National award honors Hudson Health Plan for 'doing the undoable'
Three years ago, Hudson Health Plan took on a daunting task – managing the care of 250 of the most expensive fee-for-service Medicaid patients in Westchester, NY – a cohort of individuals who are exempt from Medicaid Managed Care, yet in desperate need of coordinated care for chronic health conditions, mental illness, chemical dependency, and their social service needs. It's a vulnerable category of high-need, high-cost individuals ill-served by society's current patchwork of social and medical services.
Today, many of these patients are on the road to health and a better life, thanks to Westchester Cares Action Program (WCAP), an innovative coordinated-care project that Hudson developed with its behavioral health partner, Beacon Health Strategies. In recognition of WCAP's achievement, Hudson received the 2012 Medicaid Health Plan Innovation Award on May 2nd at the annual Medicaid Managed Care Congress.
"WCAP was an enormous undertaking that required us to retool conventional case management," explains Margaret Leonard, MS, RN-BC, FNP, Senior Vice President of Clinical Services at Hudson and the Executive Director of WCAP. "We used our skills, our expertise, and our complete dedication to getting the undoable done, and helped dozens of people gain access to regular medical and behavioral care, a place to live, social services, and much-needed support."
The Medicaid Health Plan Innovation Award is presented annually to the most innovative health plan over the past year and recognizes its efforts to control costs, drive quality improvements, and expand access to health care. "We are thrilled to be nationally recognized for our work, and proud to have created a model for treating Medicaid's most high-cost, high-utilization patients," comments Ms. Leonard, who received the award on Hudson's behalf.
WCAP is based on a Medicaid "health home" model of service delivery that coordinates primary and acute medical care, behavioral health care, and social services for vulnerable people. Georganne Chapin, President & CEO of Hudson Health Plan, points out that WCAP successfully coordinated overlapping safety net programs into a single patient-focused care management model that addressed multiple needs. "High-cost, high-utilization Medicaid beneficiaries are the most complex cases to manage, mostly because they live in poverty, which further exacerbates their situation," she notes. "The unfortunate reality is that many of these patients overuse the hospital emergency department or need hospitalization because they don't have the means to manage their chronic health conditions, or they're just looking for a safe and warm place to stay. They are struggling to survive."
The WCAP model has helped many program members break that cycle of despair. While final results are not yet available, a preliminary analysis of 61 patients who have been in the program for at least two years shows a 45.9% reduction in total inpatient costs in the two years after enrollment. In addition, emergency room visits were reduced by 15.4%. Hospitalization costs were reduced by more than $750,000.
Potentially saving millions of dollars
The success of programs such as WCAP could potentially save the Medicaid program millions of dollars, since it targets the costly patients who account for a large percentage of Medicaid spending. For example, in New York State, 20% of Medicaid beneficiaries account for 75% of the program's cost. WCAP was funded as a Chronic Illness Demonstration Project by the New York State Department of Health, which provided a list of high-cost, high-utilization Medicaid beneficiaries in Westchester for WCAP to find and enroll. About 40% of these individuals were homeless, and WCAP field workers canvassed homeless shelters, soup kitchens and laundromats to find them, gain their trust, and enroll them in the program. That "feet on the street" approach has continued throughout the program and is a primary reason why WCAP has succeeded, according to Ms. Leonard.
"WCAP breaks the mold of conventional case management, which is primarily based on telephonic support," Ms. Leonard notes. "WCAP team members visited the patients' homes, and accompanied them to medical appointments to make sure the patients comprehended what the doctor said. They assisted in finding them places to live, and arranged donations of clothes and furnishings. They went the extra mile to prepare patients to accept responsibility for managing their health, behavior, and their lives."
Ms. Chapin points out that WCAP is one of the first programs to prove how successful the health home model can be, and that Hudson is using what it learned in operating WCAP to create a similar health home for its at-risk members. She predicts that more health homes are likely to emerge, in part because the Affordable Care Act now gives states the option to fund Medicaid health homes for patients with complex chronic illnesses. To encourage states to fund Medicaid health homes, the federal government is initially offering a 90% federal match rate.
"WCAP has made an enormous contribution to understanding how to break the cycle of despair that grips a marginalized population," Ms. Chapin concludes. "Creating one seamless, integrated system of care is nothing short of revolutionary, and we've demonstrated that it works."
About Hudson Health Plan
Hudson Health Plan is a community-based not-for-profit health care organization that provides state-sponsored Medicaid Managed Care, Child Health Plus, and Family Health Plus insurance coverage to over 115,000 members in New York's Hudson Valley. Hudson uses every government dollar it receives to fulfill its mission, which is "to promote and provide access to excellent health services for all people." Hudson improves the health of its members and the communities in which they live through its innovations in care coordination, and by supporting over 5,000 local health providers. In both 2009 and 2010, Hudson achieved the highest quality incentive scores of any Medicaid plan in New York State, and in 2010, it received the highest overall performance rating of any Medicaid plan in the Hudson Valley. It also has earned the highest ratings in overall satisfaction among Medicaid Managed Care members in the Hudson Valley region every year since 2003.
