Niagara Falls Memorial Medical Center been awarded "health home" designation for Niagara County by the New York State Department of Health as part of a new state program designed to improve patient outcomes and control Medicaid costs.
Horizon Health Services and the Eastern Niagara Health System, which operates hospitals in Lockport and Newfane, join Niagara Falls Memorial as co-leads of an unprecedented coalition of more than 70 Niagara County-based service providers that will coordinate care for an initial 2,500 Medicaid clients and up to 6,000 clients when the program is fully established.
A health home is a care management model under which all of a patient's caregivers communicate with each other to ensure that the individual's needs are addressed in a comprehensive manner. The process will be overseen by a dedicated care manager who facilitates access to the services a patient needs to stay healthy and out of the hospital.
Services are provided through a network of organizations that collectively form a virtual health home, with designated providers appropriately sharing patient information so that services are neither duplicated nor neglected.
The new network is designed to provide not only comprehensive care management and coordination but transitional care and timely referral to community and social support services, said Memorial Vice President and Chief Operating Officer Sheila K. Kee.
"Sheila has done an admirable job of bringing together providers from all across Niagara County to participate in this home health initiative," Memorial President and CEO Joseph A. Ruffolo said. "This is a network that will combine strong, collaborative relationships with the use of current health information technology to promote health and wellness for thousands of patients while controlling Medicaid costs."
The Niagara Health Home service network consists of:
•39 Niagara County-based primary care providers, including the five major primary care sites operated by Niagara Falls Memorial, Eastern Niagara Health System and the Community Health Center of Niagara.
•Specialty doctors in the fields of cardiology, neurology, urology, obstetrics, gynecology, endocrinology, orthopedics, surgery, optometry and audiology.
•10 mental health agencies providing 51 programs at locations across Niagara County.
•Every Niagara County-based outpatient addiction treatment agency in the county.
•A hospice provider, two home care agencies, a geriatric mental health program and two nursing homes.
Seven emergency, supportive and other housing agencies, four GED and job preparation programs, four self-help programs, three social service groups, two health advocacy groups, the YMCA and Niagara University are also members of the Niagara Health Home network.
To be eligible for health home services, a person must be covered by Medicaid and have at least two chronic conditions, have one chronic condition and be at risk for another, or have a serious and persistent mental health condition.