Washington Health Home Program

Achieving Washington State's Vision of Integrated Services

The Department of Social and Health Services (DSHS) and the Health Care Authority (HCA) have collaborated on the Health Home Program with federal partners since 2013, and have received strong support from individuals, local health care providers, and advocates.

Washington has targeted its demonstration to high-cost, high-risk Medicare-Medicaid enrollees based on the principle that focusing intensive care coordination on those with the greatest needs provides the greatest potential for improved health outcomes and cost savings. The positive outcomes achieved by the Health Homes program have been organized around the principles of patient activation and engagement. In the course of integrating care for enrollees across multiple delivery systems, Health Home Care Coordinators are charged with engaging enrollees to set health action goals and increase self-management skills to achieve optimal physical and cognitive health.

All Care Coordinators receive intensive state directed training on how to develop the Health Action Plan and the six Health Home services.  Health Home seek to address complex health issues by offering:

• comprehensive care management;
• care coordination;
• health promotion;
• comprehensive transitional care and follow-up;
• individual and family support; and
• referrals for community and social services support.

Care Coordinators work to reduce gaps in services and increase coordination of all service providers including medical, behavioral health, long-term services and supports, and other social services.

The goal of the Health Home Program is to improve coordination of care, quality, and to increase an individual’s participation in their own care. Participation in the Health Home Program is voluntary and will not duplicate, change, or replace any services and supports the individual is receiving; it is simply an added benefit.

In addition, Washington has been participating in the CMS Medicare-Medicaid Financial Alignment “Demonstration” for individuals who receive both Medicaid and Medicare benefits (commonly referred to as dual eligible).  Participation in the Demonstration has been a unique opportunity for the state to receive performance payments from CMS based on achieving statistically significant savings and meeting or exceeding quality requirements.   

The most recent analysis from CMS shows the Health Home demonstration has saved the Medicare program more than $293 million, over the first six years, through better care coordination while transforming the lives of thousands of Washingtonians.

Health Home Program for Tribes

The 2021 State Legislature provided a remedy for lead agency reimbursement issues that created a barrier for contracting with Tribes.  The HCA and the Department of Social and Health Services, Aging & Long-Term Support Administration (ALTSA) have prepared a Tribal Care Coordination Organization Agreement (CCOA) for use by all Health Home Lead Organizations. Because your Tribe either has an existing Health Home contract or has expressed an interest to learn more on how to become a Health Home Care Coordination Organization, we are seeking your input prior to finalizing the Tribal CCOA template for all Lead Health Home organizations to utilize when contracting with interested Tribal Governments.

• Health Home Care Coordination Organization Agreement (CCOA) Tribal Addendum
• Health Home CCOA Tribal Addendum 12-16-2021
• Updated Health Home Tribal Program
• Tribal Health Home Factsheet
• Tribal Health Home (HH) Program: Frequently Asked Questions
• Primary Care Case Management (PCCM) vs. Health Homes Factsheet
• Tribal Health Home Care Coordinator Organization (CCO) Requirements Factsheet
• Tribal Health Home Lead Organization Requirements Factsheet

For more information about the Health Home Program

• Health Care Authority website
• Centers for Medicare and Medicaid
• Brendy Visintainer, Duals Integration Unit Manager, 360-725-2647 or brendy.visintainer@dshs.wa.gov