An Interview with Dr. Hany Abdelaal, President of VNSNY CHOICE Health Plans
What are the key priorities for VNSNY CHOICE in 2018?
One of our biggest priorities is to expand our CHOICE Managed Long Term Care (MLTC) plan. We’ve had an MLTC plan for 20 years and we think it’s time for us to expand in both an organic and inorganic fashion. To accomplish this, we’re working on strengthening our partnerships with New York’s licensed home care agencies, and are also developing a number of quality initiatives. Regarding inorganic growth, the New York State Department of Health is definitely looking for consolidation across the state’s MLTC program. The state is also mandating that all MLTC plans move to value-based purchasing agreements. There are smaller MLTC programs that are going to have some difficulty complying with new VBP regulations and being able to continue on their own, because they don’t have the scale to carry out these agreements—so we may have some acquisition opportunities.
When does this value-based payment mandate take effect?
By January 1 of 2018, all New York MLTCs need to have Level One agreements in place. These are “upside only” agreements, which basically involve measuring and tracking certain quality measures. The plans will then take on additional accountability over the next several years. The measure we’ll be focused on in 2018 is reducing avoidable hospitalizations among our MLTC members in collaboration with our provider partners. We’ll also be focused on moving away from providing fee-for-service visits, and emphasizing the quality rather than the quantity of hours that HHAs spend with each member.
How do you plan to do this?
In part, by leveraging new technologies and better communication. We’re looking at a variety of approaches, including embedding telemedicine capabilities in each member’s home, empowering our HHAs to alert us to any changes in a member’s health, and deploying our HHAs more efficiently. We’re also very focused on ways of enhancing communications among the member, their HHA, the member’s CHOICE care manager, family caregivers, and physicians in the community. This includes developing easy, secure technologies for getting everybody on the same page that don’t require multiple phone calls back and forth.
What is on the horizon for CHOICE SelectHealth?
As a Medicaid special needs plan, SelectHealth is doing a very good job of managing its members, including HIV-positive individuals and, most recently, people who are transgender or gender non-conforming. Now it needs to find new ways to grow, by making sure people are aware of the value that we bring to these populations. Besides getting the word out through advertising, we’re also installing CHOICE Member Service Representatives on the ground in designated AIDS centers and community health centers that treat SelectHealth members. Since its launch a few months ago, the program has been generating phenomenal feedback as well as boosting member retention rates, and we’ll be expanding it significantly in 2018. As for value-based payments, CHOICE SelectHealth, like CHOICE MLTC, is looking to transition over the next several years to a total cost of care arrangement, in which the plan and its providers share in the upside and downside risk for member outcomes.
Finally, what about the CHOICE Medicare plans?
The primary goal of our Medicare program has always been to service people who are dually eligible for Medicare and Medicaid, working with provider partners who are willing to partner with CHOICE. This continues to be our focus as we move into 2018. These individuals are core to our mission: They are the frail, the elderly, the poor, and the disabled. In order to support them, we’re now working with key provider groups to build stronger integrated care models that will strengthen our ability to manage the care of this population.
How would you sum up your vision for CHOICE in 2018?
I think our future, as an insurer whose core mission involves managing the care of vulnerable people, is very bright. VNSNY has been in New Yorkers’ homes for the past 125 years. Maximizing our unbelievable skill set and our longevity will be the key to our success as a managed-care company moving forward. Home is where the future of health care lies, and as we continue to improve our technology, our data and other systems, we’re poised to be leaders in the field.