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

New York City Health and Hospitals Corporation
Robert Criscuolo
Zachary Kelchner, Sumit Kumar, Kai Tsyr Lee, Bernard Ortega, Emma Zheng

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.