Person- and family-centered care occurs when the person receiving care and their family actively participate in and have control over their health decisions, and their needs and desires are prioritized to ensure high quality, coordinated, and comfortable care. Person- and family-centered care is important for all, but especially for older adults and those with complex care conditions. During NASHP’s 2022 Annual Conference in Seattle, WA in September, policymakers from Washington, Hawaii, and Texas shared how their states are integrating and prioritizing person-centered care.

State Strategies for Person-Centered Care

Washington Prioritizes Shared-Decision Making

Washington has long had strong programs for providing care for older adults and people with complex care conditions in home and community settings, and the state emphasizes choice and dignity in long-term care to ensure individuals have their rights protected and full access to the benefits of community living. The state also is working to implement shared decision making as a core tenet of person-centered care. Washington is the first state to create a certification process for patient decision aids (PDAs), which are tools that help patients and providers talk together about and understand care options. PDAs give patients and families clear information about their health choices. As Jason T. McGill, Assistant Director of Washington State Health Care Authority and Director of the Medicaid Programs Division, explained, certifying PDAs is important because it furthers the state’s goal of giving choice and dignity to individuals. For more information, see NASHP’s recent blog on PDAs in Washington.

Hawaii Seeks to Add a Community Palliative Care Medicaid Benefit

Hawaii is planning to expand access to community-based palliative care through a new proposed Medicaid benefit, which is currently in the midst of the federal review process. The state created this benefit after completing a needs assessment of high-need/high-cost individuals as part of its HOPE Initiative and discovered a lack of palliative care coverage for beneficiaries with serious illness in home and community settings. Judy Mohr Peterson, Hawaii State Medicaid Director, highlighted the importance of clearly defining the term “serious illness” to determine eligibility for the benefit, requiring an interdisciplinary team to provide such services, and having a range of services provided under the benefit (see image below).

For interested states, see NASHP’s toolkit of seven steps to create a Medicaid community palliative benefit.

Texas Develops Evidence-Informed Person-Centered Practices

Texas described developing evidence-based, person-centered practices for Medicaid managed care members with behavioral health needs. Through its Money Follows the Person (MFP) Behavioral Health Pilot, Texas tested services designed to help people with serious mental illness leave nursing facilities and thrive in their communities.  Behavioral health pilot interventions were integrated with home and community-based services (HCBS). The Pilot used a strengths-based approach, which provided people with the techniques and skills they needed to manage their daily lives and homes to achieve their desired goals. Pilot services began up to six months before a person transitioned into the community and continued for a year after their transition. Almost seventy percent of program participants remained in the community with sustained improvements in functioning after Pilot interventions ended. The Pilot produced net Medicaid savings of $25.4 million. Most importantly, Pilot participants achieved the goals they set for themselves, such as employment, education, meaningful relationships, and giving back to their communities.  Since the Pilot ended in 2017, the state has worked to sustain the progress made. Training and technical assistance for managed care organizations (MCOs) and their provider networks is provided through the International Center of Excellence for Evidence Based Practices. Texas has also been awarded additional MFP funds to improve the infrastructure in managed care that supports transition of people with serious mental illness from nursing facilities and improves transition of people with similar long-term care needs from state psychiatric facilities to HCBS services.

Texas also tested Mental Health Self-Directed Care in a randomized trial called My Voice, My Choice in several central Texas counties. Mental Health Self-Direction is a person-centered intervention that enables people with serious mental illness to direct a Medicaid outpatient mental health budget with the assistance of a trained advisor. The budget is based on an individual recovery plan created by the person and their advisor in the person’s own words. Self-direction enables greater flexibility and choice – enabling people to purchase non-traditional goods which advance their specific recovery goals. Texas developed and implemented the project in partnership with MCOs, Centers for Medicare and Medicaid Cervices (CMS), the Substance Abuse and Mental Health Services Administration (SAMHSA), state universities, providers, local mental health authorities, and people with lived experience of mental illness. The trial was successful, resulting in improved outcomes and greater personal engagement in mental healthcare at no greater cost to Medicaid than traditionally financed care. Staff are now working with partners to develop recommendations for how mental health self-direction could be implemented in the state’s Medicaid program.

Dena Stoner, Director of Behavioral Health Innovation Strategy for Texas Health and Human Services, explained that person-centered pilots succeed when there are strong partnerships centered on trust and respect between all partners, such as state agencies, universities, MCOs, advocates, providers and, most importantly the people participating in the pilots. She emphasized that person-centered practices make good human and financial sense.  They require commitment to critically examine practice at both the individual and state agency level. The state’s behavioral health division is currently collaborating with state and national partners to assess and improve organizational capacity to support person-centered behavioral health practices. Texas is also participating in national and international learning communities regarding self-direction.

Key Takeaways for State Policymakers

Washington, Hawaii, and Texas serve as strong examples of the varied ways in which states are prioritizing person-centered care in health care reform. State leaders from these three states consistently highlighted the importance of collecting and analyzing data related to person-centered care to demonstrate its value and efficacy. States are looking for ways to collect data that demonstrates both the necessity for person-centered care and the way in which person-centered care improves physical and mental wellbeing for patients. A representative from the National Committee for Quality Assurance affirmed the organization’s dedication to developing person-centered care quality measures during NASHP’s conference session.

Consideration for providing equitable access to and provision of person-centered care was another central theme. As states help individuals continue to live in communities while they receive care, it is essential to understand how that community provides culturally competent care. Person-centered care also works best with a whole-person health approach, which includes addressing social determinants of health and disparities in health care access and outcomes.

Acknowledgement: The “See Me, Hear Me: Next Generation Person-Centered Care” conference session and the NASHP resources in this blog were developed with generous funding and guidance from The John A. Hartford Foundation.