Under Section 2703 of the Patient Protection and Affordable Care Act (ACA) of 2010, states were given the option to submit a State Plan Amendment (SPA) for the establishment of ‘health homes’ targeting Medicaid enrollees with chronic health conditions. As defined by the Centers for Medicare and Medicaid (CMS), the health home model provides care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety. The Iowa Integrated Health Home (IHH) initiative was launched on July 1, 2013 as a partnership between the Iowa Department of Human Services (DHS) and Magellan Behavioral Care of Iowa (Magellan), a private health management company that has managed the Iowa Plan for Behavioral Health (Iowa Plan) from 1995 through 2015-the time period evaluated for this report (The operation of the IHH program was included in the managed care contracting with 3 managed care plans under the Medicaid modernization in 2016 and no longer managed by Magellan). The purpose of an IHH is to provide whole-person, patient-centered, coordinated care for adults with a serious mental illness (SMI) and children with a serious emotional disturbance (SED). The IHH represents an adaptation of the evidence-based practices of the health home model to incorporate a focus on behavioral care for individuals with serious psychological conditions.
Enrollment in an IHH is intended to mitigate some barriers to care among this population—namely, the challenges involved with navigating fragmented systems of care which often lack adequate coordination between behavioral and primary care medical services. Many primary care providers may lack the specialized training needed to help patients manage a mental health diagnosis, while behavioral health providers are limited in the scope of primary care services they can provide to patients. The IHH initiative attempts to create a singular point-of-access for individuals with a mental health diagnosis to obtain coordinated, comprehensive healthcare services across a spectrum of needs and conditions.
Through the IHH initiative, care is provided by community-based health homes across the state through contracts with Magellan (these contract arrangements ended when Magellan left the state on December 31, 2015). To be credentialed as an IHH, providers must meet criteria related to behavioral health accreditation and establish the team of healthcare professionals needed to provide comprehensive care coordination.
Beginning July 1, 2013, five Iowa counties (Linn, Polk, Warren, Woodbury, and Dubuque) began offering services as part of Phase I, with the remaining sites phased in as part of Phase II (April 2014) or Phase III (July 2014) over the succeeding 18 months. Individuals with an SMI or SED already receiving community-based care coordination through the Medicaid service known as Targeted Case Management (TCM) were given a transition period of six months after assignment to an IHH for the complete transfer of care over to the IHH. As of January 2015, more than 21,000 individuals have been enrolled in the program.