Behavioral Health Integrated Care (BHIC) Health Homes
Program Location:
Madison, WI
Payer Type:
Medicaid
Parent Program:
Payers:
Medicaid
Reported Outcomes
Description:
Wisconsin was approved for a 2703 Health Home State Plan Amendment in October of 2012. The BHIC health home will focus on preventive services, wellness, and chronic and acute care for both behavioral and physical health needs. The program will work to provide additional care coordination, care management resources, and dental services for eligible individuals. Care coordination is the ongoing management of the patient’s medical, behavioral, pharmacological, dental care, and community care needs by a designated team lead. Approved BHIC health homes must have a core team of professionals that include a primary care physician or nurse practitioner, medical case manager, mental health and/or substance abuse professional, care coordination, and pharmacist. Other team members might include nutritionists, social services support staff and peer specialists.
The team lead will ensure that the patient has a current, written, individualized, multidisciplinary care and treatment plan that addresses all aspects of the patient’s care (including preventive care needs, all medical subspecialties, institutional care, home and community care). Certified health homes must co-locate behavioral health services within the medical clinic, establish a consumer advisory committee and have an established quality improvement program. The BHIC pilot program will initially target Langlade, Lincoln, and Marathon counties. It is scheduled to begin in the first quarter of 2014. DHS has identified a population of approximately 450 individuals who would likely benefit from the BHIC health home model in these counties. The BHIC program may expand to other parts of Wisconsin in the future.
Wisconsin offers health home services to beneficiaries with HIV who have at least one other chronic condition, or who are at-risk for developing another chronic condition.
Payment Model:
The BHIC health home rate consists of three components: 1) an annual assessment rate for the development of a care plan; 2) rate for monthly care coordination activities that can be billed in 15 minute increments; 3) rate for certified peer specialists billed in 15 minute increments.
Payment model
- Per member per month (PMPM) care management fee, plus annual flat fee
- PMPM: $102.95; Fee: $359.00
Other Outcomes:
Costs, hospital use and chronic disease diagnoses were lower for those with longer exposure to the health home provider. The work highlights the methodological challenges of confident assessment of impacts for a program focusing on a single, relatively low prevalence condition (HIV/AIDS) with few enrollees--150 as of the end of the evaluation period, 188 total--and using a single health home provider, AIDS Resource Center of Wisconsin, which had been serving roughly half the target population for some time.
Data Source(s):
Last updated June 2019
