Four NJ entities to lead new pediatric payment model with $15.8M CMS award

Anthony Vecchione//December 23, 2019//

Four NJ entities to lead new pediatric payment model with $15.8M CMS award

Anthony Vecchione//December 23, 2019//

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Hackensack Meridian Health said Monday it received a $15.8 million award from the Centers for Medicare and Medicaid Services (CMS), to be distributed over seven years, to establish the New Jersey Integrated Care for Kids (InCK) Model that will test an Alternative Payment Model (APM) for the Medicaid program supporting multi-sectoral integrated case management and pediatric practice capacity-building in Monmouth and Ocean counties.

HMH is the administrative lead organization on the initiative and is partnering with co-leads VNA of Central Jersey (VNA), the New Jersey Medicaid Agency, and the New Jersey Health Care Quality Institute (Quality Institute).

HMH will partner with the VNA and a broad-based Partnership Council (PC) to monitor and execute the model, while the state’s Medicaid office, HMH and the Quality Institute will work collaboratively to design and implement the APM.

In a statement, HMH said the goal of this population-based approach and the associated APM is to identify children and adolescents who are covered under New Jersey Medicaid that have higher than average health issues as indicated by a combination of factors, including medical, behavioral and social risks. Once identified, this model aims to improve outcomes, including reducing Emergency Department use, inpatient admissions and out-of-home placements for escalated behavioral needs and substance use disorders through integrated care coordination and case management.

Robert Garrett, CEO, Hackensack Meridian Health
Garrett

“We are so excited to have been selected as a recipient of this cooperative agreement on behalf of the state of New Jersey,” said Robert Garrett, chief executive officer of HMH. “This is a novel concept that once proven, can be replicated throughout the state, and we are truly energized to begin implementation with these tremendous partners, who were integral to being awarded this cooperative agreement.”

According to HMH, only eight awards were issued by CMS across the country and the one awarded to HMH, the VNA and the Quality Institute, was the only one given in New Jersey.

Linda Schwimmer, CEO and president of the New Jersey Health Care Quality Institute.
Schwimmer

The impact of early identification and immediate support of at-risk New Jersey children and families is two-fold, leading to improvements in health and service accessibility and health outcomes for the highest risk children who will receive integrated care coordination and case management by HMH and the VNA. Lower acuity children will benefit from improved capacity of primary care offices to screen for, and address, risks.

“This model aims to improve the care of children with complex needs through early identification and integrated care management, while reducing costs that typically have been associated with disjointed and high-acuity care, creating a model that is better for everyone,” said Linda Schwimmer, CEO and president of the Quality Institute. “We are eager to work directly with the NJ Medicaid team and we’re thankful to CMS for entrusting us with this innovative concept.”