Caring for Medicaid Recipients

Mount Sinai’s https://mountsinai.org Institute for Community Living (ICL) and Healthfirst https://healthfirst.org are partnering to provide high quality care for more than 400 Medicaid recipients with high need mental health and substance abuse disorders. So far, hospitalizations are reduced and have saved $1.3 million in Medicaid savings.

This collaboration was one of two formal New York State Value-Based Payment (VBP) pilots in 2017 and 2018. The two year pilots developed and implemented coordinated care interventions between Medicaid patients who frequently used emergency and inpatient-level behavioral health and physical health services.

Mount Sinai Health System, a major healthcare system provides physical and behavioral healthcare, a health home for care management, Home and Community-based (HCB) services, and Healthfirst, plus a payer financed the treatment group.

One pilot focused on a group of Healthfirst members living with mental illness or Substance Use Disorders (SUD) plus chronic medical conditions who were enrolled in the Health and Recovery Program (HARP). In addition to standard Medicaid coverage, HARP members are eligible for additional recovery-oriented services to support them in the community such as Home and Community-Based (HCB) services.

Services include peer support services, vocational services, educational services, and in-home individual and family counseling. Statewide approximately 130,000 Medicaid recipients are eligible for HARP.

The pilot focused on developing a multi-agency model to effectively connect and sync together the various types of care management interventions available to HARP members into one consolidated and integrated pathway.

Professionals work together to engage patients at various sites across the healthcare system and patients that are enrolled in HCB and/or use general care management services. Interventions include not only enrolling patients in HCB services but also proving more stable housing, providing transportation, educating Medicaid recipients on how to care for their illness, and guiding them on self-care.

The pilot program included improvements in blood glucose testing/monitoring, medical attention for nephropathy, follow-up after hospitalization for mental illness, and diabetes screening for people with schizophrenia or bipolar disorders using antipsychotic medications.

As a result, there was a decrease of $50 per member per month in the overall cost of care, driven primarily by decreased inpatient medical hospitalizations and ER visits. This also included lowered medical surgical, behavioral health, and pharmacy costs.

According to Sabina Lim MD, VP and Chief of Strategy, Behavioral Health for the Mount Sinai Health System, “This pilot clearly demonstrates that when you effectively address behavioral health conditions and SODHs, a person’s overall health status improves, and as a result decreases the overall cost of care. This can be achieved by people with some of the most complex medical and behavioral health conditions.”

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