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Kansas – Medical Homes
/in Policy Kansas Cost, Payment, and Delivery Reform, Health System Costs, Primary Care/Patient-Centered/Health Home, Quality and Measurement /by Medical HomesIn 2007, the Kansas Health Policy Authority (KHPA) (now known as the Kansas Division of Health Care Finance) delivered a comprehensive health reform plan to the Legislature and the Governor intended to improve health in Kansas. A key component of the plan was promotion of the medical home model. In 2008, Kansas lawmakers demonstrated support for adopting the medical home concept for Medicaid, Children’s Health Insurance Program (CHIP), and state employee enrollees by passing the Health Care Reform Act of 2008 (L. 2008, ch. 164), which statutorily defined the medical home. Following passage of that legislation, KHPA dedicated staff working with stakeholders to develop a Kansas-specific medical home model. However, due to budget shortfalls, the state did not launch a Medicaid/CHIP medical home initiative.
Through a Systems in Sync grant, the Kansas Department of Health and Environment provided support to the Kansas Patient Centered Medical Home Initiative (PCMHI) to support better care for children with special health care needs. Led by the state’s provider associations, eight practices received practice transformation support from TransforMed through in a two-year pilot with Blue Cross Blue Shield of Kansas with the support of the United Methodist Health Ministry Fund, the Sunflower Foundation, and the Kansas Health Foundation. Analysis of the program’s first year found improvements in same-day access, breast cancer screening rates, and hemoglobin A1c control among participating practices.
Federal Support:
- The Centers for Medicare & Medicaid Services (CMS) has approved one Health Home State Plan Amendment (SPA) in Kansas. Kansas’ SPA (approved 7/28/14, effective 7/1/14) covers Medicaid enrollees with one or more serious and persistent mental health condition enrolled in one of the state’s managed care organizations. For more information on Kansas’ health homes, visit the state’s health homes webpage or see the Program Manual. To learn more about the Health Home State Plan Option, visit the CMS Health Homes webpage.
Last updated: June 2015
| Forming Partnerships | Shortly after passage of the Health Care Reform Act of 2008 (L. 2008, ch. 164), the Kansas Health Policy Authority (now known as the Kansas Division of Health Care Finance) convened a broad stakeholder group to develop systems and standards for the implementation of the medical home in Kansas. Membership in the stakeholder group included a range of providers, consumers, insurers, safety net clinics, state health agencies, and information technology vendors. |
| Defining & Recognizing a Medical Home | Medical Home Definition: The Health Care Reform Act of 2008 (L. 2008, ch. 164) defined a medical home as “a health care delivery model in which a patient establishes an ongoing relationship with a physician or other personal care provider in a physician-directed team, to provide comprehensive, accessible and continuous evidence-based primary and preventive care, and to coordinate the patient’s health care needs across the health care system in order to improve quality and health outcomes in a cost effective manner.” Health Home Definition: Section 2703 of the Affordable Care Act defined a health home as “a designated provider (including a provider that operates in coordination with a team of health care professionals) or a health team selected by an eligible individual with chronic conditions to provide health home services.” Health home services statutorily include: “comprehensive care management; care coordination and health promotion; comprehensive transitional care, including appropriate follow-up, from inpatient to other settings; patient and family support (including authorized representatives; referral to community and social support services, if relevant; and use of health information technology to link services, as feasible and appropriate.” |
| Aligning Reimbursement & Purchasing | Health Homes: As the Lead Health Home Entity, each managed care plan receives a per-member per-month payment for each eligible member who is provided at least one of the six core health home services within a month. The rates fall into one of four cohorts, which vary based on patient complexity, ranging from $117.21 to $327.48 (statewide average: $171.79). The Lead Health Home Entity shares the payments with its contracted Health Home Partners, community-based providers who negotiate their own rates with each health home. Additional information on the payment methodology is available here. |
| Supporting Practices | Health Homes: The Kansas Department of Health & Environment contracted with Wichita State University to convene a learning collaborative to support program implementation. Learning activities have included a mix of in-person and remote activities designed to facilitate peer-to-peer learning and promote continuous quality improvement. A January 2014 report on the collaborative report is available here. |
| Measuring Results | Health Homes: In addition to the health home core quality measure set, Kansas identified four primary goals for the health home program (Appendix C): 1. Reduced utilization associated with inpatient stays; 2. Improve management of chronic conditions; 3. Improve care coordination; and 4. Improve transitions of care among primary care and community providers and inpatient facilities. |
Kansas
/in Policy Kansas /by NASHPIn Kansas:
- Medicaid services are delivered on a managed care basis, and KanCare (Kansas Medicaid) members are assigned to one of three managed care organizations (MCOs). Kansas operates KanCare through a Section 1115 Waiver, which was approved in 2012, and went into effect in January 2013. The KanCare MCOs provide most Medicaid services and are responsible for physical, behavioral and long-term care services. Some of the MCOs use subcontractors to provide certain services, such as a behavioral health, dental, and vision services.
- Prior to the transition to KanCare there were a total of 354,664 beneficiaries enrolled in Kansas’s Medicaid program as of July 2011. Of these 310,036 were enrolled in managed care programs. According to a KanCare quarterly report, there were a total of 330,019 beneficiaries enrolled in KanCare MCOs as of December 31, 2013.
- Kansas also delivers Home and Community Based Services (HCBS) through seven HCBS waivers including six that include children among the target population: autism, physical disability, intellectual/developmental disabilities (I/DD), technology assisted, traumatic brain injury, and serious emotional disturbance. In January 2014 Kansas received approval to incorporate the HCBS and targeted case management services for I/DD individuals into KanCare.
As of 2013, 280,343 individuals were eligible for KAN Be Healthy (KBH), Kansas’s Medicaid benefit for children and adolescents (also known at the Early and Periodic Screening, Diagnostic, and Treatment benefit, or EPSDT). According to CMS data from 2013, Kansas achieved an EPSDT screening ratio of 82% and a participation ratio of 58%. 119,617 children received dental services of any kind, with 112,350 receiving preventive dental services.
Last updated June 2014
| Medical Necessity |
The State of Kansas defines medical necessity as follows:
“Medical necessity means that a health intervention is an otherwise covered category of service, is not specifically excluded from coverage, and is medically necessary, according to all of the following criteria:
Kansas statutes also add that KAN Be Healthy services (see pgs. 60-61) also include:
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| Initiatives to Improve Access |
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| Reporting & Data Collection |
KanCare, as part of its Section 1115 Waiver, has a significant quality measurement component. Additionally, each of the three KanCare health plans and their subcontractors are required to obtain accreditation by the National Committee for Quality Assurance.
In terms of Evaluation Design of its 1115 Waiver, Kansas incorporates different measures from the KanCare contracts related directly to the goals of the KanCare program. This includes quantitative measure such as: Healthcare Effectiveness Data and Information Set (HEDIS); mental health measures including Serious Emotional Disturbance (SED) Waiver reports and National Outcome Measures; Substance Use Disorder measures; and Case Record reviews. Kansas also includes a number of qualitative reports such as: Consumer Assessment of Health Plans Survey (CAHPS), Substance Abuse Disorder consumer surveys, Provider Surveys, and other reports/surveys.
KanCare also has a pay for performance (P4P) program that ties payment to six performance measures related to operations for the first year, and fifteen performance measures related to quality for the later years. Among the fifteen quality measures that Kansas will be tying to payment are: well-child visits in the first 15 months of life and preterm births.
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| Behavioral Health |
The three KanCare MCOs are required to cover behavioral health services; and some use subcontractors to provide these services. Kansas also has a HCBS waiver for individuals age 5 and over who meet thee definition of having a developmental disability or are eligible for care in an Intermediate Care Facility. As of January 2014 this waiver and the services provided are incorporated into KanCare. The services from this waiver that are now provided by KanCare include long-term services and supports services and targeted case management.
Kansas is also working on an Affordable Care Act Section 2703 Health Homes State Plan Amendment that will be used to provide comprehensive and intensive coordination of care to those with Serious Mental Illness and Chronic Conditions. Kansas anticipates launching its Health Homes effective July 1, 2014.
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| Support to Providers and Families |
Support to Providers
The KanCare website offers information to providers on how to become a KanCare Provider as well as information on each of the health plans.
Support to Families
Kansas Medicaid has developed a KAN Be Healthy Kontact Korner document, which provides information and links on topics such as physical and developmental growth, dental, nutrition, immunization, blood lead, hearing and vision. Kansas has also held a series of events for consumers to provide information related to the roll out of KanCare, the integration of I/DD services, and the Section 2703 Health Homes State Plan Amendment.
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| Care Coordination |
KanCare expects that the health plans are actively engaged in care coordination for their members. One of the KanCare Contracting Principles, as identified in the Section 1115 Waiver that created KanCare, is that the health plans are required to perform a number of functions related to care coordination. This includes undertaking a health risk assessment to identify health and service needs in order to develop care coordination and integration plans for each member. Additionally, there are several measures among the quality measures that are tied to Kansas’ pay for performance program that are related to care coordination, or indicate that care coordination is occurring, including:
Care coordination is also a central part of Kansas’s Section 2703 Health Homes State Plan Amendment. Kansas defines its health homes as: “A team of health professionals: May include a physician, nurse care coordinator, nutritionist, social worker, behavioral health professional (including mental health or substance use disorder providers), and can be free standing, virtual, hospital-based, community mental health centers, etc.”
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| Oral Health |
Dental Screens are part of a KAN Be Healthy visit. The Health Plans, or their subcontractors, provide dental services to all children eligible for KAN Be Healthy, including more advanced dental services as deemed medically necessary. |
Kansas
/in Policy Kansas /by NASHPNASHP’s Accountable Care Activity map is a work in progress; state activity pages will be launched in waves throughout Fall 2012.
At this time, we have no information on accountable care activity that meets the following criteria: (1) Medicaid or CHIP agency participation (not necessarily leadership); (2) explicitly intended to advance accountable or integrated care models; and (3) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
If you have information about accountable care activity in your state, please email skinsler@nashp.org.
Last updated: October 2012
Building Medical Homes: Lessons from Eight States with Emerging Programs
/in Policy Reports Cost, Payment, and Delivery Reform /by Mary TakachStates are seeking to strengthen primary care through the medical home model to achieve better outcomes and lower costs. The eight states profiled in this report—Alabama, Iowa, Kansas, Maryland, Montana, Nebraska, Texas, and Virginia—are at different stages in the development and implementation of medical home programs. The states have drawn on both well-tested approaches and innovative tactics to help primary care providers adopt the model. As a whole, their experiences demonstrate that states can play critical roles in convening stakeholders, helping practices improve performance, and addressing antitrust concerns that arise when multiple payers collaborate.
| building.medical.homes_.emerging.states.pdf | 529.2 KB |
State Strategies to Improve Quality and Efficiency: Making the Most of Opportunities in National Health Reform
/in Policy Reports /by Abigail AronsThere is an acknowledged need for extensive reform to the health care delivery system in the United States. The Patient Protection and Affordable Care Act offers unprecedented opportunities to transform care delivery, with numerous provisions that support systemic improvements. States have an imperative to greatly improve system efficiency if they are to effectively and sustainably implement the law’s changes, particularly mandatory coverage expansion. This report examines specific Affordable Care Act provisions that support state system improvement goals and profiles efforts in 10 states: Colorado, Kansas, Maine, Massachusetts, Minnesota, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington. The report highlights the opportunities and challenges that federal health care reform will bring and offers suggestions for how state and national leaders can streamline implementation.
| state.strategies.improve.quality.efficiency.pdf | 580.5 KB |
Kansas
/in Policy Kansas /by EBPHIT_AdminKansas is still developing its HIE Strategic Plan but has released an unfinished draft.
Kansas Health Policy Authority. “Kansas Health Indicators.” (March 2009)
/in Policy Kansas /by NASHP StaffKansas Health Online
/in Policy Kansas /by NASHP StaffState Partnerships to Improve Quality: Models and Practices from Leading States Issue Brief
/in Policy Reports /by NASHP StaffThe National Academy for State Health Policy identified ten leading state quality improvement partnerships – interrelated broad-based partnerships, mostly with public and private sector representation, which have long-term, statewide, systemic quality improvement strategic intent, and transparent agendas. This State Health Policy Briefing summarizes results of NASHP’s full report examining these partnerships in Colorado, Kansas, Maine, Massachusetts, Minnesota, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington. The key factors, policies, and practices that influence the quality improvement partnerships in these 10 states offer insights for achieving systemic improvement in health care quality and performance. The full report is also available.
| QI Models and Practices | 136.6 KB |
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For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
