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
The Institute for Community Living (ICL), Mount Sinai Health System, and Healthfirst announced Monday that their partnership in providing improved quality of care for more than 400 Medicaid recipients with high-need mental health and substance abuse disorders helped reduce hospitalizations and achieved $1.3 million in savings in Medicaid costs in 2018.
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.
Professionals 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
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties.
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