Bob Wychulis
CEO, Amerigroup New York
Achieving Value for States with Coordinated
Long-Term Care Solutions
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Overview
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About Amerigroup
New York Medicaid Redesign Solutions
State Models of Managed Long-Term Care (MLTC)
Medicaid Health Plans and MLTC
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Who We Are: Amerigroup
• We coordinate health care services for 2 million
members in 11 states, including New York
• We meet the health care needs of financially
vulnerable Americans, seniors and people with
disabilities
• We serve those on Medicaid, Medicare and other
publicly funded health care programs
• We build strong community relationships and
alliances to support our local health plans
• We offer 15 years experience dedicated to
government programs
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Benefits of Medicaid Public-Private
Partnerships
As a Medicaid managed care organization we:
1. Increase access to care
Managed care increases access to primary care and the use of
preventive services while lowering costs
2. Yield cost savings
By collaborating with doctors, hospitals and other providers to ensure
beneficiaries receive proactive health services and supports, managed
care reduces the incidence of acute episodes of care, improves the
quality of life and reduces overall burden on the taxpayers
3. Achieve quality improvements
Managed care achieves quality improvements by adhering to quality
standards and monitoring procedures. No comparable standards or
procedures are required in Fee-For-Service arrangements
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Amerigroup in New York
• Amerigroup New York serves 109,000
members in the Medicaid, Children’s Health
Insurance Program (CHIP), MLTC and
Medicare Advantage programs
• Serves members in Putnam County
and the five boroughs of New York City
• We employ 380 associates, including 49
doctors, nurses and social workers
• Network includes 16,375 providers and 48 hospitals
• Fully integrated long-term care plan offering
for dually eligible individuals
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Looking Forward: Medicaid Redesign in
New York
• Focus of New York Medicaid Redesign Team (MRT):
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New York’s Medicaid program is unsustainable
Need to build on managed care’s significant quality gains
Goal: Develop a reform package that saves money and improves quality
Identify major savings opportunities, including managed long-term care
• New York Medicaid status quo:
o 66 percent of recipients enrolled in a managed care model at a total
cost of $17 billion; 27 percent are excluded from managed care at
nearly double the cost – $29 billion
o 11 percent of long-term care recipients are enrolled in MLTC,
at a cost of slightly more than $1 billion
o 89 percent receive LTC through an alternative model of care or an
institution, at a total cost of more than $11 billion
Source: State of New York Department of Health, New York Medicaid
Redesign Team, “Building a more affordable, cost-effective Medicaid
program” (Jan. 13, 2011)
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State of Spending: High-Cost
Patients
865,000 New York Medicaid Patients with Multiple Chronic Illness
Intellectual or Development Disability
Long-Term Care
50,000 recipients
$6 billion/$10,500 Per Member,
Per Month (PMPM)
Issue: Rapidly growing expense
200,000 recipients
$11 billion/$4,500 PMPM
Issue: High cost – lack of services
management and coordination
Behavioral Health
Chronic Medical
300,000 recipients
$5 billion/$1,400 PMPM
Issue: High cost – lack of services
management and coordination
300,000 recipients
$21 billion/$695 PMPM
Issue: High cost – lack of services
management and coordination
Source: State of New York Department of Health, New York Medicaid
Redesign Team, “Building a more affordable, cost-effective Medicaid
program” (Jan. 13, 2011)
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New York MRT Recommends
Focused Approach to Long-Term
Care
Percent Change Per Recipient of Long-Term Care Spending, 2003–2009
(in New York, by Program, Six-Year Average)
89.5%
New Solutions for
Long-Term Care:
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Managed
Long-Term Care
Consumer Directed
Models
Integration of Medicaid
and Medicare
37.5% 38.3%
15.6%
23.6%
0.3%
MLTC
Nursing Adult
Homes
Day
Care
Source: State of New York Department of Health, New York Medicaid
Redesign Team, “Working together to build a more affordable, costeffective Medicaid program: (Feb. 9, 2011)
Long-Term Personal Certified Home
Home
Care
Health Care
Health Care
Agencies
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Tennessee and New Mexico:
Other Successful MLTC Models
Other models of managed long-term care help states
increase quality of care while lowering costs
TennCare CHOICES in
Long-Term Care Program
• 4,000 face-to-face assessments
completed within first six months
• Lowered nursing facility rate from 81
to 71 percent of membership
Coordination of Long-Term
Services (CoLTS) Program
• 16,282 members enrolled into
disease management programs
• Cost of serving the CoLTS population in
2011 projected to save $25 million
• 41 members transitioned from a nursing
facility to a community-based setting,
saving the State more than $1 million
• Raised share of members in the community
• 1,013 new services identified as “gaps
in service” for members in home-based care
• 207 members reintegrated from nursing
facilities to the community
• 2,345 healthy dual-eligible members at
imminent risk of nursing facility placement
have been kept out of nursing facilities
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Developing Long-Term Care That
Advocates Community Living
• New York Managed Long-Term Care (MLTC) program
enables members to maintain independence while
receiving the care they need
• Key program components include:
o Applying a system of assessment, care planning and service coordination
in order to restore or retain an individual’s level of function
o Key services include: nursing services in the home, therapies in the
home, home health aide services, personal care services in the home,
adult day health care, social day care
• By ensuring the right mix of services and supports, the
Amerigroup program is able to:
o Push-out the point at which an individual enters a nursing facility, or
o Eliminate the need for institutionalization
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Value of Managed Long-Term Care
• Provides a one-source contact to help seniors and
people with disabilities navigate the health care system
• Transitions residents from institutional settings to
their preferred setting: at home or in the community
• Coordinates a system of care to identify additional
service needs that prevent avoidable acute conditions
• Offers caregivers and family members help
supporting their loved ones
• By preventing and avoiding institutionalization,
improves member independence and quality of life
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Real Stories, Real Results: “Rosa”
• Amerigroup interventions improve the
quality of life for New York MLTC recipients
• About an Amerigroup member – “Rosa”
o Diagnosed with degenerative scoliosis
o Received Medicaid, Medicare Part D and a health plan
benefits but was not receiving adequate care
• Through Amerigroup, “Rosa” received
supportive counseling and an assessment of her
home environment and her functional status
o She is able to keep her current home health aide, who was employed
by a nonparticipating vendor
o With Amerigroup, she is able to remain at home and maintain her
independence
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Real Stories, Real Results: “Sarah”
• Amerigroup efforts enhance availability of services
for New York MLTC recipients and their families
• About an Amerigroup member – “Sarah”
o Bedridden, diagnosed with aphasia and had limited mobility
o Relied on her daughter for daily care and other services
• Through Amerigroup, “Sarah” gains access
to new equipment enhancing her quality of
life and lessening the likelihood of hospitalization
o She is able to access a proper hospital bed, pressure-reducing mattress and
geriatric wheelchair to keep her healthy
o With Amerigroup, she and her family accessed the services and equipment
necessary to ensure Sarah remains at home with her family
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Thank You
Bob Wychulis
Chief Executive Officer
Amerigroup Community Care of New York
360 West 31st Street, Fifth Floor
New York, NY 10001
(212) 372-6902
rwychul@amerigroupcorp.com
www.amerigroupcorp.com
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