Medical homes may give better quality of life to chronically ill

States can "drastically improve" the health of their sickest Medicaid beneficiaries by taking advantage of the new option in the Patient Protection and Affordable Care Act to offer "health homes" to enrollees with chronic conditions, according to Renée Markus Hodin, director of the Integrated Care Advocacy Project at Community Catalyst in Boston, MA.

This can be done, Ms. Hodin says, by improving the coordination of medical care and connecting patients to appropriate community and social supports.

"States that have implemented these kinds of health homes have seen improved quality of life for chronically ill patients," reports Ms. Hodin. Medicaid enrollees with asthma in North Carolina's medical home program, Community Care of North Carolina, experienced 17% fewer asthma-related ER visits and 40% fewer asthma-related hospital admissions between fiscal year 2003 and 2006, she notes.

North Carolina's Medicaid medical home program saved the state between $154 and $170 million in 2006 alone, says Ms. Hodin, while Illinois saved $220 million in the first two years after its Medicaid medical home program was fully implemented.

"The health home option offers a viable alternative to the kinds of draconian Medicaid cuts we've seen in Arizona, which eliminated coverage for some heart, liver, lung, pancreas, and bone marrow transplants," says Ms. Hodin. It also offers an alternative to less drastic cuts in other Medicaid benefits, she adds, and reductions in already-low Medicaid provider reimbursement rates.

Not much of a downside

"Truly, there are not many downsides for states in electing to take this option," says Ms. Hodin.

In order to receive approval from the Centers for Medicare & Medicaid Services for the state plan amendment required to receive the enhanced federal match dollars associated with the health home option, she notes, states must provide at least six key services to eligible enrollees. These are comprehensive care management, care coordination and health promotion, comprehensive transitional care from inpatient to outpatient settings, individual and family support, referral to community and social support services, and the use of health information technology to link services.

"States have flexibility in determining the reimbursement structure," says Ms. Hodin. "They have a number of options to choose from for provider arrangements that can qualify as health homes."

Contact Ms. Hodin at (617) 338-6035 or hoden@communitycatalyst.org.