Care Coordination Organization Health Home Care Management Profile

Care Coordination Organization Health Home Care Management Profile
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Understanding the Data

  • It is important to note that the COVID-19 health emergency has had a significant impact on all CCOs’ operations, therefore, the data presented in this report may not be representative of timelines or demographical information during a typical year.
  • The Care Coordination Organization/Health Home Care Management Profile provides an overview of enrollment and care planning information for individuals with intellectual and/or developmental disabilities receiving OPWDD services.
  • The data displayed in this report represents statistics as of the end of calendar year 2020 with accompanying detail on data movements during January - December 2020.
  • The data is compiled from CCO roster data as well as self-reported information from the CCOs that is submitted to OPWDD.
  • Health Home Care Management is also known as Care Coordination, which are services provided by Care Coordination Organizations (CCOs). There are seven CCOs operating across New York State.

CCO/Health Home Care Management Enrollment

Figure 1:  People Receiving Care Management Services by Program Type (2020)
Count and Percent of Total Enrollees

A total of 17,060 individuals new to OPWDD care management enrolled in CCOs since the July 2018 implementation (7,301 of these individuals enrolled in the 2020 calendar year).

Individuals have a choice of two service options. The number of people receiving either Health Home or Home and Community Based Services (HCBS) Basic Plan Support has remained constant at 97% and 3% respectively, since the implementation of CCOs (see Figure1).

Figure 2:  People Receiving Care Management Services by Program Type and Care Coordination Organization (as of December 31, 2020)
  Advance Care Alliance Care Design NY Life Plan Person Centered Services Prime Care Coordination Southern Tier Connect Tri-County Care Total
Health Home Services 23,577 26,143 17,992 16,621 7,795 1,168 13,442 106,738
HCBS Basic Plan Support Services 1,056 767 442 499 146 36 234 3,180
Total 24,633 26,910 18,434 17,120 7,941 1,204 13,676 109,918

 

Figure 3: People Receiving Care Management Services by Care Coordination Organization (2020)
Percent of Total Enrollments by CCO
 Figure 4: People New to Receiving Care Management Services [1]
Care Coordination Organization New to CM (August 2018 – December 2019) New to CM (January 2020 – December 2020) Total
Advance Care Alliance 1,312 885 2,197
Care Design NY 2,653 1,381 4,034
Life Plan 1,296 948 2,244
Person Centered Services 827 724 1,551
Prime Care Coordination 1,068 737 1,805
Southern Tier Connect 144 124 268
Tri-County Care 2,459 2,502 4,961
Total 9,759 7,301 17,060

 [1] Since January 1 through December 31, 2020, an additional 7,301 people enrolled in CCOs. On average only 1% of new enrollees select Basic HCBS Plan Support Services.

CCO Disenrollment

Figure 5:  Total People Disenrolled from a CCO (2020) [2]
  Total Enrollments
(as of December 31, 2020)
Total Disenrolled 2020
January – December
Percentage of Disenrolled compared to Total Enrollments
Advance Care Alliance 24,633 1,245 5.05%
Care Design NY 26,910 1,471 5.47%
Life Plan 18,434 837 4.54%
Person Centered Services 17,120 734 4.29%
Prime Care Coordination 7,941 450 5.67%
Southern Tier Connect 1,204 78 6.48%
Tri-County Care 13,676 515 3.77%
Grand Total 109,918 5,330 4.85%

[2] This data includes people who transferred from one CCO to another but who are still enrolled in a CCO (see figure 6).

Figure 6: Disenrollment Count by Reason (2020) [3]
Reason for Disenrollment Jan-Dec 2020
Count
Jan-Dec 2020
% of Total 
Disenrollment
ACA CDNY LP PCS PCC STC TCC
Enrolled in Another Comprehensive Care Management Program Not Delivered Through a CCO 369 6.92% 45 247 15 16 17 0 29
Ineligible for Medicaid 141 2.65% 14 19 24 45 19 1 19
Moved Out of State 716 13.43% 149 176 120 89 59 14 109
Not Residing in a CCO Eligible Setting 570 10.69% 100 129 114 119 49 8 51
Passed Away 1,523 28.57% 313 507 291 229 82 12 89
Requirements Not Met for Level of Care 279 5.23% 68 38 59 30 31 0 53
Transferred to Another CCO [4] 940 17.64% 401 153 114 65 84 29 94
Voluntary Withdrawal from CCO 792 14.86% 155 202 100 141 109 14 71
Grand Total 5,330   1,245 1,471 837 734 450 78 515

[3] Data Source = Roster, CCO2 Forms Completed in CHOICES by CCOs.
[4] The Reason for Disenrollment “Transferred to another CCO” also includes 70 people (or 7% of the category total) who moved out of the CCO’s catchment area.
 

CCO/Health Home Care Management Care Planning

Figure 7: Completion of Life Plans for New Enrollees (Q1-Q3 2020) [5]
CCO Name 90 Days Q1-3 120 Days q1-3 180 Days Q1-3
Advance Care Alliance 46% 62% 76%
Care Design NY 69% 87% 97%
Life Plan 85% 96% 98%
Person Centered Services 53% 77% 90%
Prime Care Coordination 38% 53% 71%
Southern Tier Connect 45% 58% 66%
Tri-County Care 83% 89% 93%
Statewide Weighted Average 68% 81% 89%

[5] Typically, CCOs have 90 days from CCO enrollment (or HCBS Waiver enrollment, whichever comes first) to finalize an initial Life Plan for individuals new to CCO services. During the COVID-19 health emergency timelines were extended. As such, calculations in Figure 7 were based on 120 days and 180 days instead of 90 days for Life Plan completion. Only enrollees new to care management who enrolled between January 1 and September 1, 2020 (Q1-Q3) were included in the data analysis as the majority of individuals enrolling in Q4 (October 1-December 1) have until on or after January 1, 2021 to finalize an initial Life Plan. 

Figure 8: Completion of Annual Life Plans for All Enrollees (2020) [6]
CCO Name Percent of Annual Life Plans Completed
(January – December 2020)
Advance Care Alliance 88%
Care Design NY 93%
Life Plan 100%
Person Centered Services 93%
Prime Care Coordination 93%
Southern Tier Connect 95%
Tri-County Care 92%
Statewide Weighted Average 93%

[6] CCOs perform annual assessments to inform the review and revision of Health Home and Basic Plan Support Life Plans annually for all enrollees. Figure 8 depicts the percent of total enrollee annual Life Plans finalized.