NYAPRS Note: Here’s the executive summary of a newly released report looking at how health home based care management has fared in New York State. NYAPRS and our partners at the Center for Practice Innovation, NY Care Coordination Program and the NYS Council for Community Behavioral Healthcare are about to launch a second iteration of our Department of Health-funded Care Management Training Initiative.

See http://healthhometraining.com for resources and details associated with our last such initiative…and stay tuned for more details about our new program.

 

Care Management in New York State Health Homes

By Joslyn Levy & Associates  August 2014 for the NYS HealthFoundation

 

Realizing the promise of care management requires a fundamental shift in the way health care is conceptualized, organized, and delivered—from a medical model of disease treatment toward person-centered care that incorporates social service provision, behavioral health care, self-management support, and family engagement alongside primary and specialty medical care.

 

New York State’s Medicaid health home initiative offers an unprecedented opportunity to expand and improve care management for beneficiaries with intensive, high-cost service needs. The health home model provides the basis for unified systems of care to coordinate and integrate physical and behavioral health care, chemical dependence treatment, and social services provided to health home members.

 

New York State defines care management as the comprehensive assessment of health home members’ needs with an individual care plan carried out through specific interventions designed to provide coordinated, efficient, quality care to achieve the care plan goals and optimize health outcomes for people with complex health issues and needs. To inform practitioners and policymakers about progress toward the health home vision of comprehensive care management, the New York State Health Foundation (NYSHealth) commissioned a study on a limited number of health home networks from across the State.

 

The key objective of this research was to identify the many aspects of the health home model that influence the design and delivery of care management within health home networks. Secondary objectives were to identify common challenges to implementing care management in health homes, highlight promising practices in care management, and identify issues that warrant more in-depth exploration to inform the field.

 

The study was conducted during fall 2013. Four health homes with diverse administrative structures, organizational histories, and geographic locations participated in semistructured interviews by telephone on a broad array of topics: Adirondack Health Home, Bronx Accountable Healthcare Network, Brooklyn Health Home, and FEGS Nassau Wellness Partners Health Home. For each health home, interviews were conducted with the health home administrative lead agency (health home administrative lead) and with two of its care management partner agencies (care management partners). Care management partners represent a wide array of organizational types and sectors, including health care institutions; patient-centered medical homes (PCMHs); behavioral health and social service agencies; and nonclinical agencies that have provided support to regional health care initiatives.

 

From the analysis of the qualitative findings, nine topics were identified as impacting the design and delivery of care management in health homes:

• Health Home Network Structure

• Care Management Approaches

• Staffing Models and Credentials

• Care Management Staff Training

• Health Home Member Risk Assessment and Care Planning

• Caseload Balance

• Assignment of Health Home Members to a Care Management Partner

• Health Information Technology and Data Sharing

• Care Manager Collaboration with Care Providers

 

Each topic was complex and impacted the health homes in different ways. However, all health homes interviewed were implementing promising practices to reconcile systemic challenges related to care management service delivery, providing examples of innovation and areas for future research. This survey was not intended as a means toward developing an inventory of current promising practices; furthermore, at this early stage, findings cannot inform recommendations for systemwide adoption.

 

However, examples presented in this report provide encouraging directions for future exploration, including the development of quantitative research projects and evaluation strategies to assess health home member outcomes associated with these innovative practices.

 

The following areas for action were identified:

• Increase standardization.

While administrative flexibility was essential to getting the State’s health home program underway at the outset of the initiative, early evidence uncovered in this study indicates that greater standardization of administrative practices at individual health homes may now be needed. Increased standardization could help to further the goals of comprehensive care management by (1) preventing undue burdens on care management partners and network providers participating in multiple health homes and (2) reducing variation in fundamental services and quality assurance mechanisms in health homes across the State.

 

• Define the right staffing mix.

Bringing together the rich experience of care management professionals from a variety of backgrounds is an important strength of the health home’s comprehensive care management vision—a vision that will impact the way in which care management is conceptualized throughout the health system in the coming years, at PCMHs, accountable care organizations (ACOs), and beyond. As health home networks identify promising practices in staffing, the New York State Department of Health (NYSDOH) has a role to play in sharing those practices with all health homes and potentially adapting those practices into statewide guidelines for health homes to help operationalize the vision of comprehensive care management.

 

• Increase training opportunities.

All agencies in health home networks need more training for their care management staff. In general, care managers in health care organizations require training to work more effectively within the social service and behavioral health realms—particularly in relation to housing needs and behavioral health care—while care managers in social service and behavioral health agencies need additional training in medical diagnoses and chronic conditions, as well as in facilitating medical care. Training in data use and reporting would benefit care managers in agencies of all types.

 

• Revise reimbursement measures.

Incorporating social risk measures (such as homelessness, food insecurity, employment status, and recent prison release) into the development of acuity scores will lead to a more accurate reflection of health home members’ status. Such changes will also enhance the ability of care management partners to provide and be reimbursed for the type, intensity, and level of services they deem appropriate, delivered by the team members most fitting for the tasks.

 

• Reassess health home member needs and update acuity scores.

Health home members have complex needs that require regular reassessment to ensure the delivery of the appropriate intensity and type of care management services. Developing a mechanism by which acuity scores may be formally adjusted more frequently to reflect changes in member status, and through which the continuum of need among health home members can be addressed, is essential.

 

• Increase access to timely and appropriate data.

Health homes need timely access to health home member data from NYSDOH, Medicaid managed care organizations, and providers to accurately represent acuity, develop an appropriate care plan, and assess health home member improvement over time. At the same time, health home administrative leads need data to appropriately monitor care management partners and create incentives for them, as well as to provide them with meaningful feedback that care management partners can in turn use to manage health home members, supervise staff members, engage in improvement, and manage resources effectively.

 

• Enhance technology, connectivity, and communication.

Facilitating real-time access to health home member data through shared care plans to which all care team members contribute is essential. Social service and behavioral health agencies, which have not benefited from the sustained technology development funding afforded to medical organizations, need support for technology adoption. Minimum standards for virtual data exchange should be tightened as capacity increases to ensure that care management partners have access to needed information for all health home members irrespective of the health home to which the member belongs.

 

• Improve broader medical community participation in care management.

NYSDOH has a role to play in advancing treatment provider collaboration in the health home model. One of the key issues to be explored is what the current incentives are for treatment providers and what could possibly be put in place to help them engage more fully. Health homes and care management partners also have a role to play in formulating best practices for provider outreach and engagement.

 

Implementing health homes and establishing new care management models and infrastructure are ambitious undertakings. Capturing early lessons learned is critical for supporting model improvement at both the State and health home levels, as well as to inform plans for expanding the model to additional populations. As one of the first states to pilot health homes, New York’s experience also holds valuable lessons for other states about to embark on health home implementation.

 

http://nyshealthfoundation.org/resources-and-reports/resource/care-management-in-new-york-state-health-homes