The Visiting Nurse Service of New York created a managed care plan serving lower-income, vulnerable patients enrolled in a partially capitated Medicaid Managed Long-Term Care program or a fully capitated Medicare Advantage Special Needs Plan, or both. Every health plan member is assigned a care manager who collaborates with an interdisciplinary care team and the member’s primary care physician to enhance access to appropriate services, improve care coordination and transitions, and promote optimal health outcomes and independent living. Other key components of the model include comprehensive member assessments, patient and family education, transitional and palliative care provided by nurse practitioners, and the use of risk stratification, information technology, and staff training. Over time, Medicare plan members have experienced fewer hospital admissions, readmissions, and emergency visits. The health plan's experience should inform organizations and policymakers interested in integrating care for patients with special needs.
Note: These case studies were based on publicly available information and self-reported data provided by the case study institutions. The Commonwealth Fund is not an accreditor of health care organizations or systems, and the inclusion of an institution in the Fund's case study series is not an endorsement by the Fund for receipt of health care from the institution.