Health Home demonstration saves more than $160 million for Medicare program over four years

Monday, October 28, 2019

Medicaid-eligible clients enrolled in both Medicaid (Apple Health) and Medicare are known as “dual eligible clients,” and many are eligible to participate in Washington’s Health Home demonstration project approved by the Centers for Medicare & Medicaid Services (CMS). New analysis from CMS shows the Health Home demonstration has saved the Medicare program more than $166 million over four years through better care coordination.

Dual eligible clients receive Health Home services through managed fee-for-services agencies since they are not enrolled with an Apple Health managed care plan. (HCA also offers the Health Home program for Medicaid-only clients through managed care plans). There are 78,770 total clients enrolled in the demonstration, and 13,083 are actively participating dual eligible clients. The achieved savings are directly related to these dual eligible clients.

Health Home services, administered by the Health Care Authority (HCA) in partnership with the Department of Social and Health Services, support clients with chronic illness by enhancing their care coordination between medical and social service providers. Other program services include:

  • Transitional care following hospitalizations.
  • Building individual and family supports to maintain and promote quality of life.
  • Referrals to other services intended to improve clients overall health.

According to CMS’s evaluation, released in September 2019, “Many functions of Washington Health Home coordinators are similar to those of care coordinators in other states. What makes Washington’s care coordinators unique is their focus on engaging enrollees to set health action goals and increase self-management skills to achieve optimal physical and cognitive functioning. Health Home care coordination—which focuses on meeting enrollees in the community, primarily in their own homes, is an intensive function.”

A story of improved patient care

The result is improved patient care while cutting costs, as seen with “Jane,” a 60-year-old woman who had a liver transplant, has type 2 diabetes and is currently on dialysis three times per week. She resides in an adult family home and her Health Home goal was to be happy in the home. She was not getting along with other residents and once hit a fellow resident. Before opting into Health Home, she had uncontrolled labs and monthly emergency department and inpatient visits. The care coordinator worked with the case manager, the adult family home staff and Jane’s providers to begin working on the goals that Jane had set. The adult family home provider now cooks diabetic-friendly meals and monitors Jane’s medications and glucose levels.

Jane is now getting along with everyone in her adult family home and states, “I love it here! I feel so much better and I never want to leave.” Jane has become more mobile and leaves her room more often. She eats dinner with the other residents, when before she never left her room except to use the bathroom. She has had no emergency department visits in more than four months, attends all her follow-up appointments and has had normal lab results. She continues to receive support from her Health Home care coordinator.

Washington receives a portion of the savings achieved for the Medicare program, based on meeting cost savings and quality benchmarks, which can be used to reinvest in the program. For the most recent year HCA received $15.5 million, for a total of $52 million in preliminary Medicare Parts A & B savings payments from CMS in the first four years of the demonstration.

For more information

Centers for Medicare & Medicaid Services: Washington State Health Home demonstration

HCA’s Health Home program