Striving for More: CUCS Expands Care Management Program

August 30, 2016

There have been a lot of exciting changes happening at CUCS. Our agency continues to grow as our services continue to expand and we’re thrilled to be able to reach even more people in need in New York City. One of our expanding services is the Care Management program and we sat down with Adina Barbosa, Deputy Chief Program Officer, to find out more about the program and what these changes mean for our agency and those we serve.

This program recently underwent a name change – why?

We decided to change the name from Intensive Wellness Program to Care Management Program because that better represents what we do in the greater community and for the clients we serve. Care Management is also more in line with the Health Home model and the language used for the providers that deliver Health Home services.

Tell us a bit about the Care Management Program.

The program started in 2012, when Health Homes came out of the Affordable Care Act and Medicaid redesign in New York State. We decided to first work with our own clients in our housing programs and see how we could provide care coordination services. That meant focusing on those who had multiple hospitalizations, chronic health conditions, and a lot of health risk factors to help them improve their health. We then realized that many of our clients already had a lot of support, whereas clients in the greater community had little to no support, so we shifted focus.

During 2013-2014, we started working with Coordinated Behavioral Care (CBC) and Mount Sinai Medical Center Health Homes. They helped with contracts and we started getting referrals from them for potential clients. When we get the referral lists, our staff does outreach in the community, explain the service, evaluate based on criteria, and begin enrolling the clients. The model continues to help clients coordinate their care and avoid unnecessary hospitalization.

What led to the expansion?

The list of referrals coming from CBC and Mount Sinai was continuously growing and as the Care Management program expanded to develop a relationship with another Health Home – Health and Hospitals (HHC) – we decided it was too much to put it under one program so we wanted to create a second one, the same way we have multiple supportive housing programs. With that new relationship, we hired another director to expand the program.

Care Management program has around 420 clients and we’re looking to grow that to around 650 clients. Starting in September, we’ll receive referrals from HHC, conduct outreach and enroll clients in the program, which we expect to enroll around 150 new clients the first year.

What does this expansion mean for our clients?

The expansion gives us the opportunity to serve more clients in the community than we have been able to serve. Now we have the capacity to touch more lives and interact with more people who maybe before this, might not have had any services or anyone to help them navigate these complicated healthcare systems.

We’re also moving into a new space in midtown which will be central to Manhattan and Brooklyn where both programs are going to be moving to in September. In the beginning, we started at the Times Square supportive housing site as a little program and as we started growing, we maxed out on space at the Times Square and took some space at the Prince George supportive housing site. So it’s exciting to now have our own dedicated space to provide care management.

What makes our program unique to other Health Home programs?

In the vein of how CUCS carries all its services, we treat our clients the way you would want your family member to be treated by providing respect and high quality services to them. I think that theme resonates throughout CUCS’ programs that make CUCS what it is. It’s the same thing that makes our Care Management program do a good job with the clients that we serve.

Do you see this eventually evolving to subsequent programs?

I think the potential is definitely there. The Health Home model is most likely here to stay and changing things in the healthcare world.

We’re currently in Manhattan and Brooklyn but would like to one day expand to the Bronx.