Laurie Gill
Cabinet Secretary

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Health Home Data Dashboard

South Dakota Medicaid’s Health Homes are a person-centered system of care focused on transforming care for high cost, high need Medicaid recipients to improve the patient experience, increase preventive and primary care services while improving outcomes for Medicaid recipients and managing costs to South Dakota’s Medicaid program.
 

Transforming Care

South Dakota Medicaid’s Health Homes is changing the way Medicaid recipients receive care by creating a person-centered care team to meet the needs of the patient. The following measures show how the Health Home program is changing the way individuals receives care.

Increasing Preventive and Primary Care

Health Home participants have high-cost chronic and/or behavioral health conditions. The goal of Health Homes is to provide care in primary care settings and help participants effectively manage their conditions by increasing preventive care. Overall, primary care has increased by 6%. The measures below show health homes success in increasing preventive screenings.

Improving Clinical Outcomes

By transforming care, increasing preventive services and improving the patient experience, Health Homes can improve clinical outcomes for patients. The following charts below represent how health improves the longer participants are in the program, Diabetes: percentage of HbA1c under control and blood pressure under control; Cardiovascular: percentage of blood pressure under control; Obesity: percentage of BMI under control.

 

Cost Effectiveness of the Health Home Program

DSS matched Health Home participants and individuals eligible but not participating before and after program implementation.  Prior to Health Homes both groups PMPM costs increased.  After Health Homes PMPM costs for Health Home participants decreased relative to those not participating.  Costs for individuals not participating continued to rise. 

In CY 2017, HH recipients cost $204 less per month that recipients who looked like them.  DSS estimates $7.7 million was cost avoided in CY 2017 after payment of the PMPM.  Without Health Homes, DSS would have expended approximately 7.7 million more.

DSS found that 82% of costs avoided are due to decrease inpatient admissions, emergency room use. Physician Services and all other expenditures resulted in the remaining 18%.  Pharmacy services accounted for an increase of approximately $1 million. 

We can also see how this impacts our expenditure categories below. 


As anticipated, recipients in higher tiers produced the largest amount of savings.  Fifty-four percent of the $7.7 million in cost avoidance is attributed to Tiers 3 and 4 as shown below.



A summary of the methodology used to calculate the cost avoidance of Health Homes can be found in written format.

Improving Patient Experience

Health Homes are tasked with focusing care on the person, including establishing a relationship with health home participants. A positive patient experience helps support the health home model, leading to better continuity of care and better health outcomes.  Outcomes in this area are split between primary care clinics and community mental health centers.


View the full set of Outcome Measures here. Information about how outcome measures are collected and defined is available here.