A New York City–based not-for-profit Home health-care organization has received state approval to expand its Medicaid managed long-term care plan to 24 counties outside of the city — including several in the Syracuse and Utica–Rome areas.
The Visiting Nurse Service of New York (VNSNY) is moving on plans to spread its VNSNY Choice Medicaid Managed Long Term Care plan to Herkimer, Madison, Oneida, and Onondaga counties. That’s after the state approved the market expansion in September.
The managed long-term care plan is targeted at seniors and individuals with chronic illnesses and disabilities who cannot live independently at home, but do not want to move into a nursing home. It’s a voluntary option for Medicaid-eligible beneficiaries that provides nurse-care managers who visit members’ homes and coordinate the health-care services they receive.
News of VNSNY Choice’s expansion follows New York Gov. Andrew Cuomo accepting recommendations from a Medicaid Redesign Team in February. The redesign lifted a moratorium on the extension of existing Medicaid managed-care plans, according to Christopher Palmieri, president of VNSNY Choice Health Plans, who also acted as an adviser to the state during its Medicaid redesign. VNSNY has been open to the option of growing its service area since before that moratorium was lifted, he adds.
“We’ve been interested in expanding our service area since about 2003,” he says. “It was something that we’ve been working on for the entire year. We started our process to apply for market expansion in the early part of 2012.”
VNSNY Choice isn’t the only Medicaid managed long-term care plan that will be growing into Central New York and its surrounding areas. Fidelis Care, a Catholic health plan based in Rego Park in the New York City borough of Queens, announced in August it was expanding its Fidelis Care at Home managed long-term care program into 11 counties in and around Central New York.
Numerous plans have applied to the state for expansion, Palmieri says. VNSNY Choice wants to offer its plan to all eligible New York residents eventually, he continues.
“Our organization felt that we should be offering our coordinated care through managed long-term care across the state,” Palmieri says. “[This] expansion was one step toward becoming a statewide health plan and serving all 62 counties in the state.”
VNSNY Choice has opened a Utica–area office at 2 Ellinwood Drive in New Hartford and hired three employees to start building relationships with senior centers, nursing organizations, and hospitals that could become part of its network. Palmieri expects to hire more employees in Central New York and the Mohawk Valley in the future, although exact timelines and staffing levels are not set.
“It is safe to say that we’ll have a major presence in Oneida County, Herkimer County, and Onondaga County, and we’ll look at whether we need an office in Madison County,” he says. “A lot of our work force is field based.”
VNSNY Choice has hired its own nurse care managers in New York City. It could follow that model in upstate New York, or it could turn to subcontractors if they seem like a good fit, Palmieri says.
“Those care managers have a direct relationship with the patients today,” he says. “When there aren’t those opportunities, we’re happy to build the infrastructure ourselves.”
The Medicaid managed long-term care plan does not have any members in Central New York or the Mohawk Valley at the moment. It could sign up interested members today but will likely make a push at the end of 2012 or beginning of 2013, according to Palmieri.
VNSNY Choice doesn’t know how many members it will sign up, and it’s not clear how many competitors it will face in the upstate market. It has nearly 14,000 managed long-term care beneficiaries in New York City, Palmieri says.
Rough estimates show the plan will receive about $18,500 per member per year in Medicaid revenue. Those payments will vary by hundreds of dollars in different state rating regions, however.
“Around the first of the year is when we’ll have a formalized business plan based upon what we’ve projected and budgeted,” Palmieri says. “The challenge we have right now is, because there has not been a managed long-term care delivery system for this type of long-term care in the past, it’s going to be tricky to get the rates right.”
VNSNY Choice has 1,470 total employees. It offers Medicare Advantage plans, Medicaid long-term care plans, and a health plan for individuals with HIV/AIDS and their children. It forecasts premium revenue of about $1 billion in 2012 — about $550 million of which will come from managed long-term care plans. Palmieri didn’t have estimates of premium revenue for 2013, but says top-line revenue is estimated to be about $1.8 billion in 2013.
The managed long-term care plan has existing operations in New York City’s five boroughs and previously received state approval to grow into Nassau, Suffolk, and Westchester counties.
More recent state decisions have given it approval to expand into Herkimer, Madison, Oneida, and Onondaga counties, as well as other counties. They include Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Albany, Columbia, Delaware, Fulton, Greene, Montgomery, Otsego, Rensselaer, Schenectady, Saratoga, Schoharie, Warren, Washington, and Monroe counties.
VNSNY Choice has hired seven people in Fishkill in Dutchess County to spearhead its efforts in the Hudson Valley counties. It leased a 3,000-square-foot office there.
Palmieri is no stranger to the Mohawk Valley. He’s a Utica–area native who helped build Faxton St. Luke’s Healthcare’s Senior Network Health managed long-term health-care plan in the late 1990s, he says.
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***PULL QUOTE: “Our organization felt that we should be offering our coordinated care through managed long-term care across the state,” Palmieri says. “[This] expansion was one step toward becoming a statewide health plan and serving all 62 counties in the state.”