ACA Health Home program saves money, lowers inpatient care

How can public health do better at addressing both physical chronic health conditions and mental health issues in high-risk populations? The answer might lie in combining care for both.

At a Monday afternoon session on “Integrating mental health and chronic disease intervention strategies,” three presenters from Mount Sinai Health System in New York outlined how they implemented the Health Home program — established by the Affordable Care Act — in their system. They also explained how rather than continuing to wait for statewide evaluation of the program, they evaluated their work on their own.

Put simply, in the team’s small sample, Health Homes work. To be accepted into the program, adults with Medicaid coverage needed to be diagnosed either with two qualifying chronic health disorders and a diagnosis of a serious mental health condition or HIV. Once in the program, participants could access all of their health care — mental, behavioral and physical — from one team, including a licensed social worker, that shared all of their patient data. Health Homes provide comprehensive care management; care coordination and health promotion; comprehensive transitional care; patient and family support; referrals to community and social support services; and use of health information technology to link patients to services.

Even in this small study, the results spoke for themselves. Use of outpatient services increased over a year, while use of inpatient and emergency department services decreased. Average cost savings per participant was more than $8,000, and annual savings per care team was $571,900 in medical utilization costs, even after taking into account the cost of starting enrollment and sustaining the program.

And health care providers were better able to provide comprehensive care, the researchers said. Sometimes people don’t want to tell their primary care provider or specialists that they’re using psychiatric medications. With a care coordinator communicating patient data between all members of the health care team, providers were able to the examine the full scope of a person’s health and could modify their recommendations for treatment based on a more complete picture.

Of course, with a small study such as this, there are some limitations. The researchers used the New York Psychiatric Services and Clinical Knowledge Enhancement System to collect their data, so their results are dependent on how accurately patient data was entered.

And researchers noted that even with the Health Home program, the absence of social workers or care coordinators working in the community to address social determinants of health means patient outcomes won’t likely improve. For example, if a patient doesn’t have heat at home or clean water to drink, cook with or use to clean wounds, he or she might continue to return to the emergency department time and time again.

As the program continues to grow — as of 2017, it started including children in its coverage as well — researchers suggested there’s room for improvement, particularly in providing more culturally informed care. One example: Why not have peers included in the Health Home model? After all, as we’ve learned time and time again at this Annual Meeting, the people disproportionately affected by health issues are also the people most likely to have the solutions.