National Governors Association’s (NGA) https://www.nga.org Center for Best Practices, Health Division plus several expert leaders from Michigan and West Virginia gathered at the National Press Club on December 5, 2017 to address the problems associated with dealing with the issues affecting the populations in their states that require complex care.
The NGA event emphasized how the complex care program can effectively build and advance as discussed in detail in the just released NGA report titled “Building Complex Care Programs: A Road Map for States” www.nga.org/cms/vuilding-complex-care-programs. .
In addressing complex care issues, Hemi Tewarson, Director, Health Division, NGA’s Center for Best Practices, https://www.nga.org/cms/center, discussed policy issues facing Medicaid. She explained, “Enabling complex care programs to work with Medicaid can reduce the high level of unnecessary emergency room visits and unnecessary admittance to hospitals.
Sandra Wilkniss, Program Director, Health Division, NGA Center for Best Practices, advised, “To build a complex care program, it is the important to develop not only internal resources but also work with stakeholder partnerships.
Many realize that some patients experience high utilization of health care services especially when going to hospital emergency rooms unnecessarily”, reports James Becker MD, Medicaid Director for the West Virginia Department of Health and Human Services http://dhhr.wv.gov,
He said he knew of a case where a grandchild with asthma would have attacks and the grandmother would take the child each time to the emergency room when the medical condition could have been taken care of at local clinic. By intervening and educating the grandmother on how to care for the grandchild’s asthma attacks by utilizing other clinics and facilities in the community, the emergency room visits were greatly reduced.
West Virginia is partnering with academic medical centers and their health plan partners to serve as hubs for regional pilots in order to provide evidence-based interventions for Medicaid patients with complex care needs. The Academic Medical Centers are going to help local providers collect more data, accurately analyze the data, and then support improved patient-centered care to handle complex health needs.
The state faced with a high number of homeless is developing pilots to shore up social determinants of health. Preliminary findings obtained from the pilots show that the homeless being managed through primary care providers, has enabled participants in the pilot to better manage their chronic diseases. Also, an effective working relationship between physicians and Managed Care Organizations is taking place.
Matt Lori, Deputy Director, Michigan Department of Health and Human Services (DHHS), https://www.michigan.gov/mdhhs explained, “By examining Matching Medicaid claims and the Homeless Management Information System, the state found that at least 16 percent of the 2,700 identified complex care patients in the state were homeless.”
He reports that in Lansing Michigan, he has observed that the homeless aren’t really familiar with available clinical support assistance since they don’t really feel they are part of the community. He strongly views housing as a social determinant of health.
Michigan has determined that a “Housing First” approach for the homeless is essential to provide complex care interventions. Providing housing for the homeless is cost effective and has been shown to improve health outcomes and reduce costs.
The state is also advancing ideas on how to effectively integrate and coordinate physical and behavior health to not only help the homeless but other residents in communities with complex health issues.
In October 2017, the Michigan DHHS took the first step to develop and structure pilots to address how to effectively work with the homeless to improve their overall need to feel at home in the community. The development of the pilots will eventually lead to a Request for Information that will enable the selection of pilot sites.
From another viewpoint Natassia Rozario, Associate Counsel and Senior Director of External Affairs, for the Camden Coalition of Healthcare Providers www.camdenhealth.org, a nonprofit community-based coalition of providers caring for people with complex health and social needs. The project was developed by Jeffery Brenner, a private practice family physician.
So far, the coalition has been able to identify individuals needing comprehensive psychosocial assessment, provides health professionals to visit patients to coordinate care, plus provides information sharing through a health information exchange to coordinate care.