St. Mary’s in Amsterdam seeks lead as kids’ health home

PHOTOGRAPHER: Bethany Bump

St. Mary’s Healthcare of Amsterdam wants to lead a regional version of a new state initiative designed to deliver better health care to children.

The Amsterdam hospital system will submit a letter of intent within the next week to serve as lead agency for a children’s health home in the Mohawk Valley and Capital Region.

The state established its health home program in 2012. This set up regional health homes that were in charge of coordinating care for local Medicaid enrollees with complex medical, behavioral or long-term care needs by assigning patients their own case manager. This is expected to improve health outcomes and save money, because case managers discover redundancies and gaps in care, keep patients on track with appointments and medications, push preventative care and prevent improper use of emergency departments.

“For kids, it’s really a whole other system of care that involves a whole other set of players, from primary care to school officials to family,” said Duane Miller, vice president of behavioral health at St. Mary’s.

For that reason, the state is launching children-specific health homes next year with input from various state departments, existing health homes, managed care plans, children’s advocates and other stakeholders. The goal is to tailor the existing health home model to serve children better.

Existing health homes can apply to expand their network to better serve children. This is, in fact, preferred because it leverages the existing infrastructure of a health home — established partnerships, case management and information technology.

St. Mary’s officials believe the Amsterdam hospital system is equipped to serve as a lead agency given its existing status as one of 49 designated health homes across the state and its roster of child and adolescent services.

“We felt we had most of the pieces of the network already in place,” said Miller. “We have an existing network of case mangers already, and an outpatient clinic for adolescents and youth. We have relationships with a lot of other providers who serve children, as well. We saw this as dovetailing with what we already have in place.”

In addition to adult services, St. Mary’s Hospital provides a family care program, a children’s mental health clinic, intensive case management, school-based outpatient services and coordinated children’s services. The children’s case management team currently serves Fulton and Montgomery counties.

Under the children’s health home, St. Mary’s would serve Fulton, Montgomery, Saratoga, Schenectady, Albany and Rensselaer counties. It would rely on its current partners, Ellis Medicine of Schenectady and St. Peter’s Health Partners of Albany, to reach children in portions of the Capital Region to the east of Amsterdam.

“Ellis has an inpatient children’s psychiatric unit, which would really complete the circle of our network,” said Miller.

Other partners would include the Family Counseling Center in Gloversville and Catholic Charities’ foster care division in Albany, among others.

Specific eligibility guidelines have yet to be established, but state leaders expect it will include children in foster care, medically fragile children with complex health conditions and children receiving care management under the state’s waiver programs.

Applicants must show established partnerships with various agencies serving children such as children’s hospitals, child welfare groups, local departments of social services, foster care agencies, juvenile justice systems, pediatric HIV/AIDS treatment providers and the education system.

“It’s not unusual to see a child with a pre-existing medical condition like diabetes and a co-occuring mental health diagnosis have difficulty managing both conditions,” Miller said.

“You might see their family have difficulties of their own, whether it be financial, medical or mental-health related. All of this can lead to difficulties in school with attendance or behavior or academics. You can see how this family would benefit from some coordination.”

Letters of interest are due July 30. Health home applications will be released Aug. 29 and are due Sept. 30.

A multiagency team, including staff from state and local agencies, will review and approve applications through October and November. Enrollment will begin at the start of 2015.