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Proviso Delays Kansas Health Home Expansion

The Kansas Senate Ways and Means Committee has adopted a budget proviso that’s expected to delay the implementation of “health homes” for KanCare patients with chronic illnesses such as asthma and diabetes.

The proviso, drafted by Sen. Jim Denning, a Republican from Overland Park, stipulates that no state money shall be spent on KanCare health homes for chronic conditions without the Legislature’s explicit consent in fiscal years 2015, 2016 and 2017 — through June 30, 2017.

KanCare, the state’s privatized Medicaid program, began implementing health homes for 36,000 patients with severe and persistent mental illnesses in August 2014.

At the time, Kansas Department of Health and Environment officials said they hoped to roll out health homes for patients with chronic illnesses sometime in 2015.

The program, which is optional under the Affordable Care Act, relies on closely managed, wraparound or integrated health services for specifically targeted, high-risk, high-cost Medicaid enrollees. Health home providers are expected to operate under a "whole-person" philosophy, integrating and coordinating primary, acute, behavioral health, and long-term services to treat the whole person, according to the Centers for Medicare and Medicaid Services.

Denning’s proviso, which is expected to pass the Senate and likely meet little resistance in the House, further delays an already uncertain start-up.

“I don’t think we should be pushing another (home health) program until we see how the first one works,” Denning said.

“We have anecdotal information from the mental health centers that it (health home model) is working, and the advocates say they like it,” he said. “But I think we need to wait until we have some hard outcome measures to see if a) it’s actually improving patient care and b) it’s bending the cost curve.”

In legislative circles, Denning is seen as a key figure in the state’s health care debate. He is vice chairman of the Senate budget committee and chairman of its social services budget subcommittee. He also serves on the Senate Public Health and Welfare Committee and on the Robert G. Bethell Joint Committee on Home and Community Based Services and KanCare Oversight.

Outside the Legislature, Denning is a vice president with Discover Vision Centers, a network of eye clinics in the Kansas City metropolitan area.

Denning also said he was troubled by estimates that show while launching health homes for patients with chronic illnesses likely would lower the Medicaid program’s long-term costs, their start-up costs, depending on how broadly they’re implemented, could be between $45 million and $100 million.

Though KDHE officials have said the second phase of the health home expansion would focus on asthma and diabetes, federal statutes would have allowed it to include heart disease, obesity and substance abuse disorders as well.

Denning’s proviso occurs as legislators look for ways to offset a projected shortfall of nearly $344 million in the budget for the current fiscal year, which ends June 30, and fill a $600 million hole in the budget for the next fiscal year.

KDHE Deputy Secretary Aaron Dunkel said the proviso, if enacted, likely would temper but not derail the agency’s interest in health homes.

“It might slow us down a little bit,” he said. “But we’d already been having conversations about the SMI (severe mental illness) health homes and how, if the data shows SMI health homes to be as effective as we think they’re going to be, lessons learned might be applied to the chronic condition health home implementation. Those conversations will continue. But between gathering information and the effect of the proviso, it would be at least another year before they’re implemented.”

Across Kansas, more than 80 providers — a mix of community mental health centers, safety net clinics, county health departments, and programs for developmental and medical facilities — offer health home-type services for mental health patients.

For many of the providers, the proviso was not unexpected. 

“It seems a little penny wise and pound foolish, but the state is in a budget crisis, so I can’t say I’m surprised,” said Krista Postai, chief executive of the Community Health Center of Southeast Kansas, a multi-county safety net clinic based in Pittsburg.

“It’s a shame because all a health home is, really, is super-duper case management,” Postai said. “And I can absolutely prove to you that every time I’ve been able find some money to spend on case management and help people manage their disease, we’ve saved money. That’s just a fact.”

Dave Sanford, chief executive at GraceMed, a group of safety net clinics in Wichita, agreed with Postai’s assessment.

“It’s very disappointing,” he said, “primarily because we believe that once health homes are in place and we’re working with that Medicaid ‘frequent flier’ population, we will have the ability to change behavior, to develop accountability, to help people achieve better outcomes and at the same time reduce the overall cost to the state.”

GraceMed and COMCARE, the community mental health center in Sedgwick County, have put together a health home for mental health patients.

“As most everybody knows, most of these people with a severe mental illness are dealing with a chronic condition as well,” Sanford said. “So we’ve gotten our toes wet. It’s a SMI health home, but we’re seeing a lot of chronic conditions.”

Dave Ranney is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.

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