[NYAPRS Enews] TU: NYS Seeks Savings With Health Homes

[Harvey Rosenthal]

State Seeks Savings With Health Homes

New York Shaping a New System for Highest-Need Medicaid Recipients

By Cathleen F. Crowley Albany Times Union  August 18, 2011

 

A disbelieving Diana Babcock
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Diana+Babcock%22>  remembers
walking back to the homeless shelter where she was living in Schenectady
in 2001.

The staff at the local mental health clinic had just informed Babcock
that her intensive outpatient therapy was "done."

Babcock was recovering from a nervous breakdown and struggling with
depression and addiction. She had lost her apartment, given up her
children to state care and resigned from her job as a classified account
representative at The Daily Gazette
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Daily+Gazette%22> .

"What do you mean I'm 'done'?" Babcock said.

It took her five hospitalizations and nearly 10 years to recover. This
month, the Rensselaer 52-year-old got off Medicaid and took a full-time
job as a peer counselor at the Mental Health Empowerment Project in
Albany.

Babcock also sits on a subcommittee of the state's Medicaid Redesign
Team
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Medicaid+Redesign+Team%22>  as it
shapes a new system of care for the most expensive and highest-need
Medicaid beneficiaries, who often suffer from a combination of mental
health problems, addictions and chronic medical problems like diabetes,
asthma and heart disease.

Medicaid is the state health program for low-income and disabled New
Yorkers. Fewer than 20 percent of Medicaid enrollees, about 1 million
people, account for $26 billion in Medicaid spending -- more than half
the total spending for the program in New York.

Much of that spending is for hospital care.

"These patients are often referred to as 'frequent fliers' because they
are in and out of hospitals," said David Sandman
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22David+Sandman%22> , senior vice
president of the New York State Health Foundation
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22New+York+State+Health+Foundation%22
> , a nonprofit that has conducted extensive research on the state's
Medicaid system.

The state has fast-tracked the initiative called "health homes" that
targets this high-need population for special attention and cost
savings.

Rather than a bricks-and-mortar building, a health home would involve a
network of providers working together to care for complex Medicaid
patients. Ideally, the state wants each network to include a hospital, a
primary care group, a home health agency, a mental health provider, an
affordable housing agency and other community groups.

Every patient would have an individualized care plan and a case manager
responsible for making sure a patient gets the help he or she needs,
ranging from medical care and counseling to housing needs, food
assistance and family support.

"These individuals not only have complex health care needs, but have
complex lives," said Jason Helgerson
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Jason+Helgerson%22> , the state
Medicaid director. "If we don't address these complexities as a whole,
we're not going to do a good job of keeping them healthy, out of
hospitals and out of nursing homes, and keeping down the costs
associated with their care."

The state expects to save $33 million in the first year of the
initiative because -- if health homes work properly -- patient problems
will be treated early and reduce avoidable hospitalizations and ER
visits.

"New York ranks (worst) in the nation when it comes to inappropriate
hospitalizations, and we think there is a great opportunity to keep
people out of hospitals and save money," Helgerson said.

Health homes must prove they are doing a good job, which will be
measured by tracking hospitalizations, ER visits, patient surveys and
health indicators for individual patients. The state plans to reward
health homes that perform well with bonus payments.

Over the next four years, the state predicts the initiative will reduce
Medicaid costs by $560 million.

Several organizations in the Capital Region are considering applying to
be a health home, including Northeast Health, which may partner with the
Rensselaer County Mental Health Department
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Health+Department%22> , and CDPHP,
a health insurance company that's already experimenting with coordinated
care between primary care providers and hospitals.

The state Health Department has held several webinars to explain the
program to providers, and each online event drew 800 or more callers --
numbers organizers saw as astonishing.

Health home networks must submit applications by Oct. 1, and the state
wants to begin enrolling patients into health homes on Nov. 1. About
200,000 people will be enrolled in the first year, which will focus on
Medicaid beneficiaries with addictions, mental health problems and
chronic medical conditions. If the program is successful, it will be
expanded to enrollees who are developmentally delayed or in nursing
homes.

One of the reasons the initiative is moving ahead so quickly is that the
federal government, through the Affordable Care Act, will pay 90 percent
of care coordination costs for the first two years -- a strong incentive
for the state and providers.

"This is exciting and long overdue," said Harvey Rosenthal
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22Harvey+Rosenthal%22> , executive
director of the New York Association of Psychiatric Rehabilitation
Services
<http://www.timesunion.com/?controllerName=search&action=search&channel=
local&search=1&inlineLink=1&query=%22New+York+Association+of+Psychiatric
+Rehabilitation+Services%22> . "It should be better for consumers and
better for taxpayers.

But Rosenthal and others are concerned about the rapid pace of
implementation. Providers are scrambling to form partnerships, submit
applications and get approval -- even though the state hasn't revealed
the reimbursement rates for care coordination, or the performance
measurements that will be used to evaluate health homes.

The home health networks will face many challenges, including a patient
population that's often tough to reach. Some are homeless, and others
are shutting out the world because of mental health and addiction
problems.

Babcock said health homes will only work if patients "feel they are the
center of this process, and it's all about whatever it takes for them to
be well."

Reach Crowley at 454-5348 or ccrowley at timesunion.com.

 

By The Numbers

*         5.4 million: Number of Medicaid beneficiaries

*         $46 billion: Total annual spending on NY's Medicaid program

*         976,000: Number of Medicaid enrollees with complex health
problems

*         $26 billion: Total spending on complex Medicaid enrollees

*         $2,338: Average monthly spending on complex enrollees

*         $890: Average monthly spending on a typical enrollee


http://www.timesunion.com/local/article/State-seeks-savings-with-health-
homes-2082984.php#ixzz1VOhz9ihL

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