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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

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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Impact Analysis Methods:
Analytic Plan
Mechanism analysis
 Association between patient characteristics and outcomes
 Association between care management activity outcomes
© CASAColumbia 2013
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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
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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
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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
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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
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18.
Ending Addiction
Changes Everything
www.casacolumbia.org
© CASAColumbia 2013

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Speaker Notes
Slide 3:
•
From November 2012 Medicaid Update
© CASAColumbia 2013
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