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NHP/Brightwood Evaluation. If special programs work - clinically and financially - for small groups of members with complex but homogeneous disability and medical needs ….. Can these programs be adapted to work on a population basis with the broad range of SSI members?.
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NHP/Brightwood Evaluation • If special programs work - clinically and financially - for small groups of members with complex but homogeneous disability and medical needs ….. • Can these programs be adapted to work on a population basis with the broad range of SSI members?
Selection of Brightwood as Pilot Site • Large community health center in Springfield, MA • Much higher SSI clinic population than other community health centers • Strong clinical leadership and vision • Already operating a specialized program for NHP members with HIV/AIDS • Largely Spanish-speaking population, and poor access to culturally and linguistically appropriate behavioral health care
Initial Model: Identification • Convert 800 SSI fee-for-service patients to NHP members • Convert 500 long-term unemployed fee-for-service patients to NHP members • Conduct health risk assessment • Conduct chart review • Identify individuals through ED, Inpatient admissions
Model: Stratification • Who gets preventive care reminders? • Who gets telephone care management? • Who gets intensive care management? • Who gets enhanced behavioral health coordination or services? • Who gets peer interventions?
Model: Intervention • Reminders for primary and preventive care visits • Integrated care management team: • RNPs, RNs • Behavioral health clinicians • Peer support team – Addictions Advocate, Clinical Assistants • Different levels of care management intervention
Financing • Spend an additional $50 PMPM on primary care and care coordination • Take $14 PMPM out of the behavioral health carve-out to purchase on-site behavioral health care • Spread costs over approximately 1000 SSI and Long-term unemployed members
Barriers and Improvement Cycles • Enrollment • Negotiation over model • Politics, politics, politics
Implications of Selection • DXCG risk adjustment, applied to 282 SSI members at Brightwood. • Predicted costs would be 17% higher than NHP SSI average costs. • Disproportionate number of Brightwood SSI members with HIV or chronic mental illness (reflected later in RX expenditures)
