In response to nationwide efforts to better coordinate and manage service delivery to Medicaid recipients, the State of Washington initiated the Health Home Model of care coordination, which focuses on high-cost, at-risk Medicaid enrollees who have one or more chronic health conditions. These beneficiaries struggle with multiple issues, such as access to safe and affordable housing, which often are referred to as “social determinants of health.” When aging services professionals engage with these clients to assess their motivation levels and personal health goals, they can connect them with community resources that may alleviate obstacles to well-being, help to improve health outcomes through better care management and disease prevention, and avoid costly medical treatments.
David Kelly, Executive Director, Area Agency on Aging & Disabilities of Southwest Washington
Samantha Waldbauer, Case Management Services Manager, Area Agency on Aging & Disabilities of Southwest Washington
• Identify the targeted outcomes of the Health Home Program;
• List the services delivered to Health Home Program clients; and
• List the best practices of Washington’s Health Home and Care Coordination model.