Healthcare Program Evaluation Analysis

Evaluation of the Medicaid Health Home option for beneficiaries with chronic conditions

A five-year evaluation of the program’s implementation and its impacts on utilization and costs was conducted. Success was measured by analyzing improved access to integrated and coordinated primary and behavioral healthcare that reduces unnecessary use of costly facility-based care thus resulting in reduced spending.

The program targets Medicaid beneficiaries from all the states in America. Medicaid serves more than 66 million low-income beneficiaries. Of the 66 million, more than 9 million individuals qualify for Medicaid based on their disabilities. More than half of individuals with disabilities suffer from mental illnesses with 45% of them having multiple chronic conditions (Paradise & Nardone, 2014). Qualifying conditions to be accepted into the program include; serious and persistent mental health conditions, substance use disorder, diabetes, obesity, heart disease or asthma.

There was a significant impact of the policy since a majority of the affected spent less Medicaid money on treatment at medical facilities.

The evaluation relied on a mixed-methods approach focusing on both qualitative and quantitative data. Qualitative data was collected from document reviews, site visits and telephone interviews with key stakeholders in all the states that were evaluated to track progress on how the health home models were implemented. Quantitative evaluation used administrative data to assess improvements on the rate of hospital admissions, skilled nursing facility admissions, emergency department visits and Medicaid spending for health home enrollees.

The stakeholders identified in the evaluation include; the urban Institute, the Office of Assistant Secretary of Planning and Evaluation in the U.S Department of Health and Human Services.

The results of the evaluation will benefit States, policymakers, health home enrollees, program designers and healthcare providers

The initial goals of the long-term evaluation of the Medicaid health home model were:

1. To assess models, providers, processes, states that are opting for health homes;
2. To assess the extent to which health homes increased the coordination across clinical and nonclinical domains of care;
3. To assess whether health home services improve quality of care and whether it affects utilization and spending outcomes (“ASPE”, 2017).

ü  The evaluation did not successfully associate health home enrollment with reductions in facility-based spending. However, the evaluation found significant increases in Medicaid spending. Thus, the evaluation partially achieved goal number three

ü  By assessing eleven states and their adoption of the Medicaid health home model, the evaluation achieved its first and second goal.

I would not recommend implementing the Medicaid health home model at my place of work. This is due to the fact that there is limited research on the effectiveness of the model and no clear guidelines on how a healthcare facility might benefit from the program. Additionally, the model has several data issues and no standard program design. Thus, there is no significant data available on the best design to use as a facility. Lastly, the healthcare facility that I am affiliated with does not offer care services to patients with chronic mental and behavioral needs therefore, it might not benefit from the findings of the evaluation.

As a nurse advocate, one can become involved in the evaluation process by giving feedback to the implementation team. When giving feedback, the nurse advocate determines whether system concerns are unit specific or affect the entire system. Nurse advocates should also participate in focused surveys to assist the evaluation team determine severity of the system errors and to identify compliance or non-compliance patterns (Weckman & Janzen, 2010).