United Hospital Fund Reports Inform Implementation of Medicaid Reforms for Costly, Vulnerable Patients
New York Initiates Major Shift to Care Management for Behavioral Health Services and Long-Term Care
Two new reports from the Medicaid Institute at United Hospital Fund focus on the implementation of Medicaid policy changes in New York, which will require participation in care management for beneficiaries receiving either long-term care or behavioral health services. Until now beneficiaries have typically received these services under a fee-for-service payment model.
Beneficiaries relying on these services have come into focus in part because their care is recognized as fragmented and uncoordinated, often resulting in suboptimal outcomes. They have also accounted for significant spending, mostly on a fee-for-service basis. In New York in 2010, Medicaid spending on long-term care services was $13.4 billion, while spending on beneficiaries who received behavioral health services in New York (for both physical and behavioral health) totaled $6.3 billion. Total Medicaid spending for New York in 2010 was $52.1 billion.
Each report examines the specific changes to state policy and the resulting changes in roles and responsibilities for health care providers and care management organizations, such as managed long-term care plans and behavioral health organizations. Both reports also examine the critical topics of the assumption of risk by care management organizations, quality measurement, and performance evaluation. They also look at how best to maximize opportunities to provide community-based services rather than institutional care.
The reports also explore topics that are particular to long-term care or behavioral health. For example, some Medicaid beneficiaries are already enrolled in one of three capitated care management programs covering long-term care services, which are outlined in the report and inform implementation options. In the behavioral health report, special attention is focused on opportunities and challenges associated with integrating behavioral and physical health services.
“We are at a critical juncture as New York State has committed to expanding managed care for an increasing number of vulnerable and high-cost Medicaid beneficiaries with complex needs,” said Michael Birnbaum, vice president and director of the Medicaid Institute. “The State’s goals are ambitious, and the considerations are numerous, as we spell out in these reports.”
Implementing Long-Term Care Reform in New York’s Medicaid Program, was written by Sarah Samis, health policy analyst, Andrew Detty, research assistant, and Michael Birnbaum, vice president and director of the Medicaid Institute. Implementing Behavioral Health Care Reform in New York’s Medicaid Program was written by Elizabeth M. Patchias, health policy analyst, and Mr. Birnbaum. Both reports are available from the Fund’s website.
“These reports lay the groundwork for the many considerations facing stakeholders in New York—not just the State, but health care providers, health plans and other care management organizations, and beneficiaries, as well,” said Jim Tallon, president of the United Hospital Fund. “Addressing the challenges strategically is critical to the successful implementation of care management for Medicaid beneficiaries with truly complex needs here in New York.”
About the United Hospital Fund: The United Hospital Fund is a health services research and philanthropic organization whose primary mission is to shape positive change in health care for the people of New York.
About the Medicaid Institute: The Medicaid Institute at United Hospital Fund provides information and analysis explaining New York’s Medicaid program, with the goal of helping all stakeholders redesign, restructure, and rebuild the program.