The report below is a cautionary tale.
The pilot project undertaken in New York met greater resistance and challenges than might have been expected. As efforts to create Health Homes are expanded it will be important for organizers to consider these issues and take steps to alleviate them.
New York’s Chronic Illness Demonstration Project
Between 2008-11, 6 CIDP health home-like pilots were operated under grants from the NYS Department of Health. 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.
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).