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Mount Sinai, Institute for Community Living (ICL), and Healthfirst Unite to Provide Behavioral and Physical Health Services to Highest-Need Patients, Yielding $1.3 Million in Medicaid Savings
Collaboration improved quality metrics and reduced hospitalizations for hundreds of people with significant physical and behavioral health conditions
This collaboration was one of two formal New York State Value-Based Payment (VBP) pilots in 2017 and 2018. The two-year pilot focused on developing and implementing a highly coordinated set of care engagement interventions between the three entities for a group of Medicaid patients who most frequently used emergency and inpatient-level behavioral health and physical health services. The program sought to address the multi-layered issues of physical, behavioral, and psychosocial factors that affect patient health outcomes.
The effort focused on a group of Healthfirst members living with mental illness or substance use disorders and 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 called home and community-based (HCB) services to support them in the community. These 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.
Because one of the biggest barriers to treatment is the complexity of the health care system and the fact that different health care entities rarely work together in a meaningful way, 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.
Specifically, the model was an integrated partnership in which Mount Sinai Health System, a major health care system, provided physical and behavioral health care in addition to a health home for care management; ICL, a community-based organization, provided HCB services; and Healthfirst, a payor, financed the treatment group.
Pofessionals from all three health care entities worked together to engage patients at various sites across the health care system and enroll in HCB and/or general care management services. The core principle underlying engagement interventions was to build trust and help the member identify the key social determinants of health that were affecting their ability to manage their health conditions. Interventions included everything from enrolling patients in HCB services to providing more stable housing, family interventions, improved transportation, education about their illnesses, and guidance on self-care. Unlike many other care management interventions, this pilot concretely addressed physical and behavioral health and social service needs, since all are interconnected in how they impact a person’s overall health status and how they ultimately use health care services.
Through their collaborative effort, the pilot achieved four out of six quality metrics as a part of the VBP program, which 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 disorder using antipsychotic medication. 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 emergency department visits. This included lowered medical surgical, behavioral health, and pharmacy costs. As a part of the shared savings arrangement with Mount Sinai, ICL earned $338,000.
“For too long, our health care system has operated in behavioral and physical health silos, which has led to poor outcomes and continually escalating costs,” said David Woodlock, President and CEO of ICL, a premier behavioral health agency serving more than 10,000 New Yorkers annually. “This pilot taught us a great deal. Most importantly, it challenged the long-held belief that this population is ‘impossible’ to serve—that we could not make a meaningful difference in their health and bring down the cost of their care. Instead, it showed that with well-coordinated and high quality care, the health of this population can be improved and the health care system can reduce historically high costs.”
“There was no magic bullet intervention or recipe of interventions. For people with complex behavioral health and physical health conditions, you can’t use a one-size-fits-all approach. We developed a very deep understanding of the core clinical and psychosocial issues for these members, and then tailored interventions to them, based on what they believed was most important to them,” said Sabina Lim, MD, MPH, Vice President 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 social determinants of health, a person’s overall health status improves, thereby decreasing the overall cost of care. And that this can be effectively done for people with some of the most complex medical and behavioral health conditions.”
“Healthfirst was pleased to collaborate on this unique and successful pilot focusing on members/patients with significant physical and mental health challenges,” said Ian A. Shaffer, MD, MMM, CPE, Healthfirst. “As New York’s largest not-for-profit health insurer, we understand the importance of working closely with healthcare providers and community organizations so that our members get the best care possible. This pilot is a great example of how the Healthfirst model works and what can be achieved when a health plan and providers work closely as one team. Our goal at the outset was improving health outcomes by ensuring that members receive access to the care they need while lowering the costs of care. The results have been impressive and demonstrate the importance of coordinated care.”
About the Institute for Community Living ICL provides trauma-informed, recovery-oriented, integrated, and person-centered care through supportive and transitional housing, counseling, and rehabilitation services for adults, children, and families with mental health challenges and those living with developmental disabilities. We serve 10,000 people each year; every night 2,500 New Yorkers call ICL home. Our goal is to help people achieve better health and the most fulfilling life possible.
About the Mount Sinai Health System
The Mount Sinai Health System is New York City’s largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai’s vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report’s “Best Medical Schools”, aligned with a U.S. News & World Report’s “Honor Roll” Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report’s “Honor Roll” of top U.S. hospitals; it is one of the nation’s top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 “Best Hospitals” issue. Mount Sinai’s Kravis Children’s Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology, Mount Sinai St. Luke’s and Mount Sinai West are ranked 23rd nationally for Nephrology and 25th for Diabetes/Endocrinology, and Mount Sinai South Nassau is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke’s, Mount Sinai West, and Mount Sinai South Nassau are ranked regionally.
For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.
About Healthfirst
Healthfirst is New York’s largest not-for-profit health insurer, earning the trust of more than 1.4 million members by offering access to affordable healthcare. Sponsored by New York City’s leading hospitals, Healthfirst’s unique advantage is rooted in its mission to put members first by working closely with its broad network of providers on shared goals. Healthfirst takes pride in being pioneers of the value-based care model, now recognized as a national best practice. For more than 25 years, Healthfirst has built its reputation in the community for top-quality products and services New Yorkers can depend on. It has grown significantly to serve the needs of members, offering market-leading products to fit every life stage including Medicaid plans, Medicare Advantage plans, Long-Term Care plans, Qualified Health plans and individual andsmall group plans. Healthfirst serves members in New York City and on Long island as well as Westchester, Sullivan and Orange counties. For more information on Healthfirst, please visit healthfirst.org.
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