Westchester Cares Action Program Honored for Coordinating Care of Expensive Medicaid Patients

March 27, 2012 - PRLog -- Westchester County Board of Health President Douglas G. Aspros, DVM, presented the 2012 Distinguished Public Health Service Award to Westchester Cares Action Program (WCAP) today. WCAP was honored for doing the “impossible” -- managing the complex health and human service needs of 250 high-cost, high utilization fee-for-service Westchester Medicaid patients, helping them regain their lives while reducing the cost of their care. The ceremony took place at The Sharing Community, a community-based organization in Yonkers that works with WCAP.

WCAP was developed in 2009 by Hudson Health Plan and its behavioral managed care partner, Beacon Health Strategies. It provides integrated, coordinated care for Medicaid beneficiaries who are exempt from Medicaid Managed Care, yet desperately need coordinated care for their chronic health conditions, mental illness, and chemical dependency. Many of these individuals rely heavily on emergency departments for primary health care, and this often leads to costly inpatient hospitalizations. But WCAP has broken that pattern. 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%.

“The Westchester Cares Action Program fills a niche in our health care system by providing wrap-around care for residents who have complex health care and social needs,” said Westchester County Executive Robert P. Astorino in his remarks at the award ceremony. “Residents avoid unneeded emergency room visits that can place an undue burden on both taxpayers and our local hospitals. In short, this exemplary program provides quality care and saves us all money.”

Georganne Chapin, President & CEO of Hudson Health Plan, explained that WCAP was developed around a “health home” model of service delivery that coordinates primary and acute medical care, behavioral health care, and social services for vulnerable people. “High-cost, high-utilization Medicaid beneficiaries are the most complex cases to manage because they frequently suffer from multiple chronic diseases, behavioral health issues, chemical dependency, and social challenges, mostly the result of poverty, which further exacerbates their situation,” she said. “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.”

“You can’t begin to deal with the medical issues until you’ve resolved the social issues,” said Margaret Leonard, MS, RN-BC, FNP, Senior Vice President of Clinical Services at Hudson and Executive Director of WCAP. “The first concern of a homeless person with diabetes is finding a place to live, not an HbA1c screening.” Ms. Leonard accepted the Distinguished Public Health Service Award on behalf of WCAP.

Potentially saving millions of dollars
The success of programs such as WCAP could potentially save millions of dollars in New York State, where 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 noted. “WCAP team members visit the patients’ homes, and accompany them to medical appointments to make sure the patients comprehend what the doctor says. They assist in finding them places to live, and arrange donations of clothes and furnishings. They go the extra mile to prepare patients to accept responsibility for managing their health, behavior, and their lives.”

“It’s made an astonishing difference”
Russell Wells of Mount Vernon, who has been enrolled in WCAP since 2009 and spoke at the award ceremony today, said “It’s a good feeling to know that someone cares, and that I can pick up the phone if I need to talk to someone.” Mr. Wells, 57, suffered a stroke in 2007, and has diabetes, bipolar disorder, and schizophrenia. For 30 years he abused drugs and alcohol, skipped his medication, and had a poor diet. Now WCAP team members visit him frequently, take him grocery shopping to help him choose the right foods, and are willing to sit and talk. “It’s made an astonishing difference in my attitude,” he said. “I take my meds, I’m more calm. I feel good.”

Ms. Chapin pointed out that WCAP is one of the first programs to prove how successful the health home model can be, and Hudson is using what it learned in operating WCAP to create a similar health home for its at-risk members. She predicted 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 concluded. “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 110,000 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.

Hudson Health Plan is based in Tarrytown, N.Y. Visit Hudson on the Web at http://www.hudsonhealthplan.org, and on Facebook at http://www.facebook.com/hudsonhealthplan.