Determine the Long-Term Financial Sustainability of the Emergency Department Care Management Program

New York City’s integrated health care system, New York City Health and Hospitals (H+H) Corporation, serves approximately 1.4 million New Yorkers annually, 479,000 of whom are uninsured. In September 2014, H+H was awarded a three-year $17.9 million grant through the Center for Medicare & Medicaid Innovation (CMMI) to support the enhancement of H+H’s Emergency Department (ED) Care Management Program located in six of its 11 hospitals. Currently in the grant’s second year, H+H is required to develop a strategy for the program’s financial sustainability beyond grant funding. Initial plans include collaboration with MetroPlus, the wholly-owned subsidiary health plan of H+H, and Healthfirst. A Capstone team was engaged to provide recommendations concerning the long-term financial sustainability of H+H’s ED Management Program after the completion of the CMMI grant. The team assessed the program and developed a payment model to support the program beyond the grant funding expiration. Additionally, the team conducted a cost savings analysis utilizing insurance claims and hospital billing data to determine if the risk–based contracts can sustain the program.