HHC and MetroPlus Designated Medicaid Health Home To Improve Care For Patients
Dedicated Funding Will Be Available to Provide Care Management Services in Brooklyn and the Bronx to Improve Patient Health, Reduce ED visits and hospitalizations
Dec 20, 2011
The New York City Health and Hospitals Corporation (HHC) and its health plan MetroPlusHealth have been designated as a New York State Health Home organization that will provide more effective and cost-efficient ways to manage the care of Medicaid patients who have multiple chronic medical and serious mental health conditions. The HHC/MetroPlusHealth Health Home is one of 8 applicants approved by the State Department of Health last week to improve the care coordination of a pre-assigned group of high needs Medicaid and Medicaid-Medicare dual eligible individuals who live in Brooklyn and the Bronx.
HHC-MetroPlusHealth is one of four Health Home providers that will operate in Brooklyn and one of four in the Bronx that will receive dedicated State funding to support care management services. This Health Home partnership expects to enroll up to 30,000 patients in each of these two boroughs. The Medicaid Health Home program is projected to achieve state Medicaid savings of $33.2 million in fiscal year 2011-12 by reducing hospitalizations and emergency room visits while improving the health, quality of life and outcomes of these patients.
“This is a terrific opportunity that provides much needed resources to help many of our patients who have complex medical, mental health and long term care needs and have difficulty navigating the current healthcare system. As an integrated healthcare delivery system of primary care providers, hospitals, nursing homes, a home health agency, strong community partnerships, advanced electronic health records, and our own health plan, HHC is well positioned to provide the coordinated services patients will need to keep them healthy and out of the hospital and emergency room,” said HHC Chief Medical Officer Ross Wilson.
“This new opportunity will greatly enhance the current partnership between MetroPlusHealth, HHC, HHC Home Care and community providers by providing additional resources to ensure that these complex patients are given access to care of the highest quality,” said MetroPlusHealth President, Dr. Arnold Saperstein. “Our MetroPlusHealth Health Homes services will provide each patient with a care coordination team that will make sure that these patients not only receive improved access to care, but that the care being delivered is as efficient, cost effective and sensitive as possible, with the ultimate goal of improving the patient’s health.”
By early 2012, the State will assign each Health Home organization a designated number of eligible patients who have either two chronic conditions, one chronic condition and are at risk for a second chronic condition, or have serious, persistent mental health condition. MetroPlusHealth will receive a list of eligible members meeting those criteria who will be offered the opportunity to be assigned to the appropriate Health Home and begin receiving services under this new plan. The chronic conditions will include mental health needs, substance abuse disorders, diabetes, asthma, heart disease, HIV/AIDS and hypertension.
The Health Homes will receive set monthly payments that range from $73 to $390 per patient to have assigned care managers who oversee and provide access to all the services a patient needs, from medical and mental health care to other supportive services including housing, food assistance and family support. The HHC/MetroPlusHealth Health Home will include a number of community based health and social service providers to ensure access to the full array of comprehensive services.
Health Home services will include: comprehensive care management; care coordination and health promotion; transitional care, including follow-up care when an patient leaves an inpatient setting; patient and family support; referral to community and social support services; and the use of health information technology to link services.
“We know patients with multiple medical conditions are often difficult to reach, some are homeless, many have language or health literacy issues and lack social support systems. All of these factors underpin their need to have this level of care coordination in order to restore their health ,” added Dr. Wilson. “We know this is the right thing to do for our patients and we know it can be done in a way that will improve health outcomes while reducing health care costs.”
The State’s Medicaid Health Home program follows a similar approach to a small but successful pilot program at Bellevue Hospital started several years ago where patients receive individualized, intensive care management both in the community and in the hospital. Inpatient admissions for patients enrolled in the program decreased by 37.5%, Emergency Department visits decreased by 10%, outpatient visits increased, and Medicaid spending decreased by $16,383 per patient. For more information about the New York State Medicaid Health Home program, visit www.health.ny.gov.
MetroPlusHealth Health Plan, Inc. is a health services plan certified under Section 4403-a of the New York Public Health Law and a wholly-owned subsidiary of the New York City Health and Hospitals Corporation (HHC), the largest municipal healthcare organization in the country, MetroPlusHealth provides managed care to over 400,000 eligible people living in Manhattan, Brooklyn, the Bronx and Queens. In addition to Medicaid Managed Care, MetroPlusHealth offers Child Health Plus, Family Health Plus and several Medicare Advantage Plans and a Special Needs Plan (SNP) for people with HIV and their families. In operation for more than 25 years, MetroPlusHealth offers a vast network of primary care doctors and specialists, including many independent community providers. Plan staff is drawn from the communities that MetroPlusHealth serves and speaks more than seventy languages.
The New York City Health and Hospitals Corporation (HHC) is a $6.7 billion integrated healthcare delivery system with its own 420,000 member health plan, MetroPlusHealth, and is the largest municipal healthcare organization in the country. HHC serves 1.4 million New Yorkers every year and more than 475,000 are uninsured. HHC provides medical, mental health and substance abuse services through its 11 acute care hospitals, five skilled nursing facilities, six large diagnostic and treatment centers and more than 70 community based clinics. HHC Health and Home Care also provides in-home services for New Yorkers. HHC was the 2008 recipient of the National Quality Forum and The Joint Commission’s John M. Eisenberg Award for Innovation in Patient Safety and Quality. For more information, visit www.nychhc.org/hhc or find us on facebook.com/NYCHealthSystem or twitter.com/NYCHealthSystem.