Fragmented care has long been a frustrating thorn in the sides of those living with multiple or chronic illnesses. Despite the complexity of their conditions, these patients often receive little to no support when coordinating their medical treatment and struggle to shoulder the administrative burden themselves. Change, however, may be on the way in Illinois; in late 2018, the Illinois State Plan Amendment put forth an initiative that would launch the nation’s very first integrated health home: a fully-integrated care coordination service for all members of the state’s Medicaid community. This measure could be one that sparks a national revolution in how providers, payers, and patients alike approach chronic care management — provided, of course, that it manages to get off the bureaucratic ground and prove its potential.
Unfortunately, the program is currently hovering in a state of limbo, waiting out a delay caused by rulemaking provisions in the Illinois Administrative Procedure Act. With any luck, it should emerge from the pause and begin supporting chronic care patients soon — but truthfully, luck shouldn’t be necessary.
Let’s discuss why the program is such a (necessary) game-changer.
The Need for Care Coordination in America
Fragmentation isn’t only inconvenient, time-consuming, and stressful for patients with chronic conditions — in some cases, it’s outright dangerous. According to one study published in 2018 by the Commonwealth Fund, patients who live with one or two chronic conditions and experience highly fragmented care are 13% more likely to visit the emergency department and 14% more likely to be admitted to the hospital than those who have well-coordinated care. The lack of inter-provider communication fragmentation causes can also put patients at risk of experiencing lower-quality treatment or suffering from medical mistakes caused by misunderstandings between members of their disjointed care team.
Cost, too, is a concern. Poor care coordination can increase the typical cost burden for patients with chronic conditions by more than $4,500 over three years. Moreover, researchers for a study conducted by the healthcare performance improvement firm Vizient found that beneficiaries with two or more chronic conditions accounted for a startling 90% of Medicare spending. However, not all chronic care patients incurred the same costs, even if they struggled with identical illnesses; as one writer for the study describes, “Medicare incurred substantially lower episode costs for patients who received the overwhelming majority of their care from a single multispecialty physician practice organization compared to patients whose care was fragmented across multiple provider organizations.”
Care coordination, not disease alone, determines a patient’s cost burden.
Resolving Care Fragmentation Through Health Homes
Several factors contribute to the prevalence of care fragmentation in the U.S. These include but are not limited to: the separation of primary care from hospital services, physician payment structures that do not reward collaborative patient treatment, and fraying personal relationships between PCPs, specialists, and inpatient care facilities. EHRs have the potential to make communications easier; however, many providers use platforms that are incompatible with competitors’ software, rendering data-sharing between the two difficult to the point of impossibility. All of these problems can be frustrating for patients who only want the medical care they need to manage their chronic conditions.
Health homes offer a solution to fragmentation.
The term is somewhat of a misnomer, given that it doesn’t refer to a physical building. Instead, Health Homes are an optional Medicaid State Plan benefit that, if facilitated by a given state, can offer eligible patients comprehensive care management, coordination, and social services support. Under this program, enrollees would be connected to a health home care provider who would take responsibility for coordinating their care. The above benefits would be available to those who have: one to two medical conditions, a single condition and are at risk of developing another, or one serious and persistent mental health condition. Qualifying conditions include — but are not limited to — asthma, diabetes, heart disease, addiction, and obesity.
Illinois’ Integrated Health Homes: A New Model?
The Integrated Health Homes initiative sets itself apart from other such programs because it expands access to care coordination to the entirety of the state’s Medicaid population, regardless of match status. This means that even those with a single chronic condition — or no chronic condition but complex care needs — could opt into the logistical support that care coordination services provide. Moreover, the Integrated Health Home program goes further than other states’ iterations, encompassing care planning and monitoring, physical health provider engagement, behavioral health provider engagement, supportive service engagement, member engagement and education, and population health management.
Ultimately, the proponents of the program seek to “evolve toward a full clinical integration of behavioral, physical, and social healthcare.”
It’s certainly a worthy goal. Moving forward, we can only hope that Illinois’ Integrated Health Home program emerges from its approval delay quickly — and that other states follow its example.