What is a CMHC Healthcare Home?

Missouri's CMHC Healthcare Homes are designed to integrate care for chronic health conditions into the CMHC setting. They assist individuals in accessing needed health services and supports, and learning to manage their health conditions, and improve their general health, by monitoring health conditions and healthcare needs of enrollees and intervening with clients whose health conditions are not properly controlled or managed. HCHs promote and encourage wellness, healthy lifestyles and preventative care, educate and teach persons how to better manage their chronic health conditions, educate agency staff about chronic health conditions and how to manage them, and encourage a population health approach to help improve chronic health conditions for persons served by CMHCs.

Individuals covered by MO HealthNet are eligible to be served by a CMHC Healthcare Home if they have:

  • A serious mental illness (including children and adults receiving psychiatric rehabilitation services under the Medicaid Rehabilitation Option), or
  • A mental health condition and a substance use disorder, or
  • A mental health condition or a substance use disorder, and one of the following chronic conditions or risk factors:
    • Diabetes
    • Asthma/COPD
    • Cardiovascular Disease
    • Developmental Disability
    • Overweight (BM >25)
    • Use Tobacco

This website provides information regarding the development, and current status, of Missouri’s CMHC Healthcare Homes. Information regarding Missouri’s Primary Care Health Homes can be accessed at the following website: dss.mo.gov/mhd/cs/health-homes/

HCH Policy Memos and Clinical Bulletins

This section contains the policy memos, clinical bulletins, and guidelines regarding the operations of HCHs.

CMHC HCH General Memos and Bulletins

Nurse Care Manager (NCM) Policy Memos and Tools

Primary Care Physician Consultants

Metabolic Syndrome Screening

HCH Training

This section contains educational information for training new staff and provides other HCH training materials.

HCH General Training Tools

HCH Director Training Tools

HCH Nurse Care Manager (NCM) Training Tools

  • HCH Nurse Care Manager Roles and Responsibilities - coming soon

HCH Primary Care Physcian Consultant Training Tools

HCH Care Coordinator Training Tools

  • HCH Care Coordinator - coming soon

Metabolic Syndrome Screening Training Tools

Medication Reconciliation Tools

Health Screen Tools

HCH Training Links

The Missouri Coalition for Community Behavioral Healthcare and the Missouri Department of Mental Health are sponsoring this website for champions of health and wellness. On this website you will find health and wellness articles, news, videos, and webinars. You can find documents from trainings, meeting minutes, activities, PowerPoints, etc. https://www.wellmissouri.com/

 

HCH Health Information Technology (HIT)

This section contains information regarding the HIT tools that is utilized by the HCHs.

CareManager - Under Construction

CyberAccess - Under Construction

Risk Stratification Tools - Under Construction

MO Outcome Measures Catalog - Under Construction

Disease Management

This section contains a brief introduction to the Disease Management (DM) programs in MO, as well as a link to the DM home pages.

The Disease Management (DM) projects are a collaborative effort among the Department of Mental Health’s (DMH) Division of Behavioral Health (DBH), the Department of Social Services’ (DSS) MO HealthNet Division (MHD), and the Coalition for Community Behavioral Healthcare. The project targets Medicaid-eligible adults with high medical costs who have a serious mental illness or substance use disorder and who are not currently receiving behavioral health services. The goal is to locate and enroll these individuals in services, who frequently have impactful chronic medical conditions, in order to improve health outcomes and reduce related medical costs. The DMH has adopted a whole person approach regarding treatment and services. To make any impact in reducing premature mortality and costs and to increase individual outcomes, services can no longer be delivered in silos. An integrated approach must be embraced. Services should be delivered based on a chronic care model rather than an acute care model. This model enables providers to assist consumers with their overall health care needs and gain an understanding of their strengths and barriers which may impact their recovery and quality of life. Disease management is a philosophy that embraces the above models and involves coordinating complex care with multiple providers. For individuals with chronic health conditions, high quality care truly requires integrated, person centered, and coordinated care. Many individuals with a mental illness or a substance use disorder also have chronic physical health conditions resulting in premature mortality. Despite this fact, behavioral and physical health services have historically been delivered through separate systems with little cross-system coordination. This results in poor individual outcomes and excessive costs to the healthcare system.