Health Homes Implementation Process, Frequently Asked Questions

FAQ Categories

Staffing Questions

What are the expected patient ratios for the following positions: Nurse Care Manager, BHC, Care Coordinator, Health Home Director?

The current staffing ratios are as follows:

  • Health Home Director 1/2500
  • Nurse Care Manager 1/250
  • Behavioral Health Consultant 1/750
  • Care Coordinator 1/750

We anticipate that if an organization has fewer than the number of patients in the staff to patient ration that they will be able to use the PMPM to staff proportionately.

What credentials must you have to be a Health Home Director? We would like our COO to serve in this role?
Initial thoughts were physicians, but have since moved off that position, allowing others, provided that they are familiar with the concept of health care homes. However, we are not looking for the assignment of current staff (as that will be a cost offset), but added capacity. At all costs, we must avoid supplantation.
Could you post job descriptions for each of the positions you mentioned on the call?
Position Patient Ratio
& Salary		 PMPM Duties
Nurse Care Manager 1 FTE/250 enrollees
$105,000 / year		 $35.00
  1. Develop wellness & prevention initiatives
  2. Facilitate health education groups
  3. Participate in the initial treatment plan development for all of their Health Home enrollees
  4. Assist in developing treatment plan health care goals for individuals with co-occurring chronic diseases
  5. Consult with Community Support Staff about identified health conditions
  6. Assist in contacting medical providers & hospitals for admission/discharge
  7. Provide training on medical diseases, treatments & medications
  8. Track required assessments and screenings
  9. Assist in implementing MHD health technology programs & initiatives (i.e., CyberAccess, metabolic screening)
  10. Monitor HIT tools & reports for treatment
  11. Medication alerts & hospital admissions/discharges
  12. Monitor & report performance measures & outcomes
Behavioral Health Consultant

1 FTE/750 enrollees

$70,000/year

 $7.78
  1. screening/evaluation of individuals for mental health and substance abuse disorders
  2. brief interventions for individuals with behavioral health problems
  3. behavioral supports to assist individuals in improving health status and managing chronic illnesses
  4. The behavioral health consultant both meets regularly with the primary care team to plan care and discuss cases, and exchanges appropriate information with team members in an informal “curbside “ manner as part of the daily routine of the clinic
  5. Integration with Primary Care
    • Support to Primary Care physician/teams in identifying and behaviorally intervening with patients who could benefit from behavioral intervention.
    • Part of front line interventions with first looking to manage behavioral health needs within the primary care practice.
    • Focus on managing a population of patients versus specialty care
  6. Intervention
    • Identification of the problem behavior, discuss impact, decide what to change
    • Specific and goal directed interventions
      • Use monitoring forms
      • Use behavioral health “prescription”
      • Multiple interventions simultaneously
  7. Education
    • Handouts
    • “Teach back” strategy
    • Tailored to specific issue
  8. Feedback to PCP
    • Clear, concise, BRIEF
    • Focused on referral question
    • Description of action plan
    • Plan for follow-up
Health Home Director Administrative support

1 FTE/2500 enrollees

$90,000 / year

Non-PMPM paid staff training time

Contracted services

 $8.87
  1. Provides leadership to the implementation and coordination of Healthcare Home activities
  2. Champions practice transformation based on Healthcare Home principles
  3. Develops and maintains working relationships with primary and specialty care providers including inpatient facilities
  4. Monitors Healthcare Home performance and leads improvement efforts
  5. Designs and develops prevention
  6. and wellness initiatives Referral tracking
  7. Training and technical assistance
  8. Data management and reporting
  9. Non-PMPM paid staff training time
Care Coordination

1 FTE/750 enrollees

$65,000/year

 $7.22
  1. Referral tracking
  2. Training and technical assistance
  3. Data management and reporting (can be separated into second part time function)
  4. Scheduling for Health Home Team and enrollees
  5. Chart audits for compliance
  6. Reminding enrollees regarding keeping appointments, filling prescriptions, etc.
  7. Requesting and sending Medical Records for care coordination
TOTAL PMPM $58.87
Are there any sites we could visit from other states to see how they are managing this workload in terms of staffing?
We based the staffing model on contractor input gleaned from other health home experiences. A visit to another state’s facility may be possible; we suggest first discussing this idea at the Learning Collaborative.
Are the ratios for patients/staff member evidence based? What was the source? Is this a suggested or required number? Do you have recommendations for salary ranges for the positions?
Currently, there is not a lot of literature regarding health home staffing models. These are in large part under development. Our proposed ratios are based on several things including information from other health home initiatives, salary ranges for each provider type, and the global budget. The ratios are required and projected average costs in the table above are for total employee cost including salary, fringe, and indirect costs.
Regarding the staffing levels and ratios, how do FTEs factor in? i.e. the nurse care coordinator position is expected to have a ratio of 1 to 250 eligible participants – is this considered to be a full-time position?
We would anticipate that the organizations will use the PMPM to provide a salary appropriate to the proportion of FTE required. For example, If an organization has 125 enrolled patients, the nurse care manager would be needed as a half FTE and thus draw half of the recommended salary above. 250 Health Home enrollees is the maximum caseload for a full time nurse care managers on average across all of an organizations participating sites.
How will the overlap work for physicians serving both the Medicare PCMH and the HCH?
A clinic participating in both the Medicaid Health Home project and the Medicare PCMH project will have to be able to show that they were not paid twice for the same service. This can done by either not enrolling the same Dual eligible in both or by being able to show that you provided eligible HH/PCMH services equal in value to the sum of both payments.
How will the overlap work for the similar positions between MO HealthNet Health Home and Medicare PCMH? Can we allocate staff time between the two? Are there any planned trainings on the coordination of the two initiatives?

The proportion of time required for each position in the MHD primary care health home is based on the staffing ratios shared earlier. The cost for each staff is also based on that staffing ratio and the number of patients enrolled. MHD expects the health homes to meet those staffing and time allocation requirements. The same staff can provide services to a patient under both the Medicaid Health Home project and the Medicare PCMH projects if the clinic can show that you provided eligible HH/PCMH services equal in value to the sum of both payments.

A clinic participating in both Medicaid Health Home project and the Medicare PCMH project will have to be able to show that were not paid twice for the same service. This can done by either not enrolling the same Dual eligible in both or by being able to show that you provided eligible HH/PCMH services equal in value to the sum of both payments

Currently, we have no planned trainings regarding the coordination of both initiatives.

What is the final say about the qualifications to be a Nurse Case Manager?
There is a strong preference for the position to be staffed by an RN (as the PMPM is based on an RN salary). However, The State is prepared to consider individual exceptions based on difficulty with recruitment (e.g., in rural areas).
Should the HCH team members be employees or contractors, particularly as this is a time limited program?
Either is permissible.
How do we allocate staff time to protect against revenue coming off the cost report?
The PMPM is NOT an offset against the cost report.
Do the staff have to be new staff or can we use existing, i.e. Behavioral Health, etc.?
Staffing for the Health Home does not have to be new hires, although they must be dedicated to their Health Home position at the required percentage of FTE per number of Health Home patients in your practice. The PMPM payment is intended to enhance your clinic’s current existing capacity. It is not acceptable to use the PMPM to cover existing costs (i.e., staff you already have assuming duties that are definable as a Health Home service without any change in their existing duties). If you choose to use current staff to do health home services you should be prepared to demonstrate that the current staff’s prior duties are being covered by another staff or in some manner show that capacity has been enhanced and the Health Home PMPM has not supplanted other funding. Please reference the report you received from MHD for the percent of FTE calculated by MHD for your organization.