Business Case
New York State pays for more than $60 billion in Medicaid services on an annual basis.
High-risk individuals (patients with multiple chronic illnesses) representing approximately 20% of the state’s Medicaid population, are responsible for nearly 80% of the state’s annual Medicaid spend.
Savings and improved outcomes can be realized, by introducing care models and tools that facilitate increased coordination in service delivery.
The Solution
IBM and CMA partnered to build and deploy an integrated Health Home solution, that has enhanced the timeliness in which high risk individuals are identified and facilitates enhanced coordination and delivery of necessary interventions and services. Launched for the first time in the State of New York, this solution has empowered providers with a more comprehensive view of the individual and holistic approach to patient-centered care management.
Operating on IBM’s Cúram Social Program Managed Solution, The Health Home Initiative works with care coordinators, non-profits, and other organizations to create an advanced, highly-integrated system that delivers the best care possible to patients.
The ability to detect high-risk patients centers on data collection. The State of New York uses claims, encounters, pharmacy data, and post-inpatient discharge information to create a type of internal red-flag system.
Using this in-depth monitoring of collected data, The State of New York tracks preventable health incidents – such as hospitalizations, emergency department use, detoxification, and so on. This system tracks chronic illness and detects poor disease management. As a result, the state is able to recognize and categorize high-risk patients earlier by comparing current costs to past medical records.
The Results
- A speedier diagnosis process for patients, using proactive detection.
- More easily prevented malpractice suits that arise from misdiagnosis.
- Significantly reduced Medicaid costs for New York State.
- A reduced number of preventable health visits.
- Better managed high-risk patient cases.
New York’s prior Health Commissioner, Nirav R. Shah, M.D., M.P.H. stated that “The new initiatives are critical elements in providing better care for patients at lower costs for taxpayers.” Outcomes from this ground-breaking project included a 23% reduction in hospital admissions and emergency department visits, and a 14% increase in the rate of primary care visits among this challenging Medicaid cohort.