cross Blue Shield of Missouri, and United Healthcare. MFH says these payments will help care providers make the transition to the medical-home model.

During nine years of grantmaking, MFH has handed out $434 million in grants and awards to help improve the health of unserved and underserved residents in 84 Missouri counties, including St. Louis.

Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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