Health Home & Managed Care Collaboration NYS Care Management Conference May 20, 2016

Introduction: HRHCare Background * ✚ Founded in 1975 by a group of 4 women seeking to address the lack of accessible and affordable health services in Peekskill, NY ✚ HRHCare Fast Facts:  Designated as a Federally Qualified Health Center  Joint Commission Accredited  Level 3 Patient Centered Medical Home  26 Practice Sites throughout the Hudson Valley & Long Island  Serving 135,000 patients ✚ Services Provided: Primary Care, Dentistry, Women’s Health OB/GYN, Behavioral Health Care, Podiatry, Optometry, Health Education, HIV Specialty Care, Substance Abuse Treatment, Care Coordination

Introduction: CCC Overview * ✚ HRHCare’s Lead Health Home is called CommunityHealth Care Collaborative (CCC) ✚ Designated as a Health Home Lead in 2012 ✚ Over 15,000 enrolled members, over 20,000 members in outreach across 10 counties ✚ CCC works with 45 Care Management Agencies in the Hudson Valley and Long Island ✚ CCC works with 8 Managed Care Organizations

Introduction: HRHCare Service Area

Overview: United MCO Collaboration ✚ Monthly Meetings ✚ Ongoing Communication & Feedback Loop ✚ Data from United to CCC:  Hospital Alerts (daily)  Claims Information (monthly)  Gaps in Care (quarterly) ✚ Data from CCC to CMAs:  Hospital Alerts (daily)  Claims Dashboard: Hospital, Outpatient, Overall Spend (monthly)  Care Opportunities Workbook (quarterly)

Sample Hospital Alert

Sample Care Opportunities

United Collaboration: Successes ✚ CMAs have reported discovery that certain members were going to the hospital 30+ times per year, previously members had only reported 4-5 hospital visits ✚ CMAs were able to work with these members on decreasing utilization and managing their health conditions to avoid hospitalizations ✚ Member Crisis Intervention: one CMA was able to work with the MCO to avert a member crisis

Thank you!