Health Home program saves more than $100 million for Medicare program over three years
OLYMPIA – An innovative program meant to support Apple Health (Medicaid) clients with chronic illness has saved Medicare more than $107 million over three years, according to new analysis from the Centers for Medicare & Medicaid Services (CMS).
In 2013, Washington piloted the Health Home program, which provides community-based care coordination as part of the Apple Health program. The program began as part of the federal Affordable Care Act. It’s one of the programs to help states find innovative ways to improve patient care while cutting costs.
Many clients use this benefit through their Apple Health managed care plan. Clients enrolled in both Apple Health and Medicare (known as “dual eligibles”) are not enrolled in managed care plans and instead use their Health Home program through what are called managed fee-for-services (MFFS) agencies.
About 19,600 dual eligible individuals are currently enrolled in the Washington Health Home program.
The analysis—produced by an independent evaluator for CMS—looked at the quality of the Health Home program and the savings generated by these MFFS agencies.
The state is eligible to receive a portion of these savings achieved for the Medicare program through better coordination. HCA received more than $36 million in preliminary savings in the first three years of the demonstration. HCA reinvested most of these funds back into the program to increase the number of trained care coordinators. The funds also were used to increase payments for services provided as well as performance incentive payments to Health Home agencies.
Using predictive modelling with past health care data, the state identifies Apple Health clients who might benefit from the Health Home program. Specific services available to Health Home participants include:
- Care management and coordination between medical and social service providers.
- Transitional care following hospitalizations.
- Individual and family supports to maintain and promote quality of life.
- Referrals to other services that could improve their overall health.
Before the Health Home program, many dual eligibles navigated the health care system completely on their own. Lack of care coordination resulted in fragmented care that was hard for these individuals to navigate, and resulted in potentially avoidable costs in emergency room, hospital and institutional care.
“The Health Home program is providing a more person-centered, holistic approach to Washingtonians with some of the most complex health needs,” said State Medicaid Director MaryAnne Lindeblad. “This pilot is helping demonstrate that better coordination and individual empowerment can achieve better health outcomes and savings.”
HCA and the Washington State Department of Social and Health Services partner to administer the Health Home program.