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2011 Year in Review

HHC Board of Directors

We have worked diligently to ensure that our primary care sites developed the full capabilities of a medical home. All 39 of HHC's primary care sites – both hospital and community-based - that applied to the National Committee for Quality Assurance (NCQA) and New York State for PCMH certification have now been certified at level three, the highest level. This covers nearly 600 HHC primary care providers. Requirements to remain certified at level three become more stringent next year so our work continues as our facilities prepare to reapply in January 2013. So far, our existing designations have qualified HHC for more than $15 million in enhanced Medicaid reimbursement which we will re-invest in our primary care services.

HHC's Designation as a Health Home

The Affordable Care Act authorizes the federal government to fund 90% of the cost of care coordination for chronically ill patients through "Health Homes." Last year New York State established a "Health Home" program focused on Medicaid patients with two or more chronic illnesses or serious and persistent mental illness. The goal is to have designated "Health Home" networks use multidisciplinary teams of medical, mental health, and chemical dependency providers, together with social workers, nurses, and others, to ensure that enrollees receive needed medical, behavioral, and social services in accordance with a single care plan. There is an expectation that the Health Home program will reduce long-term healthcare costs by reducing the need for inpatient or other expensive institutional care. The program pays the Health Home for care management and coordination services on a per capita basis.

In December, HHC was designated a Health Home for eligible Medical patients in Bronx and Brooklyn. We have begun to establish linkages to community partners and to scale up our own care management infrastructure to accommodate the several thousand patients we expect to be assigned to us initially. And we have submitted our application for Health Home designation in Manhattan and Queens, and expect to receive such designation sometime in April.


Our evolving Health Home operation will be informed by our several years of experience with our state-funded Chronic Illness Demonstration Project (CIDP), which focused on developing care coordination approaches and resources that could successfully engage and help to better manage the care of patients with complex conditions and very high rates of healthcare utilization. Our CIDP patients, who typically struggle with chronic medical and behavioral health issues – and often with socio-economic stressors like homeless as well – mirror the most challenging of the Medicaid patients to be assigned to Health Homes.