Case Study: NewYork-Presbyterian System SelectHealth Submitted by: Eli Camhi, LMSW Executive DirectorELC9016@nyp.org212-404-1278
HIV Special Needs Plans • New York State Department of Health has supported the development of HIV Special Needs Plans (SNP) since 1995. • As of December 2007 there are 3 such Plans operational in New York City: MetroPlus, NewYork-Presbyterian System SelectHealth, and VidaCare. • HIV SNPs are Medicaid Managed Care Plans licensed by NYSDOH to provide comprehensive and coordinated care to adults living with HIV and their dependent children regardless of HIV status. • SNPs receive a capitated rate per member per month and are at risk for the full Medicaid benefit package excluding medications, outpatient substance abuse treatment and Medicaid reimbursed case management.
Distinguishing Features of HIV SNPs: • Primary Care Providers must be HIV Specialists (as defined by NYSDOH) • Patient to PCP Ratio - 350:1 • Universal Case Management • Adult Members must be HIV Positive, eligible for Medicaid and living in New York City • Care Coordination with Community Based Collaboration • Enhanced access to subspecialty care
System Aims • What are your specific aims relative to your population: • Individual experience: • Population health: • Per capita cost: