COMMUNITY CARE COORDINATION
Health Home Program Lead
COMMUNITY CARE COORDINATION > HEALTH HOME PROGRAM LEAD | HEALTH HOME CCCCO
The Health Home program is a Medicaid benefit available at no cost to help promote person-centered health action planning to empower clients to take charge of their own health. This is accomplished through better coordination between the client and members of their care team and encourages involvement and independence. The Health Home program is designed to ensure clients receive the right care, at the right time with the right provider.
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Health Homes Provide:• Comprehensive care management.
• Care coordination and health promotion. • Transition planning. • Individual family support. • Referral to relevant community and social support services |
Health Home Program Goals:• Comprehensive care management.
• Care coordination and health promotion. • Transition planning. • Individual family support. • Referral to relevant community and social support services |
HEALTH HOME LEAD ENTITIES
The Health Care Authority contracts with designated “Health Home Lead Entities” to provide Health Home services directly, or through contracted Care Coordination Organizations. The Health Home program emphasizes person-centered care with the development of the Health Action Plan (HAP). The HAP includes routine screenings such as the Patient Activation Measure (PAM).
The PAM is an assessment that gauges the knowledge, skills and confidence essential to managing one’s own health and healthcare. The HAP also includes screenings for body mass index, depression, level of independence in accomplishing activities of daily living, risk of falls, anxiety, chemical dependency, and pain.
The HAP and assessment screens are updated on a 4-month cycle. The centerpiece of the HAP is the client’s self-identified short and long-term health related goals, including what action steps the client and others will do to help improve his or her health. With client consent the HAP can be shared with care providers in order to foster open communication, support, and encouragement to reach their health goals.
The PAM is an assessment that gauges the knowledge, skills and confidence essential to managing one’s own health and healthcare. The HAP also includes screenings for body mass index, depression, level of independence in accomplishing activities of daily living, risk of falls, anxiety, chemical dependency, and pain.
The HAP and assessment screens are updated on a 4-month cycle. The centerpiece of the HAP is the client’s self-identified short and long-term health related goals, including what action steps the client and others will do to help improve his or her health. With client consent the HAP can be shared with care providers in order to foster open communication, support, and encouragement to reach their health goals.
HEALTH HOME CARE COORDINATORS
Health Home Care Coordinators will help clients manage their chronic conditions and assist them in meeting their health goals. The Health Home Program reduces gaps in services and increases coordination between all types of service providers (medical, behavioral health, long term services and supports and other social services).
A Health Home Care Coordinator is an individual who works with eligible clients, their families, and providers to:
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Eligibility Criteria
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Health Home services support individuals in their health journey. Participation is voluntary. It does not impact eligibility for other services or complaint and appeal rights.
ABOUT THE CARE COORDINATION NETWORK PROGRAM
Care coordination services provided through the Health Home Program include: |
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