Health Homes Software Solutions for Treating the Whole Person

The Affordable Care Act of 2010 created an optional Medicaid State Plan benefit for states to create health homes to coordinate care for those with chronic conditions. Consumers with multiple and serious chronic conditions are often treated by more than one healthcare provider. Unfortunately, those providers – more often than not – do not coordinate care. The health home concept creates one organization that’s is responsible for coordinating the care of the whole person…mind and body.

How Does It Work?

Who Is Eligible For A Health Home?

Health homes are for people with Medicaid who:

  • Have two or more chronic conditions
  • Have one serious and persistent mental health condition
  • Have one chronic condition and is at risk for a second
For health homes, chronic conditions include mental health, substance use, asthma, diabetes, heart disease and have a body mass index above 25. Additional chronic conditions, such as HIV/AIDs, may be considered by CMS for approval. In addition, states can target health home services geographically and cannot exclude people with both Medicaid and Medicare from health home services.

An eligible consumer is assigned to a health care organization/health home or selects one themselves.

In return, the health home provides:

  • Comprehensive care management
  • Care coordination
  • Patient and family support
  • Health promotion
  • Comprehensive transitional care/follow-up
  • Referral to community and social support services

Establish Your Health Home With An Experienced Care Coordination Software Solution Partner

We are software solution providers experienced in working with client partners to establish health homes. We help organizations determine the next steps required to get involved in a local health home.

Whether your organization is planning to participate in an existing health home, or become a lead organization in a new health home and take responsibility for managing all aspects of a consumer’s health care, we can help.

See how we can help you determine the best approach for supporting cross-organizational care coordination and realize financial incentives quicker.

Incentives for Health Homes

New provisions allow Medicaid to reimburse providers for the time they spend on vital tasks such as care management and coordination. The care coordination can be done in person or virtually. It also includes meeting with family members to help support recovery.

Health home providers must report quality measures to the state. In addition, states are required to report expenditure and quality data as well as report utilization. States do have flexibility in designing their payment options and may propose alternatives to those published.

States receive a 90% enhanced Federal Medical Assistance Percentage (FMAP) for health home services listed in Section 2703 of the new provisions. The enhanced match doesn’t apply to the underlying Medicaid services also provided to people in a health home.*

The 90% enhanced FMAP is good for the first eight quarters the program is effective. A state can get more than one period of enhanced FMAP, but can only claim the enhanced FMAP for a total of eight quarters for one enrollee.*

*Source: Medicaid

See how Netsmart has helped several states around the country set up their health homes.

Keep in mind there are a few different ways health homes are being designed across the United States:

  1. Integrated
  2. Co-located
  3. Pure Care Coordination


The decision on how your organization will provide primary care resources is critical. In the integrated model, the organization may take it’s first steps as a health home by establishing and maintaining a primary care clinic.


Embedding primary care physicians from a neighboring healthcare system is also seen as an initial step on the road to becoming a health home.

Pure Care Coordination:

Although the prior two models gives the health home the responsibility for providing the primary care services this model focuses almost entirely on the management of those needs. In this model the primary care services are provisioned outside of the health home/lead agency. The health home will coordinate and manage the care not provide it.

For more information on types of health homes, where they are happening, and the care coordination software solutions we offer, click here.