Daliah Heller, PhD, MPH, joins the Center for Health Media and Policy (CHMP) at Hunter College this year as a Visiting Scholar.
I’m beginning to think Health Homes are one of the best-kept secrets in the Patient Protection and Affordable Care Act (ACA). I’ve spoken with a lot of health care providers lately, and few seem to know about this provision, and that it is not the same as a Medical Home, though could be part of one.
Health Homes are case management-type entities established by the state health authority to
serve Medicaid-eligible people with chronic health conditions. ACA includes substance use
disorders among the eligible conditions, alongside mental health conditions, asthma, diabetes,
heart disease, and being overweight. And for the record, the term ‘substance use disorder’ refers
to a spectrum of excessive or harmful alcohol or drug use.
Health Homes are charged with providing comprehensive care management, coordination, and
health promotion to address the medical (physical), behavioral (substance use and mental health),
and social support (eg, housing, transportation assistance) needs of this population. Benefiting
from this arrangement could dramatically improve health and social outcomes for people with
substance use disorders.
Historically, this group been largely shunned by the general health care system. No different
from prevailing views, health care providers have been encouraged to view people with
substance use disorders as weak-willed and often deviant. This stigma has resulted in a hostile
health care environment and not surprisingly, lots of emergency room visits and hospitalizations
for preventable infections and illnesses, because people aren’t engaged in routine primary care.
In tandem, the criminalization of drug use eventually complicates the social situations of most
people with chronic substance use, further worsening health outcomes.
There is something particularly transformative about the inclusion of people with substance use
disorders in the Health Homes eligibility list. For the first time, this group could get health care
attention and social support without contingencies demanding abstinence from substance use or
requiring participation in a drug treatment program.
And because the provision explicitly embraces a care management approach, it holds promise for
pushing health systems to recognize and respond to substance use disorders as a chronic health
condition. This is very different from how most care for this group is currently delivered, in
one-size-fits-all, time-limited treatment programs, with inconclusive results. But substance use
services are under pressure to change too, because outcomes matter in ACA.
Considered, participant-driven Health Home models could be a game-changer for how we
conceptualize substance use services and how people with substance use disorders experience
them. While it’s up to the states to propose a plan for Health Homes, providers and advocates
could advance this opportunity by developing and show-casing models now.