Rebecca Sax, MPHOctober 26, 2016
Supported by enhanced federal financial incentives, Medicaid health homes have rapidly spread across the country, with 19 states and the District of Columbia using this approach to coordinate care for people with complex health and social needs. As an early adopter, New York launched its Medicaid health home program in 2012. Since then, it has used health homes to not only transform care coordination services for Medicaid beneficiaries, but also to encourage connections to housing and job training for high-need individuals, while also addressing other social determinants of health.
A ‘Health Home’ is not a place; it is a group of health care and service providers working together to make sure you get the care and services you need to stay healthy.
New York has 35 designated lead health homes that are partnering with broad networks of community-based providers and other organizations to serve more than 230,000 individuals with chronic physical and behavioral health needs. With funding from the New York State Health Foundation (NYSHealth), the Center for Health Care Strategies (CHCS) has supported this work via a four-year Learning Collaborative that brought together health homes, community partners, state officials, and other stakeholders to share learnings and emerging best practices, and inform ongoing policy and implementation.
Health Home Meeting Insights
Our final meeting under the NYSHealth grant in August featured more than 80 attendees, including 22 from partnering community organizations and representatives from the New York State Department of Health (NYSDOH). The meeting covered a wide range of topics, including:
- Aligning New York’s Delivery System Reform Incentive Payment (DSRIP) Program with health homes;
- Addressing challenges of upstate rural providers to recruit and retain staff;
- Coordinating with Health and Recovery Plans (HARP), a new managed care product for individuals with significant behavioral needs; and
- Providing innovative health home supports for criminal justice-involved individuals.
The meeting also included a Q&A session between health home attendees and NYSDOH leadership, as has become standard over the last few years. These discussions have offered a valuable opportunity for health home representatives to collaborate with NYSDOH on a variety of implementation and policy issues ranging from data exchange, to payment methodology, to alignment with other Medicaid initiatives — and, in doing so, facilitate the evolution of health home efforts.
Celebrating Health Home Successes
The Learning Collaborative meeting ended with a session celebrating the important and difficult work that New York’s Medicaid health homes have accomplished since 2012. Participants shared success stories, highlighting ways that the program has benefited both individuals and communities across New York State. Health home representatives spoke of individuals whose health outcomes far surpassed providers’ expectations, and those who were able to get stable housing, employment, and the necessary tools to manage their needs due to support from health home care managers. Below are examples:
- Greater Buffalo United Accountable Care Organization helped K. access medical and social services including dental care, transportation, temporary housing, and legal services. K. is particularly grateful for his care manager’s availability whenever he needed resources and considered her a true partner in maintaining his health and stability.
- Catholic Charities of Broome County worked with “Ben” to gain employment and restore social connections after an extended period of homelessness and mental health crises.
- A Niagara Falls Memorial Medical Center care manager helped J. access primary care, social services (including housing, food, and clothing programs), as well as job skills classes. J. credits her care manager for going above and beyond by accompanying her to appointments and medical procedures. J. is now housed, with steady employment and access to medical care.
These stories serve as a testament to the incredible efforts of the New York Health Homes program, and to the important role it will continue to play in the state’s health care reform efforts.
Maintaining Health Home Momentum in New York
Four years after New York’s implementation of Medicaid health homes, there are an array of opportunities to support and expand the program through the state’s ongoing Medicaid Redesign Team (MRT) efforts. New York has an ambitious goal to transition at least 80 percent of managed care payments from fee-for-service to value-based payments over the next four years, using financial incentives to encourage provider adoption of care coordination and outcome-based approaches. Through HARPs, individuals with serious mental illness and certain chronic conditions can be eligible for an enhanced set of home- and community-based services — including vocational training and supported employment services, supportive housing programs, community-based residential recovery programs, and non-medical transportation (e.g., transportation to job interviews or to a GED course). Finally, New York’s DSRIP will reinvest savings from other MRT programs back into the health and safety net system, potentially including health homes, in order to reduce avoidable hospital admissions by 25 percent over the next five years.
Through these wide-ranging initiatives, New York is continuing its trajectory to transform the delivery and financing of services for low-income, high-need populations across the state — we look forward to continuing to support the work of New York’s health homes, and to following the state’s next steps.