Health Homes

Health Home is an added Medicaid benefit created to help manage all of the patient’s health care needs — physical, mental and social.

Benefits of a Health Home

  • All people who provide individual health care work together to provide services to meet the patient’s needs. This includes the primary care physician, specialists and home health providers, community-based service providers, and a care manager who will coordinate all care among the providers.
  • The care manager ensures patients get what they need to stay healthy, out of the emergency room and out of the hospital.
  • The care manager will also assist with social services (such as food, benefits transportation and housing).

How it works:

The care manager works with the patient to complete the Health Home Patient Information Sharing Consent Form to ensure enrollment.

By signing the form, the patient agrees to share their health information with:

  • The patient’s primary care physician
  • Specialists
  • Home health providers
  • Other types of community-based service providers
  • Highmark Blue Cross Blue Shield

To ensure coordination of care, the patient has one point of contact. The care manager will:

  • Develop a care plan
  • Schedule appointments
  • Coordinate transportation
  • Follow up to confirm appointments were kept
  • Track outcomes

Criteria for Health Home eligibility:

Health Home eligibility criteria require patients to have one of the following:

  • Two or more chronic conditions (such as substance use disorder, asthma, diabetes*)

Or

One single qualifying chronic condition:

  • HIV/AIDS
  • Serious mental illness (SMI) (adults)
  • Sickle cell disease (both adults and children)
  • Serious emotional disturbance (SED) or complex trauma (children)

Physical and behavioral health criteria alone do not make all patients eligible for a Health Home. Patients must also have one of the following risk factors:

  • Determinants of medical, behavioral, and/or social risk including:
    • Probable risk for adverse events (such as death, disability, inpatient or nursing home admission, mandated preventive services, or out of home placement)
  • Lack of or inadequate social, family, housing support or serious disruptions in family relationships
  • Lack of or inadequate connectivity with health care system
  • Non-adherence to treatments or medications or difficulty managing medications
  • Recent release from incarceration, detention, psychiatric hospitalization or placement
  • Deficits in activities of daily living, learning or cognition issues
  • Or is concurrently eligible or enrolled, along with either their child or caregiver, in a Health Home

How does a patient join a Health Home?

If a patient appears to meet eligibility requirements, a referral is sent to a Health Home that is contracted in the patient’s county. The Health Home will assign the patient to one of its care management agencies (CMA).The CMA will contact the patient to review the services of the Health Home program, determine if the individual meets program criteria, and the patient has the choice of enrolling or may decline.

If the patient enrolls, the Health Home Patient Information Sharing Consent Form is signed. This allows information to be shared among listed providers and the health plan.

How does a provider refer a patient to a Health Home?

Find a Health Home

Related information

Documents

Provider tools and resources

Interested in becoming a provider in the Highmark BCBS network?

We look forward to working with you to provide quality service for our members.