The Promise Of Medicaid Health Home Technology

The following is a guest post by Ms. Lori Evans Bernstein, President of GSI Health.

The Affordable Care Act of 2010 introduced the health care industry to Medicaid Health Homes, an optional Medicaid State Plan benefit program designed to improve Medicaid care coordination and delivery for patients with two or more chronic conditions. Of course, like so many aspects of the new legislation, this provision created at least as many questions as it has answered. Most importantly, what kind of technology will Medicaid Health Homes require to ensure successful implementation?

In order to answer that question, you need look no further than the primary benefits this new care model offers:

Collaboration
Medicaid Health Homes are expected to offer “whole-person” care. That means breaking down the silos that have traditionally separated care providers into categories such as medical, social and behavioral and inpatient, outpatient and post-acute. This is no easy task.

Medicaid Health Home technology needs to offer care providers the tools and resources required to bridge the information and collaboration gap those traditional care silos have created. Individual care providers require a flexible solution to share patient information and collaborate on their care effectively and efficiently among multiple providers and across the care continuum.

In short, Medicaid Health Homes and Accountable Care Organizations (ACOs) need a health IT platform capable of unifying not only data from different sources but also providers in different settings and distributing relevant patient information in a precision-targeted manner.

Accountability
Delivering on the promise of “whole-person” care is not just about connecting systems. It’s about connecting people and creating a clear path to accountability. Medicaid Health Home technology needs to connect patients with the integrated network of care providers required to address their unique individual needs. In order to achieve that mission, care providers require a health IT solution that goes beyond today’s electronic health record systems used “inside the four walls” capable of connecting them seamlessly with the colleagues and fellow professionals required to establish a complete picture of each patient’s care history.

With so many different professions and providers collaborating on patient care, creating a comprehensive workflow is essential if Medicaid Health Homes are to be successful. Analyzing data and reporting outcomes and predicting risk and events are necessary, but not sufficient to improve outcomes and reduce costs.  The tools enabling collaboration on patient care that, for example, alert the provider to an ED admission, manage referrals to various providers and community services, reconcile medications during a transition of care, engage patients in their care and provide a dynamic coordinate care plan are essential to building and succeeding along the path to accountability among various providers and with patients. In order to oversee the implementation of those collaboration tools and provide accountability, you need Medicaid Health Home technology that connects your care team quickly and dynamically to act on patient events, care processes and new information.

Payment
One of the most important and pressing questions Medicaid Health Homes raise is how best to handle payment under this new care model. Currently, many ACOs and Medicaid Health Homes are trying to retrofit old payment models to the new paradigm or manage the old and new paradigms simultaneously. This approach isn’t working because, given the diversity of providers (medical, behavioral, social), it is dramatically less efficient and effective to bill incrementally and too complex to manage multiple payment models.

Instead, these organizations need to start viewing their billing coordination efforts along a continuum and from a more whole person care perspective. In the future, payers will have to figure out a new approach to allocation and distribution between different organizations. In order for this new model to be successful, ACOs and Health Homes need the health IT tools and platforms capable of unifying their reporting, allocating payments and providing administrative tracking capabilities.

As new Medicaid Health Home payment models evolve, Medicaid Health Home technology needs to create the sorts of integrated financial tools that allow a diverse group of providers and payers to create a truly cohesive care experience for every patient.

So what does all this mean for ACOs and other networks or organizations currently weighing the benefits of establishing a Medicaid Health Home? While there are plenty of important questions to be asked on a case-by-case basis, one answer is clear: In order to deliver the increased quality of care and potential cost-saving benefits, it pays to invest in the kind of Medicaid Health Home technology that takes the key criteria above into account.

GSI Health recently authored a free downloadable whitepaper for healthcare organizations considering forming a Medicaid Health Home titled, How To Turn The Promise Of Medicaid Health Homes Into Reality. To download it and learn more about GSI Health’s momentum with Medicaid Health Homes, visit medicaidhealthhomes.gsihealth.com

Ms. Lori Evans Bernstein is the President of GSI Health, a health IT provider. Ms. Evans Bernstein has over two decades of experience in healthcare, including: executive roles within health care and health IT corporations; senior federal and state governmental appointments; health care delivery system operations; and health services and policy research. She writes and speaks regularly on health IT across the country and participates in numerous industry and federal and state policy initiatives as a national expert. Follow GSI Health and Ms. Evans Bernstein on Facebook, Twitter and Google+.  

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

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