VNS CHOICE is an innovative managed long term care program serving the frail elderly in New York City. It is financed by risk-adjusted monthly Medicaid capitation payments, is at full risk for all covered services, and coordinates medical care as a non-covered service. Within three years, enrollment exceeded 2,600 members. Typically, VNS CHOICE serves individuals who are more medically complex and functionally compromised than other contemporary managed care programs. The average VNS CHOICE member is 79 years old, needs assistance with three activities of daily living, has five chronic medical conditions, takes eight medications and lives alone. One-third of the enrolled population is cognitively impaired, and 99% use assistive devices.
VNS CHOICE developed dual roles for Nurse Practitioners. As clinical consultants for an average of 300 patients, Nurse Practitioners advise interdisciplinary team members, provide geriatric assessments for clinically complex members, conduct staff education, and confer with individual physicians. They are also primary care providers with collaborating physicians for a select group of homebound elders and bill Medicare directly.
Management data indicate that Nurse Practitioners as clinical consultants have led to reductions in hospital lengths of stay and admission rates as well as improving medication management and overall quality of care for individuals with complex needs.
Learning Objectives: At the end of this session participants will be able to: 1. Outline innovative features of the VNS CHOICE managed long term care model, its interdisciplinary team structure and advantages for members. 2. Compare the responsibilities of the Nurse Practitioner as clinical consultant and primary care provider. 3. Use case studies to illustrate the selection process and outcomes of care.
Keywords: Community-Based Health Care, Case Management
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: VNS CHOICE
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Ms. Kuchins is a Nurse Practitioner in the VNS CHOICE program.