Care Coordination Organization Profile


Understanding the Data

  • 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.
  • Health Home Care Management, also known as Care Coordination, is provided by Care Coordination Organizations (CCOs). There are seven CCOs operating across New York State.
  • CCO Care Management is required for enrollment into OPWDD’s Home and Community Based Services (HCBS) Waiver.
  • The data displayed in this report represents statistics as of the end of calendar year 2024 with accompanying detail on data movements during January – December 2024.
  • The data is compiled from CCO roster data and self-reported information submitted to OPWDD through CCOs.

Care Management Enrollment

Figure 1:  People Receiving Care Management Services by Program Type (as of December 31, 2024)
The number of people receiving either Health Home or HCBS Basic Plan Support has remained constant at 97% and 3% respectively, since the implementation of CCOs.

Individuals have a choice of two service options, Health Home care management, which is the more comprehensive option, or HCBS Basic Plan Support, which is designed for individuals who do not need or want ongoing comprehensive care management.

The number of people receiving either Health Home or HCBS Basic Plan Support has remained constant at 97% and 3% respectively, since the implementation of CCOs.
 

Figure 2:  People Receiving Care Management Services by Program Type and Care Coordination Organization (as of December 31, 2024)
 Advance Care AllianceCare Design NYLife PlanPerson Centered ServicesPrime Care CoordinationSouthern Tier ConnectTri-County CareTotal
Health Home Services25,19727,84719,35117,2868,6291,34219,459119,111
HCBS Basic Plan Support Services1,1781,133457712119263153,940
Total26,37528,98019,80817,9988,7481,36819,774123,051

 

Figure 3: People Receiving Care Management Services by Care Coordination Organization (2024)
LIFEPlan 16%, Person Centered Services 15%, Prime Care Coordination 7%, Southern Tier Connect 1%, Tri-County Care 16%, Advanced Care Alliance 21%, Care Design NY 24%
Figure 4: People New to Receiving Care Management Services 
A total of 44,895 people new to OPWDD Care Management services have enrolled since CCOs were implemented in 2018. Figure 4 breaks out this enrollment by years. On average only 1% of new enrollees select Basic HCSB Plan Support Services.

A total of 44,895 people new to OPWDD Care Management services have enrolled since CCOs were implemented in 2018. Figure 4 breaks out this enrollment by years. On average only 1% of new enrollees select Basic HCSB Plan Support Services. 

Figure 5: People New to Receiving Care Management Services by CCO
Care Coordination Organization2024Historical Data-2023Historical Data- July 2018-December 2022Total
Advance Care Alliance2,2601,1983,7327,190
Care Design NY1,5041,2386,5739,315
Life Plan1,2089814,0636,252
Person Centered Services8337773,0424,652
Prime Care Coordination4445392,8823,865
Southern Tier Connect8976429594
Tri-County Care8702,4809,67713,027
Total7,2087,28930,39844,895

CCO Disenrollment

Figure 6Disenrollment Count and Percentages by Reason (2024)1
Bar graph that shows percentages of the reasons people disenrolled. Passed away: 23%, voluntary withdrawal from CCO: 22%, moved out of state: 20%, transferred to another CCO: 16%, not residing in a CCO eligible setting: 12%, enrolled in another comprehensive care management program not delivered through a CCO: 5%, requirements not met for level of care.

(1) Data Source = Roster, CCO 2 Forms Completed in CHOICES by CCOs. This data includes people who transferred from one CCO to another but who are still enrolled in a CCO. Additionally, the Reason for Disenrollment “Transferred to another CCO” also includes people who moved out of the CCO’s catchment area.

Figure 7:  Count of People Disenrolled from each CCO (2024)
Care Coordination OrganizationTotal Enrollments (as of December 31, 2024)Total Disenrolled January - December 2024Percentage of Disenrolled compared to Total Enrollments
Advance Care Alliance26,3758773% 
Care Design NY28,9801,0594% 
Life Plan19,8088945%
Person Centered Services17,9987564% 
Prime Care Coordination8,7485386% 
Southern Tier Connect1,368816% 
Tri-County Care19,7749995%
Grand Total123,0515,2044% 

 

Figure 8: Disenrollment Count by Reason and CCO (2024)
Reason for DisenrollmentACACDNYLPPCSPCCSTCTCC
Voluntary Withdrawal from CCO1912112061891288371
Passed Away209286272214721956
Moved Out of State166204119936913239
Transferred to Another CCO21151011168411321174
Not Residing in a CCO Eligible Setting1191419885421164
Enrolled in Another Comprehensive Care Management Program Not Delivered Through a CCO4573202939241
Requirements Not Met for Level of Care521292936533
Ineligible for Medicaid2722343339221
Grand Total8771,05989475653881999

2: The Reason for Disenrollment “Transferred to another CCO” also includes people who moved out of the CCO’s catchment area.


CCO/Health Home Care Management Care Planning

Figure 9: Completion of Life Plans for New Enrollees (2024)
CCOs have 90 days from CCO enrollment to finalize an initial Life Plan for individuals new to CCO services. Figure 9 includes metrics based on enrollees new to care management who enrolled between November 2023 and October 2024, as these individuals would have a Life Plan due in the year 2024.
CCO Name% of Life Plans Completed for Individuals New to CCO Services- 90 Days
Advance Care Alliance88%
Care Design NY76%
Life Plan96%
Person Centered Services75%
Prime Care Coordination87%
Southern Tier Connect79%
Tri-County Care93%
Statewide Average86%

 

Figure 10: Completion of Annual Life Plans for All Enrollees (2024)
CCOs perform annual assessments to inform the review and revision of Health Home and Basic Plan Support Life Plans annually for all enrollees. Figure 10 depicts the percent of total enrollees’ annual Life Plans finalized within the annual required timeframe.
CCO NamePercent of Annual Life Plans Completed Within the Annual Timeframe
Advance Care Alliance95%
Care Design NY97%
Life Plan99%
Person Centered Services99%
Prime Care Coordination97%
Southern Tier Connect99%
Tri-County Care98%
Statewide  Average97%