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Health Home Evaluation Overview


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The Health Home project is evaluating a new program that is part of healthcare reform in New York State. The program identifies individuals with substance use disorders who have other medical and psychiatric problems and offers them a new form of integrated care. The evaluation will study whether this program results in better quality of care and a reduction in health care costs for this vulnerable and chronically ill population.

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Health Home Evaluation Overview

  2. 2. HH Evaluation Committee • NYS Department of Health • NYS Office of Mental Health • NYS Office of Alcoholism and Substance Abuse Services • Columbia University • New York University © CASAColumbia 2013 Partial support provided by the National Institute on Drug Abuse 2
  3. 3. Presentation Overview • Critical features of NYS health homes (HH) • Evaluation goals • Methods  Quantitative study (well-defined)  Qualitative study (in progress) • Bidirectional provider-evaluator feedback loops  Inform evaluation  Improve HH implementation • Conclusions © CASAColumbia 2013 3
  4. 4. Overview of Section 2703 if ACA: What Federal Statute Attempts to Accomplish? • Medicaid recipients with multiple chronic conditions • Fragmented, inefficient, crisis-driven care leads to high costs to govt. and poor health outcomes • Expansion of medical home “whole person” approach  Care management and service integration  Flexibility for states to design programs  90% FMAP rate for 8 quarters • Better health care outcomes (quality measures) and reduced costs © CASAColumbia 2013 4
  5. 5. NYS HH: Overview of Distinctive Features • Medically complex, costly chronic behavioral health conditions  Priority based on clinical acuity & care disconnection • “Whole person” care enabled via diverse network partners (new/merged entities)  Patient centered care includes robust outreach & engagement efforts  Novel payment arrangements to incentivize system-redesign  Flexible approach to defining HH standards coupled with quality measurement • Engagement, access, and receipt of appropriate care can reduce crisis care (ED, inpat. readmissions), improve health outcomes, and reduce costs © CASAColumbia 2013 5
  6. 6. Health Home Evaluation Goals I. Did HHs increase “appropriate” care, improve health outcomes & reduce costs? (Impact)  Across diagnostic and “priority” subgroups  Across regions  Consistency across success metrics II. Were HHs implemented as planned? (Implementation)  Needed context to interpret patient-level outcomes  Critical to inform NYS healthcare system redesign III. Can evaluation feedback to providers improve HH performance?  DOH led efforts  Develop bidirectional-evaluator information sharing loops © CASAColumbia 2013 6
  7. 7. Impact Analysis Methods: Administrative Data • Medicaid Claims & Encounters  Basic demographics (e.g., gender)  Diagnostic groups & health status  Geography, managed care status, prior case mgmt. enrollment  Service utilization  Quality indicators  Pharmacy © CASAColumbia 2013 7
  8. 8. Impact Analysis Methods: Administrative Data • CMART  Care management activity  Functional assessment • OASAS Client Data System  SUD tx outside Medicaid  Richer individual description • OMH utilization and program status © CASAColumbia 2013 8
  9. 9. Impact Analysis Methods: Outcome Domains Outcome Domain Data Source Example Question Assignment/Enrollment Eligibility/HH Enrollment What are characteristics of enrollees? Avoidable Utilization Medicaid Claims/Encounters Do HH reduce ED visits and rehospitalizations? Medicaid Claims/Encounters, CMART Are quality of care indicators (e.g., HEDIS HbA1c for diabetes) improving? Is care management activity associated with improvement in quality of care? Patient Functioning & Experience CMART Is patient functional status improving? Are patients satisfied with care? Cost Reductions Medicaid Claims/Encounters Are HH reducing costs? Quality of Care © CASAColumbia 2013 9
  10. 10. Impact Analysis Methods: Quality Indicators Quality Domain Care Management Guideline Concurrent Care Continuity of Care Example Engagement rate; Contact rate HEDIS & Behavioral Health indicators (e.g., appropriate medication utilization) Post-discharge admissions to next level of care Prevention Chlamydia screening in women Patient Functioning Improved capacity to perform basic tasks Patient Experience of Care Patient satisfaction © CASAColumbia 2013 10
  11. 11. Impact Analysis Methods: Analytic Plan Descriptive • Patient characteristics  Overall and by HH • Quality of care  Overall, by patient sub-population (e.g., MH, SUD HIV/AIDS), and by HH © CASAColumbia 2013 11
  12. 12. Impact Analysis Methods: Analytic Plan Multivariable • Times series  Longitudinal trends (2006-2017)  Control for individual (demographic, clinical) and regional characteristics  “risk-adjusted” by HH • Statistically matched comparison group  Propensity score methods  Longitudinal design © CASAColumbia 2013 12
  13. 13. Impact Analysis Methods: Analytic Plan Mechanism analysis  Association between patient characteristics and outcomes  Association between care management activity outcomes © CASAColumbia 2013 13
  14. 14. Implementation Analysis: Areas For Inquiry • Assignment, enrollment, and engagement process • HH structure, organization, staffing, roles & training • Implementation of HH core services (e.g. integrated care plans) • Health Information Technology (HIT) • Payment methods (e.g., acuity-based CM rates) & quality measure © CASAColumbia 2013 14
  15. 15. Implementation Analysis: Methods • Survey of all HHs • Site visits to representative sample of HHs for more intensive assessment  Key stakeholder interview across partners  Chart reviews  Focus groups with staff & possibly HH enrollees © CASAColumbia 2013 15
  16. 16. Feedback Efforts to Improve HH Implementation DOH led efforts  Quality indicator feedback  CMART training and feedback Potential to develop process improvement collaborations across evaluators and HHs  Select high priority areas HHs (e.g., HIT)  Limited number of HHs interested in specific issues  Create low threshold process improvement feedback cycles  Strong evaluator support and access to expert technical assistance © CASAColumbia 2013 16
  17. 17. Summary Federal HH legislation encourages state to experiment  Strategies to improve care to vulnerable populations  Foster healthcare system redesign NYS HH project is among the most novel and ambitious state program  Size, scope, complexity  Goals for system redesign Evaluation is designed to support HH goals  Multiple methods  Multiple perspectives  Attempt to provide timely feedback © CASAColumbia 2013 17
  18. 18. Ending Addiction Changes Everything © CASAColumbia 2013
  19. 19. Speaker Notes Slide 3: • From November 2012 Medicaid Update © CASAColumbia 2013 19