Implementing a Health Home: Michigan’s Experience

Abstract

As the number of individuals in the United States with chronic conditions and the associated costs in caring for these individuals continues to rise, there is a need to transform how health care services are delivered. Under Section 2703 of the Affordable Care Act of 2010, the federal government provides state Medicaid programs the opportunity to improve care coordination for people with chronic conditions in a person-centered approach through the establishment of health homes. Given the complexity of care for Medicaid beneficiaries with chronic conditions, addressing the social determinants of health and providing integrated care are central to effectively improving health outcomes and generating cost-savings. Although launching a health home model is a step toward improving care coordination and care management for high-risk individuals, there are myriad components to implementing such a program. The purpose of this article is to explain the process that Michigan policymakers undertook to implement its Section 2703 Medicaid health home initiative, named the MI Care Team. The authors present lessons learned for policymakers and stakeholders in other states seeking to implement a Medicaid health home and explain how the nursing profession is integral for health homes.

Nursing impact on chronic disease Medicaid health home patients: A qualitative study

“…The MHH team includes primary care physicians, behavioral‐health consultants (eg, social workers), nurse care managers, community health workers (CHWs), health‐home coordinators, and access to a psychiatrist or psychologist for consultation purposes. The team convenes regularly to monitor patient care and progress, and was responsible for coordinating care with all health care providers …”

“…In 2009, more than 145 million Americans had one or more chronic diseases, and health care trends indicate that by 2030, more than 171 million Americans will have a chronic disease. The prevalence of individuals with chronic diseases continues to grow as the US population ages . Unlike acute illnesses, chronic diseases do not resolve, and treatment is ongoing with a need for health care management.…”

“…Improving chronic disease health care management for individuals with limited resources aligns with the Affordable Care Act State option of implementing a Section 2703 Medicaid health home ([MHH]). Health home providers integrate and coordinate all primary care, behavioral health, and long term services and supports to treat the whole person.…”

“…The MHH, known as the MI Care Team, provides care to Medicaid enrollees who are diagnosed with a behavioral health disease (ie, mild to moderate depression or anxiety) and a physical health disease (ie, diabetes, hypertension, heart disease, chronic obstructive pulmonary disease, or asthma). The goal of the MHH is to improve health care outcomes and service use through enhanced patient‐centered care coordination and health care management for low‐income individuals with both behavioral and physical health chronic diseases …”

“…The nurse is a key MHH team member, and serves as the primary patient health care manager . The nurse completes the initial assessment, care plan that is reviewed by the MHH team, and is the discipline who has regular and ongoing interaction with the patient . The purpose of this qualitative study was to assess the nurse's perception of their MHH role and how they may impact patient health care utilization patterns.…”