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. 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 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.

 

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.

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 2018, HH recipients cost $226 less per month than recipients who looked like them.  DSS estimates $7.3 million was cost avoided in CY 2018 after payment of the PMPM ($3.96 million) and Quality Incentive Payments ($0.5 million) discussed below.  Without Health Homes, DSS would have expended approximately $7.3 million more.

DSS found that 70% of costs avoided are due to decrease inpatient admissions, emergency room use. Pharmacy and all other expenditures resulted in the remaining 27%.  Physician services accounted for an increase of approximately $50,000. 

Tier 2 recipients made up a majority of the avoidance.  Tier 3 and 4 made up 41% of the avoidance, while Tier 1 recipients cost 5% more than their counterparts not in the program



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

Quality Incentive Payments

DSS made Quality Incentive Payments to clinics for the first time in May 2019 in the amount of $500,000. Calendar Year 2017 data was used to determine which clinics should be paid.  A subgroup of our Implementation Work Group helped to create the Methodology for these payments.  More information about the methodology and the payments made can be found here.