For those Medicaid patients and providers who value quality, cost, and convenience, the future has never been brighter. One of the core objectives driving Medicaid improvements in recent years has been transforming care to be more convenient for the patient. Naturally, what improvements have been made have yielded yet more data for Medicaid providers and patients to analyze.
Of course, it’s understandable that embracing these innovative programs and options can be frustrating. The need for more regular care increases in tandem with the aging of the Medicaid population. As patients’ need for care increases, so too can the feelings of being overwhelmed by choices of providers, care facilities, and understanding the ever-growing list of available resources to help. But luckily, among these resources are three programs designed to help the aging Medicaid population find better care and relief from this unneeded stress during their twilight years. These programs are:
- Health Home
- Home Health
- Home Care
If you get these very similar sounding programs confused, you are not alone. While the common names highlight their shared objectives, they each have unique and distinct goals.
Health Home was created in 2010 as part of the Affordable Care Act. It is built on the “whole-person” philosophy of care, treating patients with a broad yet coordinated continuum of care, bringing together acute, behavioral, and long-term care services needed to treat their whole person, rather than simply reacting to acute health emergencies in facilities that only understand a fraction of the patient’s situation.
Home Health consists of physical and/or occupational therapy, provided in the home, to help someone suffering a decline in overall physical functioning to regain their independence. Home Health is typically warranted when a person has had a recent inpatient stay at a hospital, rehabilitation, or skilled nursing facility. Home health can also benefit those who have had recent medication changes and need education related to potential side effects, and also those who need to be monitored to ensure the medication is effective.
Home Care is most beneficial to those individuals experiencing difficulty performing the wide range of daily living activities, such as cleaning their house and doing laundry. Transportation to and from medical appointments, buying groceries, or for running errands can benefit someone who can no longer drive. Home care services can also, on a short-term basis, help someone who recently had surgery and suffers from limited mobility, or someone whose primary caregiver will be out of town for a period of time.
As the last two programs have the widest footprint as of 2018, they often cause the most confusion. To further help illustrate their differences, the chart below will explain the services covered by each program:
|Services||Home Health||Home Care|
|Therapy towards rehabilitation||Yes||No|
|Administration of medications||Yes||No|
|Formal monitoring of health status||Yes||No|
|Meal preparation or delivery||No||Yes|
|Help with bathing, dress, and grooming||No||Yes|
|Reminders to take medicine||Yes||Yes|
|Prescription medication management||Yes||No|
|IV therapy / injections||Yes||No|
While these services are separate in their administration and covered activities, they are not mutually exclusive. In fact, many families find that using these services in tandem can be quite helpful. Marrying these two services can best help a senior who, for example, is recovering from a hospitalization. The Home Health staff can address clinical and rehabilitative needs during the transition back into the patient’s own home, while a Home Care aide can help with personal caregiving and household chores during recovery.
And let’s not forget the newest of these three options, Health Home. Since 2010, 21 states have created 32 different Health Home models. Washington’s program became a model of effective administration during 2017. It was able to successfully reduce preventable hospital readmissions, emergency room visits, and service duplication. Coordinators also offered valuable assistance in planning and achieving health goals. The Center for Medicare & Medicaid Services (CMS) have provided a few different options regarding who can qualify as a provider in a Health Home program. Potential providers can be:
- Designated providers, such as a physician, clinical/group practice, rural health clinic, community health center, mental health centers or agencies, home health agencies, pediatricians, OB/GYNs, etc.
- Teams of health professionals, such as physicians, nurse care coordinators, nutritionists, social workers, behavioral health professionals, as well as free-standing, virtual, hospital-based, or a community mental health center
- Health team, which must include medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral health providers, chiropractors, and licensed complementary and alternative practitioners
We invite you to explore these three programs in greater detail and learn about how they can benefit you and your clients. Arming ourselves with the knowledge of these programs and how to apply them will empower us to be advocates for patients and providers. This will be crucial as we facilitate a smooth and harmonious process through coordination of care, offering a wide array of services to treat the whole person, both at the clinic and in the home.