CMSA Today - Issue 6, 2012 - (Page 12)

Operation: We Care Operation: BY MARGARET LEONARD, MS, RN-BC, FNP SHEILAH MCGLONE, RN, CCM, BC ALAN BOARDMAN, LMSW We Care I t’s one thing to go to the emergency room for emergency treatment; it’s another thing to go because you’re homeless or because you don’t know where else to get medical care. The Westchester Cares Action Program (WCAP) has helped costly Medicaid patients to break their dependency on emergency departments for nonurgent care in Westchester County, N.Y. illness – conditions that can lead to homelessness and over reliance on hospital EDs for non-urgent care. In 2009, the New York State Department of Health (NYS DOH) identified the most expensive fee-for-service Medicaid patients and invited health care organizations to compete for Chronic Illness Demonstration Project (CIDP) funding to manage the needs of this population. WCAP was one of seven CIDP contractors chosen, and was given a list of potential candidates and the challenge to find and enroll 250 as the target population. WCAP assembled a dedicated and resourceful team, trained them in cross-disciplinary integrated case management techniques, and educated them about the unique psychosocial considerations for this population. They used a “feet-on-the-street” Created through a partnership with Hudson Health Plan (Hudson), a community-based not-for-profit managed care organization, and Beacon Health Strategies (BHS), a managed behavioral healthcare organization and a pioneer of integrated behavioral health and medical care for vulnerable populations, WCAP is an integrated care management model with no interdisciplinary hand-offs. It addresses the complex physical health, behavioral health/substance abuse, and social issues for high-cost, high-utilization fee-for-service Medicaid patients. Many of New York state’s costliest Medicaid patients are exempt or excluded from managed care, yet in desperate need of care coordination. This population has a high incidence of multiple chronic health conditions, substance abuse, HIV/AIDS, developmental disabilities, and mental 12 CMSA TODAY approach: Consents, enrollments, and assessments were conducted in the field face to face; team members visited the patients’ homes, found health care professionals to treat them and places for them to live, and arranged donations of clothes and furnishings. Once members had stable living situations, WCAP coached them to manage their own health problems and their lives. The core strength of WCAP is its IT system. The team used Integrated Case Management Software and the Integrated Case Management-Complexity Assessment Grid (ICM-CAG) tool to facilitate assessment and care planning along with other standard medical assessment screening tools and care plans as part of Beacon’s FlexCare behavioral health management system; case managers conducted assessments with laptop computers to capture all data. We provide a fuller description of WCAP’s outcomes elsewhere in this document. A preliminary analysis of 61 patients who have been in the program for at Issue 6 • 2012 • DIGITAL

Table of Contents for the Digital Edition of CMSA Today - Issue 6, 2012

VA Connecticut Healthcare System Improves Cancer Care
Operation: We Care
The Path to Payment for the Medicare and Medicaid EHR Incentive Programs

CMSA Today - Issue 6, 2012