Driven in no small part by the Affordable Care Act, the healthcare industry needs a solution that coordinates and unifies providers and payers across the entire care continuum. At least one clear answer to that challenge has emerged: Medicaid Health Homes.
For those who may not yet be familiar with this new terminology, Medicaid Health Home refers to an optional Medicaid State Plan benefit program designed to improve Medicaid care coordination and delivery for patients with two or more chronic conditions.
Medicaid Health Homes are uniquely suited to help both providers and payers meet the demands of the newly emerging healthcare environment and deliver on the promise of the five key objectives that will, increasingly, act as the benchmark for success:
- Delivering whole-person care rather than fragmented care to result in better care;
- Delivering care in teams rather than in silos to result in happier patients;
- Adhering to care guidelines to manage the workflow among providers to result in higher quality;
- Measuring performance to pay for value rather than volume to lower costs;
- Engaging patients in their care to result in improved compliance and adherence.
While the seeds of change have been planted and the necessary adjustments to care delivery approach are growing fast, current forecasts suggest that 2014 will be the year Medicaid Health Homes fully take root in the new healthcare environment.
The reasons for this watershed moment in healthcare history are simple. Regulatory and market-based incentives established by and resulting from the ACA are leading payers and providers into this new system. These incentives are designed to encourage implementation and participation prior to the time it becomes required by law. As these incentive windows begin to close, more and more organizations and individual providers will rush to take advantage of the many benefits that Medicaid Health Homes offer.
But incentives and the promise of regulatory requirements aren't the only reasons Medicaid Health Homes are gaining ground as the industry sets its sights on 2014. The promise of improved care quality and patient satisfaction that this new collaborative care continuum approach offers is a major factor in both the provider and payer decision making processes. All that adds up to reduced admissions and overall care delivery costs.
While the cost-saving aspect of Medicaid Health Homes is, of course, secondary to care quality, it is a benefit that healthcare industry executives, policy leaders and insurers can't afford to ignore.
With all the benefits and advantages that Medicaid Health Homes offer, you may be wondering why every relevant care organization has not yet embraced this new approach. As with any sweeping change, the ACA has produced plenty of uncertainty. It takes a significant amount of time, money and energy to make the transition to a new model of care.
Many care providers and organizations are taking a wait-and-see approach, learning from the successes and mistakes of others before formulating their own transition plan. Of course, waiting until the last possible moment to adopt the Medicaid Health Homes model carries its own set of risks and potential pitfalls. In recognition of that fact, now that public payers have started to set the pace - thanks in no small part to government incentives that help manage the cost of transition - they are setting a credible example that other organizations are beginning to follow in growing numbers.
As 2014 draws closer, one thing is clear: those providers and payers who make the switch sooner than later are setting themselves up for greater success in the future. By adopting the Medicaid Health Homes solution now, they will have more time to integrate this new approach into their clinical programs and payment models, giving them a significant competitive advantage.
Lori Evans Bernstein is the President of GSI Health, a health IT solutions provider.