The Obamacare Report (#21) / Better ways to manage chronic conditions through “Health Homes”

November 26, 2013

health-care-lawThis is installment #21 in a continuing series of Obamacare Reports

Attorneys often find that arranging for clients to receive care for chronic conditions is a major challenge. The typical fragmented approaches to care associated with the present Health Care System may not result in satisfactory outcomes.

New approaches to chronic care could have a significant impact on these problems.

The original statutes of the Affordable Care Act (ACA) included an optional provision (section 2703) for states to provide coordinated care for Medicaid enrollees with chronic health conditions.

These new coordination programs were called “Health Homes” (HH) and were to be implemented through changes in Medicaid state plans.The objective was to illustrate both improved quality of care and reduced costs for eligible individuals.

A limited number of such operations have been proceeding during 2013.

Under an HH agreement, eligible individuals are to have either two chronic conditions; one condition with the risk of a second; or a “serious and persistent” mental health condition.

The term “Health Home” means a designated provider or a health care team that is selected by an eligible individual.

Coordination of care is to take place through a voluntary, cooperative relationship.

HH coordinators are to apply for and must be approved for this designation.

Under section 2703, not later than January 1, 2014, the Department of Health and Human Services (HHS) is to survey states implementing HH programs regarding the impact of the coordination concept. Specific measures are to include hospital admission rates, chronic disease management, impact of coordination of care, implementation success, lessons learned, and cost savings.

It is hoped that improved approaches to the management of chronic conditions will be developed through this aspect of the ACA.

This may be particularly important, since a specific aspect of the ACA that was targeted to long-term care (a public long-term care insurance program called Community Living Assistance Services and Supports, or CLASS) has been rescinded as not financially viable.

All attorneys who are involved in helping clients and families deal with long-term care and chronic conditions may find it useful to track the experiences of the HH program.

Another posting to appear this week—on this Legal Solutions blog—considers the broader access-to-care issues related to long-term care and chronic conditions (see Access to Care Report #21). An additional posting this week also describes how the State of Washington is implementing an HH program (see Washington Elder Law Practice Report #4).

More on these and related ACA topics, with an in-depth discussion of organizational reactions to implementation issues, may be found in a recent book by the authors that describes evolution of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.