Kansas – Medical Homes

In 2007, the Kansas Health Policy Authority (KHPA) (now known as the Kansas Division of Health Care Finance) delivered a comprehensive health reform plan to the Legislature and the Governor intended to improve health in Kansas. A key component of the plan was promotion of the medical home model. In 2008, Kansas lawmakers demonstrated support for adopting the medical home concept for Medicaid, Children’s Health Insurance Program (CHIP), and state employee enrollees by passing the Health Care Reform Act of 2008 (L. 2008, ch. 164), which statutorily defined the medical home. Following passage of that legislation, KHPA dedicated staff working with stakeholders to develop a Kansas-specific medical home model. However, due to budget shortfalls, the state did not launch a Medicaid/CHIP medical home initiative.

Through a Systems in Sync grant, the Kansas Department of Health and Environment provided support to the Kansas Patient Centered Medical Home Initiative (PCMHI) to support better care for children with special health care needs. Led by the state’s provider associations, eight practices received practice transformation support from TransforMed through in a two-year pilot with Blue Cross Blue Shield of Kansas with the support of the United Methodist Health Ministry Fund, the Sunflower Foundation, and the Kansas Health Foundation. Analysis of the program’s first year found improvements in same-day access, breast cancer screening rates, and hemoglobin A1c control among participating practices.

Federal Support:

  • The Centers for Medicare & Medicaid Services (CMS) has approved one Health Home State Plan Amendment (SPA) in Kansas. Kansas’ SPA (approved 7/28/14, effective 7/1/14) covers Medicaid enrollees with one or more serious and persistent mental health condition enrolled in one of the state’s managed care organizations. For more information on Kansas’ health homes, visit the state’s health homes webpage or see the Program Manual. To learn more about the Health Home State Plan Option, visit the CMS Health Homes webpage.

Last updated: June 2015

Forming Partnerships Shortly after passage of the Health Care Reform Act of 2008 (L. 2008, ch. 164), the Kansas Health Policy Authority (now known as the Kansas Division of Health Care Finance) convened a broad stakeholder group to develop systems and standards for the implementation of the medical home in Kansas. Membership in the stakeholder group included a range of providers, consumers, insurers, safety net clinics, state health agencies, and information technology vendors.
Defining & Recognizing a Medical Home Medical Home Definition: The Health Care Reform Act of 2008 (L. 2008, ch. 164) defined a medical home as “a health care delivery model in which a patient establishes an ongoing relationship with a physician or other personal care provider in a physician-directed team, to provide comprehensive, accessible and continuous evidence-based primary and preventive care, and to coordinate the patient’s health care needs across the health care system in order to improve quality and health outcomes in a cost effective manner.”

Health Home Definition: Section 2703 of the Affordable Care Act defined a health home as “a designated provider (including a provider that operates in coordination with a team of health care professionals) or a health team selected by an eligible individual with chronic conditions to provide health home services.” Health home services statutorily include: “comprehensive care management; care coordination and health promotion; comprehensive transitional care, including appropriate follow-up, from inpatient to other settings; patient and family support (including authorized representatives; referral to community and social support services, if relevant; and use of health information technology to link services, as feasible and appropriate.”

Aligning Reimbursement & Purchasing Health Homes: As the Lead Health Home Entity, each managed care plan receives a per-member per-month payment for each eligible member who is provided at least one of the six core health home services within a month. The rates fall into one of four cohorts, which vary based on patient complexity, ranging from $117.21 to $327.48 (statewide average: $171.79). The Lead Health Home Entity shares the payments with its contracted Health Home Partners, community-based providers who negotiate their own rates with each health home. Additional information on the payment methodology is available here.
Supporting Practices Health Homes: The Kansas Department of Health & Environment contracted with Wichita State University to convene a learning collaborative to support program implementation. Learning activities have included a mix of in-person and remote activities designed to facilitate peer-to-peer learning and promote continuous quality improvement. A January 2014 report on the collaborative report is available here.
Measuring Results Health Homes: In addition to the health home core quality measure set, Kansas identified four primary goals for the health home program (Appendix C):

1.     Reduced utilization associated with inpatient stays;
2.     Improve management of chronic conditions;
3.     Improve care coordination; and
4.     Improve transitions of care among primary care and community providers and inpatient facilities.