Clinical Hub or Medical Home?

Boy, you can tell I am no longer "on the ground" in Massachusetts. I am on break this week from my Fellowship, and going through my e-mails, when I spied this one, highlighting Provider Alert #78 from the Massachusetts Behavioral Health Partnership :

Beginning October 1, 2009, as part of the Children’s Behavioral Health Initiative (CBHI), outpatient providers serving youth under the age of 21 who are enrolled in MassHealth Standard and CommonHealth will be responsible for assuming the role of “clinical hub,” and will play a key role in the coordination of three new “hub dependent” services for their clients.

Therapeutic Mentoring, In-Home Behavioral Services, and Family Support and Training are new services available to youth under age 21 with behavioral health needs who are enrolled in MassHealth Standard and CommonHealth. As with all CBHI services, these services are designed to promote Systems of Care values and ensure that the care provided is:

• Family-Driven, Child-Centered, and Youth Guided

• Strengths-Based

• Culturally Responsive

• Collaborative and Integrated

• Continuously Improving

This Alert includes information on all six CBHI services so that outpatient providers are aware of the entire CBHI continuum.

Role of the Clinical Hub

Clinical Hub providers are responsible for coordinating care and collaborating with other service providers (e.g., making regular phone calls to collaterals, holding meetings with the family and other treatment providers, or convening care planning teams for ICC). Clinical Hub services in order of intensity are: Intensive Care Coordination (ICC), In-Home Therapy (beginning November 1, 2009), and Outpatient Therapy. When more than one Clinical Hub service provider is involved with a family, care coordination is provided by the most intensive service. Clinical Hub providers may refer for services that require a hub (i.e., “hub dependent” services). These services include: Therapeutic Mentoring, In-Home Behavioral Services, and Family Support and Training. Hub dependent services require a referral from one of the three Clinical Hubs (i.e., outpatient, In-Home Therapy, Intensive Care Coordination) and will not be authorized as a “stand-alone” service. There must be a goal identified on the existing outpatient or IHT treatment plan, or on the individual care plan (ICP) for youth in ICC, which corresponds directly with the need for a “hub dependent” service. It is the responsibility of the Clinical Hub provider to regularly connect with those “hub dependent” service providers to which you make referrals in order to coordinate care and obtain and provide updates on the youth’s progress.

Outpatient providers will be reimbursed for coordination activities related to their Clinical Hub responsibilities including participation in care plan team meetings and collateral contacts. Providers can be reimbursed by billing for Case Consultation or Collateral Contacts. See Provider Alert #74, dated August 20, 2009, on MBHP expanding the parameters for case consultations.

Now that sounds an awful lot like the kind of care coordination that we want to see in the Medical Home. If we can do it for kids with SED, why not for the rest of them? How will this mesh with the various Medical Home projects under development within the Commonwealth and throughout the nation? When the Medical Home comes, we will have a good model off of which to work.

Progress. More progress is always a good thing.