NYAPRS Note: Between 2008-11, 6 health home-like pilots were operated under grants from the NYS Department of Health. The following piece looks at a recently released summary of some of the results.
Some excerpts of note to those of us who provided peer services as a part of these designs (NYAPRS developed a peer wellness coaching intervention as part of OptumHealth’s initiative):
“Multi-Disciplinary On-the-Street Care Management: The participating CIDP programs assigned nurses, social workers, and
peer specialists - people who previously had experienced social and medical issues similar to those of the clients - to locate and contact potential clients identified by statistical analysis to be at risk of high health care costs. They often had to search the streets, homeless shelters, and drug clinics to find them... though many were not found. Then staffers explained the program to them and asked them to sign up. ...Moving forward, the state is offering health home participants a workforce training initiative that prepares case managers to provide more coordinated, patient-centered care. There will be a particular emphasis on training peer support specialists.”
New York's Chronic Illness Demonstration Project Analysis Reveals Six Lessons For Medicaid Health Homes
Open Minds January 14, 2013
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An informal early review of the three-year New York Medicaid Chronic Illness Demonstration Project (CIDP) for beneficiaries with chronic physical and behavioral health needs revealed that the participating provider organization faced six key challenges to providing the CIDP services, which are similar to those provided by a Medicaid Health Home.
As New York Medicaid launches its Health Home initiative, the state is developing ways to addressing the challenges reported in the CIDP. The CIDP started in 2008; six provider organizations were selected to participate via a competitive procurement. Under the CIDP model, care coordinators at the participating provider organizations connected beneficiaries to primary and preventive care as well as with mental health and addiction treatment services. The goal was to improve care for high-need, high-cost Medicaid fee-for-service beneficiaries and reduce preventable hospitalizations and emergency department use.
Over the course of the three-year CIDP, state officials and the provider organizations reported the following key challenges:
- Case managers reported difficulty accessing medical, mental health, and addiction provider organizations for their clients.
- Appropriate housing for homeless clients was hard to secure.
- Sharing patient data was difficult due to federal privacy rules and lack of capacity to exchange electronic data between organizations.
- Hiring and retaining community-based case managers was difficult due to the intense demands of the job and patient complexity.
- Locating and engaging high-cost, high-risk beneficiaries was time consuming and the CIDP model did not reimburse the organizations for this task.
- Service coordination efforts sometimes met resistance from other provider organizations; extensive education efforts were needed to build collaborative relationships.
The findings were reported in “New York's Chronic Illness Demonstration Project: Lessons For Medicaid Health Homes” by Harris Meyer, in a profile published by the Center for Health Care Strategies (CHCS). The CIDP was part of the Rethinking Care Program, a CHCS initiative made possible by Kaiser Permanente Community Benefit, with additional support for the New York pilots from the New York State Health Foundation. The Rethinking Care Program tests strategies for improving health care quality and controlling spending for high-need, high-cost Medicaid beneficiaries.
The participating provider organizations received a per-patient per-month case management fee of $300, and Medicaid reimbursed separately for the beneficiaries’ health care services. Additionally, as long as they met quality performance measures, the organizations would be permitted to share half of any savings generated during the second and third years of the demonstration. The amount of shared savings will be determined by a claims analysis. The organizations’ care management teams were charged with locating and contacting potential clients identified by a statistical analysis to be at risk of high health care costs. After locating a potential client, the care managers conducted a comprehensive assessment to develop a personalized health plan. The care manager met with the client weekly; assessments were conducted every six months or after a hospitalization or emergency department visit. The care manager was responsible for ensuring that the clients’ needs were met for medical care, housing, behavioral health and addiction treatment, food, education, and vocational training.
The provider organizations, and their projects, were as follows:
- The Institute for Community Living Inc., a non-profit human service provider organization, conducted the Pathway to Wellness project in sections of northern Manhattan. The care management team included clinical care coordinators, field care managers, peer support specialists, and regular case reviews with a medical consultant. The participating provider organizations offered same/next day appointments and extensive access to peer support specialists.
- The NYC Health and Hospitals Corporation (HHC), a public hospital health care system, conducted the Hospital 2 Home program in sections of Manhattan, Brooklyn, and Queens. The care management team included a social work supervisor, community-based care managers, chronic disease registry coordinators, HHC clinical staff, and a housing coordinator. The three hospitals in the project used a patient alert system to notify the care management team when an enrollee was at the hospital; the project also used a housing coordinator.
- OptumHealth, a for-profit health insurance company, conducted the Life Healthy Care Management Program in sections of Queens. The care management team included behavioral nurses, clinical nurses, social workers, and peer support specialists. Instead of having a central office, the staff met in “virtual office” space using information technology.
- Federated Employment and Guidance Services, Inc., a non-profit health and human service system, conducted Nassau Wellness Partners in Nassau County. The care management team included clinical care coordinators, field care managers, peer support specialists, and regular meetings with medical consultants. In this project, nurses provided the teams with medical and behavioral health expertise.
- Hudson Health Plan, a non-profit health maintenance organization, conducted the Westchester Cares Action Program in Westchester County. The care management team included a nurse supervisor, field care managers, integrated care coordinators, and a peer support specialist. In this project, the care management team used a standardized tool called INTERMED-Complexity Assessment Grid for assessment and intervention.
- SUNY Buffalo Family Medicine, Inc., a medical school faculty practice plan, conducted Healthy Partners of Erie in Erie County. The care management team included a nurse care manager, practice enhancement assistant, and a social service coordinator. This project emphasized telephonic nurse care management.
New York Medicaid is applying the lessons learned during the CIDP to its new Health home program now rolling out statewide to serve up to one million beneficiaries. To address the challenges identified through the CIDP, the Health Homes program will do the following:
- Prioritize close connections between case management organizations and provider organizations, with efforts co-location of medical and behavioral health provider organizations.
- Housing provider organizations will be incorporated into Health Home networks.
- A standard consent form will facilitate sharing patient information by Health Home provider organizations; the state also plans to use regional health information organizations as vehicles for improved data exchange.
- The state developed a workforce training initiative that prepares case managers to provide more coordinated, patient-centered care. There will be a particular emphasis on training peer support specialists.
- To cover the costs of locating eligible beneficiaries, during the three-month outreach phase, the Health Homes case managers will be paid 80% of the per-patient per-month care management fee. The outreach period payment is for the estimated number of eligible beneficiaries. After the outreach period, or upon enrolling an eligible individual, the Health Homes will receive the full care management payment for each enrolled beneficiary.
The full text of “New York's Chronic Illness Demonstration Project: Lessons For Medicaid Health Homes” was published in December 2012 by Center for Health Care Strategies. A free copy is available online at http://www.chcs.org/publications3960/publications_show.htm?doc_id=1261469&inactive=1#.UNISlW_Ac1I (accessed January 8, 2013).
For more information, contact: Lorie Martin, Communications Director, Center for Health Care Strategies, Inc., 200 American Metro Boulevard, Suite 119, Hamilton, New Jersey 08619; 609-528-8400; Fax: 609-586-3679; E-mail: firstname.lastname@example.org; Website: www.chcs.org; or Bill Schwarz, Director, Public Affairs Group, New York State Department of Health, Corning Tower, Empire State Plaza, Albany, New York 12237; 518-474-7354; Web site: www.health.ny.gov/health_care/medicaid; andwww.health.ny.gov/health_care/medicaid/program/medicaid_health_homes.
*Editor's note: this article was modified on January 14, 2013, to incorporate clarifications from the Center for Health Care Strategies.
New York's Chronic Illness Demonstration Project Analysis Reveals Six Lessons For Medicaid Health Homes. (2013, January 14). OPEN MINDS Weekly News Wire.
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