By Colleen S. Good
Times West Virginian
Some West Virginians with Medicaid will have access to a new resource with the recent launch of the Health Homes initiative. The program, which is grant-funded, launched July 1 of this year.
The general program was created by the Patient Protection and Affordable Care Act. The program is designed to provide better coordinated care for Medicaid patients with chronic conditions.
The West Virginia version of the program works to better coordinate patient care for Medicaid patients who have been diagnosed with bipolar disorder and who may have hepatitis B or C, said Penny Hall, communications manager for the West Virginia Bureau for Medical Services.
Hall said that for the first eight quarters of the program, they will receive an “enhanced match” from the federal government for individuals enrolled in the program.
While in some other areas of the country the program is being used to coordinate care for Medicaid patients with a wide variety of chronic conditions, Hall said in West Virginia, they decided to start small.
“Some states started really big and tried to deal with every issue possible,” Hall said. “We decided that we wanted to take smaller steps and make sure our model works before we try to extend it out to a bigger population. We’re hoping we see some really positive results.”
The program works through coordinated care, using a professional team to help patients manage their medical conditions and medications, remember doctor appointments, and understand and interpret medical tests and results. The team includes a care coordinator, whose primary responsibility is to “make sure that everybody is talking,” Hall said.
“He or she is the person who makes sure that when the person goes to their primary care physician, the physician knows what medicines the person is on, that they’re involved in the program,” Hall said.
There is also more direct coordination between the patient’s primary care physician and their behavioral health specialist.
“There’s electronic communication between the two, so that the primary care doctor and behavioral health specialist can see what’s going on with this person, and can collaborate on what might be the best course of action,” Hall said.
“It’s really geared toward providing them with substantive case services, and looking at them as a whole person, not just a behavioral health diagnosis,” Hall said. “Our whole goal is to hopefully keep them out of the ER (emergency room), out of crisis situations, and also help them stay on their medication so they can live a full life, and not go into that physical cycle of extreme happiness and extreme sadness.”
Hall said that without the program, a bulk of care coordination is left up to the patient.
“It’s really up to that individual to let the primary care provider or the behavioral health specialist know what drugs they’re on. It’s up to the patient basically to give that information to the doctors,” Hall said. “With this program, they have somebody that helps them with that….We know based on our own experiences that sometimes you’ll go to the doctor and forget.”
Someone will also be checking in periodically with the patient about their medications.
“Somebody will be checking with this person, basically saying, ‘Are you taking your medications? Are they working? Are you having any problems with them?’” Hall said. Hall said that then that person would follow up, and schedule them for an appointment if they were having problems to try and find another medicine that may work better for them.
These comprehensive approaches have been shown to lower medical costs and improve the patient’s health.
The program works through partnerships with approved providers. Currently, eight providers have been approved in six counties: Cabell, Kanawha, Mercer, Putnam, Raleigh and Wayne. While patients don’t have to live in those counties to enroll in the program, they do need to be undergoing treatment with one of the eight providers, which are Cabin Creek Health Systems, FMRS Health Systems, Marshall Health, Prestera Center for Mental Health, Process Strategies, Southern Highlands, WV Heath Right and WomanCare Inc.
According to the West Virginia Department of Health and Human Resources Bureau for Medical Services website, bipolar disorder was chosen because a large population is diagnosed with bipolar disorder within the six-county region, people with bipolar disorder are more likely to have hepatitis B or C, they are more likely to have substance abuse issues, they have different treatment needs than those with other severe mental illness, and they are more likely than people with other severe mental illnesses to need intense, proactive medical care.
The six-county region was chosen because the counties have high rates of individuals being treated for bipolar disorder, and have good accessibility to health care providers.
While Hall would like to see the program expand if successful, she said it can’t happen right away.
“We want to make sure our model works and make tweaks prior to expanding it,” Hall said.
The program has been thought-out and planned in detail from the beginning, Hall said.
“We have spent close to three years putting the program together. We wanted to make sure before we launched the program that we had thought through as much as possible every ramification, and made sure we had a good model right from the very start,” Hall said.
The program is currently accepting patients. The first patients to enroll were auto-enrolled from those who were enrolled in Medicaid and had the bipolar diagnosis, though all patients were given the opportunity to opt out of the program. It is open to people of all ages, and patients can be referred by their physicians, or they can self-refer. For more information, call 1-800-461-0655.
Email Colleen S. Good at email@example.com or follow her on Twitter @CSGoodTWV.