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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

  1. 1. HEALTH HOME EVALUATION OVERVIEW JON MORGENSTERN PH.D. PROFESSOR AND DIRECTOR, SUBSTANCE ABUSE SERVICES DEPARTMENT OF PSYCHIATRY CASAColumbia in Partnership with the New York State Department of Health 2013
  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 www.casacolumbia.org © CASAColumbia 2013
  19. 19. Speaker Notes Slide 3: • From November 2012 Medicaid Update © CASAColumbia 2013 19

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