The New York City Health and Hospitals Corporation (HHC) a $6.7 billion integrated healthcare delivery system with a 420,000 member health plan called MetroPlus is the largest municipal healthcare organization in the country. HHC provides medical, mental health and substance abuse services through its eleven acute care hospitals, four skilled nursing facilities, six large diagnostic and treatment centers and more than 70 community-based clinics, plus provides in-home services.
HHC has announced that all eleven city-run public hospitals have achieved full Meaningful Use status for their EMR system and will receive nearly $200 million through ARRA funds which will be reinvested back into patient care.
HHC IT is working to ensure that all patients in Patient-Centered Medical Home Practices are linked to primary care providers. To do this, HHC IT launched the Patient Panel Management System (PAMS) to train primary care front line and management staff to work with PAMS to manage patient assignment protocols. HHC PCMH practices have successfully assigned 82 percent of primary care patients to PCPs/care teams in FY 2012, an improvement of 11.4 percent since January 2012.
In 2011, the New York State Department of Health received approval for up to $250 million available over three years from CMS to conduct the Hospital-Medical Home (H-MH) Demonstration Program. HHC submitted applications for the H-MH Demonstration on behalf of their eleven hospitals in July 2012.
The demonstration funding will be available to New York State teaching hospitals to support transition of their outpatient training site to PCMHs. If successful, HHC is estimated to receive approximately $28 million of the $102 million to be disbursed in the first year of the demonstration based on a formula derived from Medicaid volume and number of primary care residents receiving training at the facilities.
Demonstration awardees will be required to submit a work-plan describing selected resident training, continuity of care enhancements, care integration initiatives with a focus on primary care and behavioral health integration, and inpatient safety projects. Continued funding will be dependent upon meeting certain performance milestones, including achieving Level 2 or 3 NCQA PCMH re-certification by December 2013.
Also, the HHC ACO has filed an application to operate as a Medicare ACO, and seeks to participate in the Medicare Shared Savings Program, a payment model that aligns payment reward with performance based on quality, process and cost reduction targets. The HHC ACO application to the Medicare Shared Savings Program is expected to be reviewed by CMS in the next few months. If approved, HHC ACO will begin operating in January 2013.
For HHC to operate over the next 20 years with upcoming changes in the healthcare industry around home care and HHS’s ACO status, the EHR system must be updated. To meet these future needs, a Request for Proposal was issued, demonstrations were held, additional product reviews were done, and site visits took place. HHC’s Board of Directors selected Epic Systems Corporation as the vendor. The EHR is being extended into behavioral health, operating rooms, emergency department, long term care, and will be integrated with the Soarian financial system.
The contract with Epic is for an initial term of ten years with an additional five year renewal option with the total amount not to exceed $302,807,986. The total 15 year cost to migrate from the current trajectory to Epic is $1.4 billion which includes both new costs and the cost to maintain existing systems during the transition.
In 2011, Governor Cuomo created a Medicaid Redesign Team to find ways to increase quality and efficiency in the Medicaid program and to reduce costs. One of the recommendations enacted into law was the creation of Behavioral Health Organizations (BHO). However, as it turned out, BHOs resulted in an increased administrative burden to hospitals without producing useful results.
Effective October 1, 2012 the two state agencies who oversee BHO performance, the NYS Office of Mental Health, and the Office of Alcoholism and Substance Abuse Services, are going to reduce the burden by changing the reporting requirements to focus on the more complex, difficult-to-discharge and frequently readmitted patients. The hope is that this change will result in more useful data for the move into the second phase of managed behavioral healthcare. It is further expected that the State will delay implementation of Phase 2 until 2014.