Federal Affordable Care Act in Action: Implementation of Health Homes in New York City

In 2010 the Federal government passed the Affordable Care Act, including a provision for building a person-centered system of coordinated care to achieve improved outcomes for Medicaid beneficiaries, and increased savings for State programs; this model is known as “Health Homes.” In New York State (NYS), Medicaid serves over 5 million enrollees, nearly 300,000 of which have serious mental illness, often co-occurring with substance abuse, HIV/AIDS and chronic health conditions (Asthma, COPD, Diabetes). This group is a primary driver of high volume costly services including repeat inpatient hospital stays and frequent emergency department visits, and would benefit from the Health Homes model. In 2011, NYS Department of Health redesigned Medicaid service delivery to implement Health Homes statewide. This shift allows NYS to: improve patient outcomes through coordinated care; achieve expanded cost savings; and receive an increase in the Federal Medicaid match from 50 to 90 percent.In early 2012, The Visiting Nurse Service of New York (VNSNY) was identified as a lead Health Home by NYS DOH in the Bronx, NY, in partnership with 8 other hospital and community based providers. If awarded the same status in Manhattan; the VNSNY lead Health Home will provide coordinated care to upwards of 30,000 of the highest need NYC Medicaid recipients. The integrated care will be guided by the ability to share vital patient information through HIT/HIE connectivity across all providers. Implementation began in February 2012 – this paper will present recommended strategies and lessons learned in implementing the Health Home model of care.