Fragmented care has long been a frustrating thorn in the sides of those living with multiple or chronic illnesses. Despite the complexity of their conditions, these patients often receive little to no support when coordinating their medical treatment and struggle to shoulder the administrative burden themselves.

1. The Challenges and
Opportunities of Integrated
Health Homes

2. Fragmented care has long been a frustrating thorn in the sides of
those living with multiple or chronic illnesses. Despite the complexity
of their conditions, these patients often receive little to no support
when coordinating their medical treatment and struggle to shoulder
the administrative burden themselves. Change, however, may be on
the way in Illinois; in late 2018, the Illinois State Plan Amendment put
forth an initiative that would launch the nation’s very first integrated
health home: a fully-integrated care coordination service for all
members of the state’s Medicaid community. This measure could be
one that sparks a national revolution in how providers, payers, and
patients alike approach chronic care management — provided, of
course, that it manages to get off the bureaucratic ground and prove
its potential.

3. Unfortunately, the program is currently hovering in a state of
limbo, waiting out a delay caused by rulemaking provisions in
the Illinois Administrative Procedure Act. With any luck, it
should emerge from the pause and begin supporting chronic
care patients soon — but truthfully, luck shouldn’t be
necessary.
Let’s discuss why the program is such a (necessary)
game-changer.

4. The Need for Care Coordination in
America
Fragmentation isn’t only inconvenient, time-consuming, and stressful for
patients with chronic conditions — in some cases, it’s outright dangerous.
According to one study published in 2018 by the Commonwealth Fund, patients
who live with one or two chronic conditions and experience highly fragmented
care are 13% more likely to visit the emergency department and 14% more
likely to be admitted to the hospital than those who have well-coordinated care.
The lack of inter-provider communication fragmentation causes can also put
patients at risk of experiencing lower-quality treatment or suffering from
medical mistakes caused by misunderstandings between members of their
disjointed care team.

5. Cost, too, is a concern. Poor care coordination can increase the typical cost burden
for patients with chronic conditions by more than $4,500 over three years.
Moreover, researchers for a study conducted by the healthcare performance
improvement firm Vizient found that beneficiaries with two or more chronic
conditions accounted for a startling 90% of Medicare spending. However, not all
chronic care patients incurred the same costs, even if they struggled with identical
illnesses; as one writer for the study describes, “Medicare incurred substantially
lower episode costs for patients who received the overwhelming majority of their
care from a single multispecialty physician practice organization compared to
patients whose care was fragmented across multiple provider organizations.”
Care coordination, not disease alone, determines a patient’s cost burden.

6. Resolving Care Fragmentation Through
Health Homes
Several factors contribute to the prevalence of care fragmentation in the U.S.
These include but are not limited to: the separation of primary care from
hospital services, physician payment structures that do not reward
collaborative patient treatment, and fraying personal relationships between
PCPs, specialists, and inpatient care facilities. EHRs have the potential to make
communications easier; however, many providers use platforms that are
incompatible with competitors’ software, rendering data-sharing between the
two difficult to the point of impossibility. All of these problems can be
frustrating for patients who only want the medical care they need to manage
their chronic conditions.

7. Health homes offer a solution to
fragmentation.
The term is somewhat of a misnomer, given that it doesn’t refer to a physical building. Instead,
Health Homes are an optional Medicaid State Plan benefit that, if facilitated by a given state, can
offer eligible patients comprehensive care management, coordination, and social services support.
Under this program, enrollees would be connected to a health home care provider who would take
responsibility for coordinating their care. The above benefits would be available to those who
have: one to two medical conditions, a single condition and are at risk of developing another, or
one serious and persistent mental health condition. Qualifying conditions include — but are not
limited to — asthma, diabetes, heart disease, addiction, and obesity.

8. Illinois’ Integrated Health Homes: A New
Model?
The Integrated Health Homes initiative sets itself apart from other such programs because it
expands access to care coordination to the entirety of the state’s Medicaid population,
regardless of match status. This means that even those with a single chronic condition — or
no chronic condition but complex care needs — could opt into the logistical support that care
coordination services provide. Moreover, the Integrated Health Home program goes further
than other states’ iterations, encompassing care planning and monitoring, physical health
provider engagement, behavioral health provider engagement, supportive service
engagement, member engagement and education, and population health management.
Ultimately, the proponents of the program seek to “evolve toward a full clinical integration of
behavioral, physical, and social healthcare.”
It’s certainly a worthy goal. Moving forward, we can only hope that Illinois’ Integrated Health
Home program emerges from its approval delay quickly — and that other states follow its
example.

9. THANK YOU!!