Last year, the CMS Innovation Center committed almost $126 million in federal funding to eight organizations for a seven-year project to develop Integrated Care for Kids (InCK) alternative payment models (APMs). Half-way through the two-year planning and partnership development phase, the Bronx Regional Health Information Organization (Bronx RHIO) has detailed the key role data sharing will play in the New York project.
The InCK model aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid through prevention, early identification, and treatment of behavioral and physical health needs. The participating states are Connecticut, Illinois, North Carolina, New Jersey, New York, Ohio and Oregon.
Participants will be required to integrate care coordination and case management across physical and behavioral health and other local service providers to provide child-and family-centered care. Finally, through the APM that is developed under this model, states and local providers will share accountability for cost and outcomes. These interventions are designed to increase behavioral health access, respond to the opioid epidemic and positively impact the health of the next generation.
The Bronx RHIO is a member of the partnership council for Bronx Equity – Integrated Care for Kids (BEInCK NY) project led by the New York State Department of Health and Montefiore Medical Center.
The organization has detailed its growing role in the project, a data-driven effort to improve children’s health in eight Bronx zip codes. It aims to model and implement integrated care networks and promote care management for children through creating a close partnership between healthcare providers, community-based organizations, health homes for children, city agencies and managed care plans. One of the key project aims is to develop an alternative payment model that can be tested and evaluated over the seven-year project. The APM will resemble a Medicare Shared Savings Plan with the flexibility to share incentives across multiple care providers.
Seven out of eight of the targeted zip codes are “Health Professional Shortage Areas” and five are “Medically Underserved Areas.” NY InCK plans to focus on targeted reductions of preventable inpatient admissions, emergency department utilization, and out-of-home placement by improving upfront care integration and leveraging delivery system reforms made through the Delivery System Reform Incentive Payment 1115 waiver program. NY InCK has also chosen to focus on two chronic conditions known for high utilization and poor health outcomes: sickle cell disease and behavioral health conditions.
Providers participating in the Bronx RHIO deliver the vast majority of healthcare received by the borough’s 1.4 million residents, including over 95 percent of the borough’s annual hospital discharges, over 600,000 annual emergency department visits and 4.5 million annual ambulatory care visits. The Bronx RHIO participates in the Statewide Health Information Network for New York (the “SHIN-NY”).
The Bronx RHIO will be providing data aggregation and analysis services to BE-InCK, which include adding a variety of new data sources for access by BE-InCK partners through the RHIO. Bronx RHIO is collaborating with another RHIO, Healthix, on the project. Healthix will be sending data to the Bronx RHIO from its members participating in the project. This includes data from several NYC Health + Hospitals facilities located in the Bronx, allowing integration of data for these children from all Bronx providers. This data sharing involves query-response technology that will allow Healthix members to use the Healthix portal to view project data otherwise only available in the Bronx RHIO.
The planning phase is being used to focus on defining data needs for the project’s different work groups, and Bronx RHIO staff are participating in work groups focused on primary care integration for sickle cell disease and reducing out-of-home placement for at-risk children. These team members are currently conducting preliminary analysis on existing available data in these areas, both clinical data and data on social determinants and influencers of health. Bronx RHIO will also be co-chairing the Data Sharing and IT Work Group, which will be addressing issues around consent for data access, sharing of data across sectors such as city agencies such as Administration for Children’s Services, Department of Homeless Services and the Department of Education.
In addition to the Bronx RHIO, Montefiore will use the Bronx Accountable Healthcare Network Health Home portal for information sharing among providers, families, and others involved in care planning.
The Montefiore Health Home portal will be adapted for service integration coordinators to enter eligibility and enrollment information, results from non-clinical assessments, summaries of interactions with attributed children and their families, and care plans.
