Evaluation of the Integrated Health Home (IHH) program in Iowa: Qualitative interviews with site administrators
The Iowa Integrated Health Home (IHH) initiative was launched in 2013 as a partnership between the Iowa Department of Human Services (DHS) and Magellan Behavioral Care of Iowa, a private health management company that has managed the Iowa Plan for Behavioral Health (Iowa Plan) since 1995. The purpose of an IHH is to provide whole-person, patient-centered, coordinated care for adults with a serious mental illness (SMI) and children with a serious emotional disturbance (SED). IHH sites are responsible for comprehensive care management, care coordination, health promotion, comprehensive transitional care, facilitating access to individual and family support services, and referring clients to community and social support services.
Qualitative, in-depth telephone interviews were conducted with administrators (n=28) at Phase I and II sites across Iowa. Administrators were asked to comment on barriers and facilitators related to different aspects of IHH program implementation, including recruitment and enrollment of members, care coordination, performance measures, and communication with program administration. Interviews were transcribed and analyzed for common themes.
Interviews with administrators revealed several issues related to IHH program implementation. Many activities mandated by the program—namely, recruitment of new members, expectations for program performance measures, and administrative load-- were perceived as unduly burdensome to agencies. Although communication from IHH program administration was mostly described as sufficient in quantity, respondents felt that guidelines issued by the administration were often inconsistent and lacked an understanding of circumstances at the agency level.
Practice Transformation Coaches (or ‘practice coaches’), who are contracted with the program to instruct and assist IHH sites with issues related to technical assistance, practice transformation, and quality improvement, were also interviewed (n=3). Using a brief qualitative instrument, practice coaches were asked about the purpose and scope of their role, the support needed by IHH sites, their perspective on lessons learned from Phases 1-3 of the program, and ways program administration can enhance support and communication with practice coaches and program sites. Practice coaches reported giving assistance to IHH agencies of a type and degree that varied widely by site. Practice coaches described concerns about the program similar to some raised during interviews with administrators—namely, issues associated with the enrollment period and communication with Magellan about program guidelines and best practices.