An article in Politico caught my attention recently. It was about the Health Homes program and some of its problems.
For those of you not familiar with this program, here’s a brief explanation from the article:
Health homes are not brick-and-mortar buildings. They are a concept based on the idea that if several providers work together to coordinate care for the most expensive Medicaid patients, they can provide better care at a lower cost.
These patients, the so-called super-utilizers, have behavioral and mental health issues, substance abuse problems, multiple chronic conditions, sometimes all of the above. Health homes, which can be a hospital or health and human services agency, assemble a network of providers that together manage care for the patient.
I’ve become familiar with the Health Homes program through some of my social service agency work. So, the article spurred some thoughts:
1. It’s hard to get incentives correct
In the Health Homes program, the state was giving incentives to health service providers to reach out to their most expensive patients. The idea was to get more Medicaid “super-users” enrolled in the program.
But while there were incentives for outreach, there was no incentive for actually enrolling patients. As a result, during the last fiscal year, health homes were paid for outreach to 387,000 people. But only about half of those were actually receiving care management.
In other words, the state was providing incentives for the wrong behaviour. It was rewarding process, not outcome.
If you have a critical nature, it’s easy to wonder why this program would pay for work that requires little effort, like sending a letter or making a phone call. And I do wonder.
But I also know from my own work that getting incentives right is really tough—even when it’s for something much more simple, like a sales commission or budget completion. In health care, incentives are orders of magnitude more difficult. This is important to me. On one hand, my current focus is helping with financial issues. Agencies should get paid for the work they do. On the other, I want our work to take place in the greater context of our clients accomplishing their missions.
2. Duplicate efforts defeats data
In this case, a duplication of efforts was being caused by different federal and state requirements and systems. Case workers were having to enter very similar data twice. Which seems silly. But before you feel too superior, ask yourself if all the data in your agency is only entered once. I didn’t think so.
In many agencies, people are eager to talk about dashboards and data, but they haven’t spent the time to eliminate duplicate entry. And whenever people do the same task twice, they rarely do it exactly the same way.
If you want data-driven transformation, you need to eliminate duplication before you talk about dashboards.
3. Sharing data across entities is hard
The main idea behind the Health Home program is patient-centered care. If we can help Medicaid “super users” get organized, we can hope for better results.
But the longer-term goal here is understanding patterns of medical service use. And this requires that different agencies talk to one another. It’s the idea behind RHIOs (Regional Health Information Organization).
I only have indirect experience with this, and I need to learn more. But again, ask yourself: How well does your organization share data internally? How well does it share with its outside partner? Or multiple partners?