More than 9,000 Inland Empire Health Plan (IEHP) members are thriving thanks to the plan’s newly-established Health Homes Program (Health Homes). Launched in 2019 to provide complex care for Inland Empire residents, Health Homes delivers broad-based care to those experiencing chronic physical, mental health, and substance use conditions.

Since implementation, Health Homes members have seen overwhelmingly positive clinical health outcomes related to blood pressure, diabetes and depression. Care teams have also proven to be an invaluable resource during COVID-19, providing at-risk members with immediate care assessments, telehealth consultations, connections to food, behavioral health services and more.

“Health Homes shows how dedicated, multidisciplinary care teams providing personalized and holistic care in the community can move the needle forward on outcomes for vulnerable populations,” said IEHP Senior Medical Director Dr. Elise Pomerance.

Administered in partnership with California’s Department of Health Care Services (DHCS), IEHP’s Health Homes program supports nearly 50% of the state’s Health Homes enrolled residents, providing integrated care management for Medi-Cal members with complex needs. The program delivers individualized, whole-person care facilitated by an integrated care team that works closely with the member’s Primary Care Physician.

One of the early successes of Health Homes is the improvement of clinical outcomes for blood pressure, diabetes, and depression. “We also found a statistically significant decrease in emergency department visits and an increase in primary care physician visits, indicating better connection to health resources for the members,” said Dr. Pomerance, “which is very encouraging this early in a new program.”

To help members gain access to resources, the Health Homes care team identifies members who have need and are eligible. This team includes a Registered Nurse, a Behavioral Health Provider, a Care Coordinator and a Community Health Worker.

“I used to cry a lot about things not getting done and not getting any help. My case managers said, ‘we’ll help’ and they did,” said Sharron, a Health Homes member since 2019. “Now, I have a large team helping me. My care team helped me get back to being a more positive person and gave me confidence to take charge of my care.”  

Health Homes care teams utilize IEHP’s real-time data to identify which eligible Health Homes members are hospitalized and initiate enrollment into the program during a hospital visit (prior to COVID-19 restrictions). In addition, care teams identify and enroll members through routine in-clinic interactions with members and providers.

“We believe in Health Homes,” said Dr. Pomerance. “We will continue to support our provider and member community by advocating for services that embody and promote IEHP’s commitment to person-centered, population health, and measurement-based care practices to improve health outcomes in our community.”

To learn more about Health Homes, visit iehp.org.

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