Expanding Health Care Coverage

Grantee Name

New York University, Robert F. Wagner Graduate School of Public Service

Funding Area

Expanding Health Care Coverage

Publication Date

April 2011

Grant Amount

$99,352

Grant Date:

July 1, 2007–August 30, 2009

DOWNLOAD FULL REPORT

A large share of Medicaid costs can be attributed to spending on patients with serious and/or chronic illnesses.

While the State has sought to improve the care of chronically ill patients through implementing a managed care program, approximately 25% of Medicaid beneficiaries still remain in the unmanaged fee-for-service (FFS) program. Many of these managed care exempt and excluded beneficiaries are among the most seriously medically ill and often have behavioral health co-morbidities. Under this grant, John Billings of New York University’s Robert F. Wagner Graduate School of Public Service (NYU Wagner) assisted the New York State Department of Health’s Office of Health Insurance Programs (OHIP) to develop and implement the Chronic Illness Demonstration Project (CIDP), an approximately $30 million initiative to improve health outcomes and contain the cost of caring for a subset of these vulnerable FFS Medicaid beneficiaries. This grant helped to provide key analytics to inform a large State investment in testing better and less costly models of care for Medicaid’s highest-need beneficiaries.

This project was part of a larger NYSHealth authorization that funded a series of quick-strike analyses to help the New York State Department of Health’s (NYSDOH’s) Office of Health Insurance Programs find ways to streamline and expand its public health insurance programs.

Read an NYSHealth special report that contains a summary of findings from this authorization.

Outcomes and Lessons Learned

  • Created an analytic database with sufficient detail to address key policy questions.
  • Identified patients incurring high costs who had not yet entered managed care to determine whether a Legislature-mandated demonstration program could improve care for these patients.
  • Created a predictive model that assigned a risk score to a patient, which identified more than 33,000 patients who were at high risk for future hospitalizations.
  • Designed intervention programs to provide better care to patients incurring high costs, including the CIDP.
  • Provided patient data to RFP bidders on diagnostic and prior utilization history that helped bidders understand the challenges patients were likely to present and illustrated the broad range of services needed in a coordinated delivery system.
  • Assessed whether Medicaid data could be used to profile provider performance.
  • Reviewed and prepared data for CIDP grantees.
  • Designed and coordinated evaluation of the CIDP.
  • Participated in a learning collaborative with CIDP grantees.