Taking integrated care management to the street: can we find the road to our triple aim?

Abstract

Hudson Health Plan, through a Chronic Illness Demonstration Project, is investigating the value that integrated behavioral and medical health case management brings to stakeholders of a comprehensive assessment and patient assistance program. The New York State Department of Health funds the pilot program dubbed the Westchester Cares Action Program. Hudson Health Plan and its behavioral health vendor, Beacon Health Strategies, are engaged in a 3-year study aimed at improving quality of life and health outcomes while reducing costs for 250 of New York State's highest utilizing, most costly "fee-for service" patients. This article describes the program, the team, and the tools that the program uses. It also discusses the challenges, successes, and lessons learned during its first 15 months of operation.