Mount Sinai PPS held a successful Health Home Awareness Forum in early March. Partners learned about the New York State Medicaid Health Home Program, a care coordination program for eligible Medicaid recipients with multiple chronic conditions. 

Through skits and patient and provider testimonials, partners were introduced to Health Home referral options and the enrollment process. 

Many thanks to Community Healthcare Network, Community Care Management Partners Health Home, Coordinated Behavioral Care Health Home, HealthFirst, Mount Sinai Health Homes, the NYC Department of Health & Mental Hygiene, and Queens Coordinated Community Partners Health Home for helping to make this event possible. 

For more information about the Health Home process,  please download our slides here. To learn how you can determine if your patients are eligible for Health Homes, please click on this checklist.

Mount Sinai PPS is hosting a series of Motivational Interviewing trainings over the next few months. It is a two day program that includes person-centered evidence-based practice that practitioners can use to help patients develop internal motivation for behavioral change. 

These training sessions will be offered on a first-come, first-served basis.  Please contact [email protected] for more information and to register.

Created by NYC behavioral health not-for-profit organizations in 2011, Coordinated Behavioral Care (CBC) operates care coordination services and innovative initiatives that help New Yorkers access quality treatment, housing, employment and other needed services. Today, CBC operates one of the largest health homes in New York State with over 50 member organizations. 

CBC is comprised of two related service entities: CBC Independent Practice Association (IPA) and the CBC Health Home (HH), both of which have a similar mission to provide patients with the highest quality of care.

The staff at CBC works hard to engage with MSPPS to improve the lives of low-income New Yorkers.

The CBC IPA was established in 2014 to provide a NYC-wide integrated behavioral health (BH) provider delivery system with the infrastructure and ability to invest in value based care delivery interventions. Together the CBC IPA agencies have created a city-wide network with the geographic coverage and service diversity needed to effectively address behavioral service needs in community settings.

This network includes Article 28, Article 31, and Article 32 clinics,

 Assertive Community Treatment (ACT)  teams, supportive housing program beds, and outpatient treatment programs licensed by the New York State Office of Alcoholism and Substance Abuse Services (OASAS). 

CBC currently operates one of the largest Health Homes in New York City, most recently expanding to serve children in December 2016. The Health Home is comprised of 50+ care management agencies (CMAs) throughout the five boroughs. According to Danika Mills, Executive Director of CBC HH and CBC IPA, "We support the administrative, quality, and technology functions for over 50 delegated CMAs that together have hundreds of care managers working with thousands of Medicaid recipients who have chronic conditions and are benefiting from care coordination." 

	CBC recently launched Project Connect, a program connecting discharged individuals to health home services.

Since forming the Health Home in 2011, CBC and its partners have been refining their outreach strategies and patient engagement by addressing social determinants of health. Some examples include deploying health coaches for better patient engagement, as well as providing a targeted intervention-Pathway Home--for patients with mental illness who need assistance transitioning from hospital to the community. According to Mark Graham, CBC's Associate Executive Director of Operations, "Our organization is very proud of Pathway Home. Through a New York State (NYS) grant and most recently a contract with the NYS Office of Mental Health, the program now operates in four boroughs to shorten inpatient stays, improve community stability, and reduce readmissions and ER visits."

CBC's Involvement with MSPPS

According to Mark Graham, "CBC can be most valuable to MSPPS as part of the planning process, so we can offer guidance as community providers and help the PPS as it rolls out projects to address any barriers to care." Due to CBC's services as a Health Home and IPA, they are already connected to many organizations. In fact, many of the agencies which comprise the Health Home are part of MSPPS and being a part of MSPPS has strengthened the already existing relationships with these organizations. Danika Mills said of this, "All of our providers are mission-driven to help our clients lead healthy, fulfilled lives. Our goals and the PPS population health goals are aligned, and we have the best chance of success working together."

Over the next few years, CBC HH plans to expand care management programs for its high-need Medicaid population, while the IPA intends to address gaps in crisis, substance abuse and transitional care. 

To read the full article, please click here. 

For more information on CBC, please click here .