Font Size: A- A A+

Results

Since its inception, the NYCCP has placed a high value on the need to continuously evaluate the impact of the programs on the individuals enrolled, the health services delivery system, and the community at large. Specific performance indicators were identified and a variety of data gathering tools developed with the anticipation of outcome studies. These were put in place from the time of first enrollment.

Results are sorted into categories based on data source. Only the highlights are reported here:

Outcomes are measured by the following:

Enrollee Satisfaction Survey

The Enrollee Satisfaction Survey is an opportunity for enrollees to rate the services they are receiving through the Care Coordination Program. A peer coordinator administers the survey to help to ensure that enrollees feel able to provide honest feedback.

Individual Service Plan (ISP) Reviews

The development of the Person-Centered Planning (PCP) approach has been a large initiative within the program and a key component for producing culture change in the way services are delivered.

The Individual Service Plan (ISP) is used to work with an individual to identify their own goals and objectives, which in turn guide service delivery. The ISP is written as one indication of how well care coordinators are listening to individuals and providing person-centered service.

The Hallmarks of Person-Centeredness Evaluation Tool reflects indicators of person-centered practices and is used to review individual service plans written by care coordinators across the NYCCP counties. This tool was revised in 2008 for use in the 2009 ISP reviews. Hallmarks of Person-Centeredness Evaluation Tool Version 2

2004 Analysis (below)

A 10% sample of Individual Service Plans were reviewed in all participating counties for indicators of PCP. A survey was developed with a 4-point rating scale for the reviewer. The rating is based on the degree of content in the record that reflects a PCP approach in each Individual Service Plan (ISP). In the 4-point scale, level 3 represents moderate content and level 4 is the highest level of content indicating PCP. Changes in level 1 and 2 are not reported here as the interest is in looking at the trends toward the positive end of the scale.

Below are five (5) questions the reviewer used for rating the person's ISP for PCP content % increase in the # of records reflecting PCP content from 2003-2004
 
Level 3 - Moderate
Level 4 - High
Q1: The person's (enrollee's) dreams, interests, preferences, strengths and capacities are explicitly acknowledged and drive activities, services, and supports (QOLSA and ISP).
6% more records
31% more records
Q2: Services and supports are individualized and don't rely solely on pre-existing models (ISP).
6%
28%
Q3: The person has a presence in a variety of typical community places. Segregated services and locations are minimized (ISP).
10%
17%
Q4: Planning activiites occur periodically and routinely. Lifestyle decisions are revisited (QOLSA, ISP).
33%
23%
Q5: A group of people who know, value, and are committed to the person remain involved (ISP).
10%
22%

Periodic Reporting Forms (PRF)

The Periodic Reporting Form is used to gather data on enrollees with respect to living circumstances or instances of homelessness, employment, education, support, risk taking behaviors, substance abuse, arrests, and hospitalizations. This form is used to help assess changes in status that may be attributed to benefits of enrollment in the NYCCP.

Periodic Reporting Form outcome data through 2004 (below)

Data completed by Care Coordinators from Chautauqua, Erie, Monroe, Onondaga, and Wyoming Counties included data from 778 individuals enrolled in the program representing 42% of all people enrolled (1870) as of 9/30/04. All 778 people enrolled in the sample had at least 2 PRF reports, at least 6 months apart, with the first PRF dated no earlier than 1/1/03. The differences between the first and last were compared:

Emergency Room Visits Average of 0.5 visits per enrollee went down to an average of 0.2 visits (59% decrease)
Days in Hospital Average of 5.6 days stay per hospitalization to an average of 2.1 days (62% decrease)
Self Harm Starting with 61 people enrolled to 40 reported to have incidents (34% decrease)
Physical Harm to Others Starting from 25 people enrolled to 17 (32% decrease)
Suicide Attempts Starting from 42 people enrolled to 17 (32% decrease)
Substance Abuse Starting from 205 people enrolled to 195 (5% decrease)
Arrests Starting from 40 people enrolled to 20 (50% decrease)
Self Help Starting from 265 people enrolled to 250 (6% decrease)
Gainful Activity (employment, school, volunteering) Starting from 10% of people enrolled to 15% (44% increase)

Medicaid Claims Data

2003-2007 Medicaid Claims Data

2003 - 2005 Medicaid Claims Data

Medicaid Claims Data 2000-2003 (below)

The outcome information presented in this section comes from the Medicaid Claims data for the years 2000 through 2003. This information was based on data from 601 individuals enrolled in the program for the full 2003 year. The comparison of data for previous years was based on the same group of people who received services in those years. This included 587 of them in 2002, 513 in 2001, and 453 in 2000. The key outcomes are listed below:

  • The average cost per person enrolled for Medicaid paid mental health services during the first full year of enrollment (2003) decreased by $1739 per person when compared to costs in 2002, the year prior to enrollment.
  • The average cost for the NYCCP enrollee was down $1302 compared to the average of the three prior years (2000, 2001, 2002), which is a decrease of 10%.
  • The average cost of inpatient services (hospitalization) for people enrolled in 2003 was down 48% when compared to 2002 costs.
  • The cost of emergency services was down 13% compared to 2002.
  • The cost of community support programs was up by 44% compared to 2002.
  • Mental health outpatient costs were also down 8% compared to 2002.

A comparison was made between NYCCP enrollees and individuals who received generic case management (Intensive or Supportive case management services without NYCCP) and how they compared between 2002 and 2003 (the first full year of enrollment). The results are stated below:

  • The average cost per care coordination enrollee who received inpatient service decreased by $3595 between 2002 and 2003, while those patients with generic case management decreased only $236.
  • The difference in average cost between the two groups went from $0 in 2001 (prior to NYCCP) to $669 in 2002, to $4028 in 2003.

At the time of this writing, the 2004 Medicaid Claims data has not yet been fully analyzed. However, initial data appears to be trending in the same positive direction for inpatient, emergency, and outpatient costs with a continued increase in community support program costs.