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Westchester Cares Action Program Honored

On Tuesday, March 27, Westchester County Executive Robert Astorino and Board of Health President Douglas Aspros presented the 2012 Distinguished Public Health Service Award to the Westchester Cares Action Program (WCAP) “for its innovative hands-on and comprehensive approach to caring for and improving the health of vulnerable residents.” (See press release.) The award ceremony took place at The Sharing Community, based in Yonkers—one of the organizations with which WCAP worked closely to reach out and find many of the individuals who were eventually enrolled in the program. To date, about 250 clients have been enrolled in the WCAP program, and many have benefited immensely as a result of the care and attention they received. You can also watch a video of the presentation at right, featuring Mr. Astorino, Hudson Health Plan President & CEO Georganne Chapin, WCAP Project Supervisor Susan Herzog, Westchester Board of Health President Douglas Aspros, WCAP participant Russell Wells, and Margaret Leonard, Executive Director of WCAP and Senior VP of Clinical Services at Hudson Health Plan.

"A successful model of integrated care," says Georganne Chapin

Hudson Health Plan is very proud to have led the WCAP effort, the State funded demonstration project being honored by the County at the ceremony. Georganne Chapin, CEO & President, recently said, “I want to express my heartfelt thanks to the WCAP Advisory Board for its dedication to this project. Their contributions enabled WCAP to become a successful model of integrated care for vulnerable people in Westchester County, and have paved the way for an integrated care model for the future—the health home.”

“The social needs of vulnerable populations far exceed their health issues,” explains Margaret Leonard. "You can’t begin to deal with the medical issues until you’ve resolved the social issues. The first concern of a homeless person with diabetes is finding a place to live, not going for an eye examination.”

Ms. Leonard went on to say, “The health home model of service delivery coordinates primary and acute physical health care, behavioral health care, and social services for an individual. It is seen as a promising way to improve care for Medicaid patients with two or more chronic conditions.”

“WCAP is one of the first programs to prove how successful this model can be,” she notes. “Not only has WCAP reduced inpatient hospitalizations for people enrolled in the program, it’s helped them gain their lives back.”

WCAP helps those who need it most

The Westchester Cares Action Program (WCAP) is an integrated, coordinated care program designed to improve health outcomes and reduce the cost of medical care for high-cost, high-utilization Medicaid fee-for-service beneficiaries in Westchester County, many of whom typically depend on emergency rooms and inpatient hospitalizations for primary health care. A partnership of Hudson Health Plan and its long-time behavioral health services manager Beacon Health Strategies, WCAP is based on a health home model of integrating physical and behavioral health care with social services support. Its innovative, “feet-on-the-street” outreach has broken a cycle of despair for many of its 250-plus participants, which include individuals with chronic medical conditions, mental illness, chemical dependency, developmental disabilities, and housing instability. Among participants who’ve been in the program continuously for two years, total emergency room visits were reduced by 15.4% when compared to the two years prior to the program. The cost and utilization of inpatient hospitalizations was reduced by 45.9% and 44.7%, respectively, over the same period.

Frequently asked questions about WCAP

Why was the Westchester Cares Action Program (WCAP) launched?
In New York State, 20% of 4 million Medicaid beneficiaries account for 75% of the program’s annual expenditures. Many of these high-cost, high-utilization Medicaid patients are exempt or excluded from managed care, yet in desperate need of care coordination for chronic health conditions, chemical dependency, and mental illness. To better manage the complex needs of this population, the New York State Department of Health in 2009 invited health care organizations to compete for Chronic Illness Demonstration Project (CIDP) funding. The Westchester Cares Action Program (WCAP) was selected as one of seven CIDPs in the state in 2009.

Who’s behind WCAP?
WCAP was formed by Hudson Health Plan, a not-for-profit community-based managed care organization, in conjunction with Beacon Health Strategies, its long-time behavioral health managed care partner. Together, Hudson and Beacon had the capabilities and skills to create an innovative integrated care coordination model to deliver service across the continuum of medical, mental health, rehabilitative care, and social services.

Why is WCAP such a different model of care coordination?
WCAP has made an enormous contribution to the case management field by developing an innovative model of integrated care coordination that rolls up three facets of case management into a single organized interdisciplinary effort. Ordinarily, Medicaid’s most costly patients would need three case managers using separate case management systems: (1) a nurse case manager to oversee medical issues, (2) a behavioral case manager to handle mental health and substance abuse concerns, and (3) a social worker to help patients find permanent housing and apply for government assistance, among other things. Even if a patient were lucky enough to be working with all three types of case managers, there would be gaps in care or duplication of services when one care manager "handed off" the case to another care manager. WCAP has created one seamless integrated case management system.

What types of case managers does WCAP have?
WCAP has two types of Integrated Care Managers ( Registered Nurses and  Social Workers)  who work as a team with access to behavioral and physical health specialists. We also have a peer support specialist who has traveled a similar road to our members, and has personally experienced homelessness, substance abuse, and chronic disease. The peer support specialist often is the one who first gains the trust of our members.

WCAP’s entire professional team is dedicated and resourceful, trained in cross-disciplinary case management techniques, and educated about the unique psycho-social considerations for this population. While conventional case management is conducted primarily by telephone, WCAP team members visit the patients’ homes several times a year, accompanying members to doctors' appointments, going food shopping with them, locating places for them to live, and arranging donations of clothes and furnishings. Patients are coached so they can manage their own health problems and their lives.

How do you measure WCAP’s success?
WCAP is a three-year program that began in 2009, so we don’t have complete results yet. But we looked at 61 patients who have stayed in the program for at least two years, and we compared their incidence of emergency department (ED) visits and in-patient hospitalizations during those two years with the two years prior to enrolling in WCAP. We found that WCAP reduced the number of inpatient admissions by 44.7%% and ED visits by 15.4%. The total cost of inpatient admissions was reduced by 45.9%.

What have been WCAP’s biggest challenges?
New York State Department of Health gave us a list of names to enroll, but many were homeless or had moved, so we had no way to get in touch with them. Our field team visited homeless shelters, soup kitchens, laundromats, and other places in the community to find these individuals, gain their trust, and persuade them to enroll in the program. We partnered with community-based organizations, such as The Sharing Community in Yonkers, which agreed to alert us if they were in contact with these individuals.

How many people are enrolled in WCAP?
Our target was to enroll 250 people. Some people dropped out of the program—it is to be expected with programs such as this—and we replaced them. We currently have slightly more than 250 people enrolled.

How much was your grant?
WCAP is paid a per capita rate per member to coordinate care. That is separate and apart from the cost of their medical care, which is covered by Medicaid fee-for-service.

Do WCAP members receive health coverage from Hudson Health Plan?
No, they do not. A dedicated WCAP staff manages their care. However, WCAP has shared its experience with Hudson, which is developing a similar “health home” coordinated care program for its at-risk members.

What is a health home?
The Patient Protection and Affordable Care Act gives states the option of enrolling Medicaid beneficiaries with chronic conditions into a “health home,” a model of service delivery that coordinates primary and acute physical health care, behavioral health care, and social services for an individual. In many cases, these patients suffer from chronic disease and behavioral health issues, as well as a constant struggle with poverty and housing instability. WCAP’s coordinated care approach is based on a health home model, and it is one of the first health home demonstration projects in the state. With the incorporation of WCAP into Hudson’s programs, Hudson will become one of the first Medicaid managed care plans to create a health home.