Care Coordination Organization Profile

Care Coordination Organization Profile

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 2021 with accompanying detail on data movements during January - December 2021.
  • 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.

Care Management Enrollment

Figure 1:  People Receiving Care Management Services by Program Type (as of December 31, 2021)
3% HCBS Basic Plan Support 3,251; 97% Health Homes 109, 542

A total of 23,673 individuals new to OPWDD care management enrolled in CCOs since the July 2018 implementation (6,613 of these individuals enrolled in the 2021 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, 2021)
  Advance Care Alliance Care Design NY Life Plan Person Centered Services Prime Care Coordination Southern Tier Connect Tri-County Care Total
Health Home Services 23,158 26,671 18,158 16,689 8,088 1,215 15,563 109,542
HCBS Basic Plan Support Services 1,052 796 476 525 136 34 232 3,251
Total 24,210 27,467 18,634 17,214 8,224 1,249 15,795 112,793

 

Figure 3: People Receiving Care Management Services by Care Coordination Organization (as of December 31, 2021)
15% person centered services, 17% life plan, 22% advance care alliance, 24% care design ny, 1% southern tier connect, 7% prime care coordination, 14% tri-county care
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) New to CM (January 2021-December 2021) Total
Advance Care Alliance 1,312 885 802 2,999
Care Design NY 2,653 1,381 1,362 5,396
Life Plan 1,296 948 858 3,102
Person Centered Services 827 724 668 2,219
Prime Care Coordination 1,068 737 556 2,361
Southern Tier Connect 144 124 75 343
Tri-County Care 2,459 2,502 2,292 7,253
Total 9,759 7,301 6,613 23,673

 [1] Since January 1 through December 31, 2021, an additional 6,613 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 (2021) [2]
  Total Enrollments
(as of December 31, 2021)
Total Disenrolled 2021
January – December
Percentage of Disenrolled compared to Total Enrollments
Advance Care Alliance 24,210 1,357 5.61%
Care Design NY 27,467 1,123 4.09%
Life Plan 18,634 825 4.43%
Person Centered Services 17,214 764 4.44%
Prime Care Coordination 8,224 442 5.37%
Southern Tier Connect 1,249 63 5.04%
Tri-County Care 15,795 558 3.53%
Grand Total 112,793 5,132 4.55%

[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 (2021) [3]
Reason for Disenrollment Jan-Dec 2021
Count
Jan-Dec 2021
% of Total 
Disenrollment
ACA CDNY LP PCS PCC STC TCC
Enrolled in Another Comprehensive Care Management Program Not Delivered Through a CCO 180 3.51% 38 58 21 24 20 0 19
Ineligible for Medicaid 59 1.15% 23 10 7 8 7 0 4
Moved Out of State 1,040 20.27% 279 241 140 116 72 9 183
Not Residing in a CCO Eligible Setting 661 12.88% 162 142 107 121 37 11 81
Passed Away 1,333 25.97% 239 327 301 286 95 16 69
Requirements Not Met for Level of Care 55 1.07% 17 21 2 3 5 1 6
Transferred to Another CCO [4] 892 17.38% 345 145 120 81 88 8 105
Voluntary Withdrawal from CCO 912 17.77% 254 179 127 125 118 18 91
Grand Total 5,132   1,357 1,123 825 764 442 63 558

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

Care Planning

Figure 7: Completion of Life Plans for New Enrollees (2021) [5]
CCO Name % of Life Plans Completed for Individuals New to CCO Services- 90 Days % of Life Plans Completed for Individuals New to CCO Services- 120 Days
Advance Care Alliance 83% 94%
Care Design NY 72% 89%
Life Plan 83% 93%
Person Centered Services 78% 89%
Prime Care Coordination 70% 81%
Southern Tier Connect 94% 99%
Tri-County Care 83% 89%
Statewide Average 79% 89%

[5] Typically, CCOs have 90 days from CCO enrollment to finalize an initial Life Plan for individuals new to CCO services. During the COVID-19 health emergency timelines were extended. As such, Figure 7 includes metrics based on 90 and 120 days for Life Plan completion. Only enrollees new to care management who enrolled between November 2020 and October 2021 were included in the data analysis as these individuals would have a Life Plan due in the year 2021. 

Figure 8: Completion of Annual Life Plans for All Enrollees (2021) [6]
CCO Name Percent of Annual Life Plans Completed Timely
Advance Care Alliance 93%
Care Design NY 98%
Life Plan 98%
Person Centered Services 98%
Prime Care Coordination 97%
Southern Tier Connect 99%
Tri-County Care 88%
Statewide  Average 96%

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