The DVHA/VCCI enrollment for top 5% high cost/high risk members will continue to decrease because:

· The DVHA/VCCI contract with APS healthcare is due to expire 12/2015 after multiple extensions. We have suffered a slow loss of nursing staff prior to our renegotiated 2015 one year extension and the newest 6 month extension for SFY 2016 such that all nursing staff is now provided remotely and telephonically vs. locally. Thus the VCCI experienced –and anticipates further –clinical staff attrition through the contract end date of 12/2015. The nursing attrition at both APS and DVHA will continue to adversely impact our ability to actively outreach, engage and case manage 25% of the total eligible cohort (8500-9500).

· With the sunsetting of the APS contract in 12/2015, the VCCI staff will help develop, learn and ultimately migrate to the new enterprise Care Management system provided by eQHealth. These transitions will require a drop in the VCCI case load as the APS Healthcare vendor provided 6 FTE nursing and 2 FTE social worker positions (8 clinical FTEs), program support functions and data analytical and reporting staff (4 FTE's). The loss of these 12 FTE's will result in a decline in our overall case load and related cost savings generated by intensive individual and population based approaches to care management. The VCCI is also loosing a part time medical director and full time pharmacist with this work being absorbed by current DVHA staff.

· The VCCI also lost one FTE nurse case manager position in the 2016 legislative budget cuts, further reducing our capacity to cover key hospital service areas (1 RN position now will serve 4 counties and 3 HSA's in the rural northeast kingdom), and the related clinical and financial benefits.

· The VCCI leadership and central support staff will be preparing for relocation to Waterbury concurrent with the Enterprise CM system deployment.

The VCCI currently utilizes a holistic and multidisciplinary approach to the intensive case management services provided to Medicaid's high risk/high cost members (top 5% VCCI eligible members account for roughly 39% of the Medicaid spend). Local partners include:

• AHS Field Directors,
• AHS district colleagues within sister departments (VDH, DAIL, DMH, DOC, DCF);
• housing authorities, facilities, shelters and advocacy groups;
• community service providers including food shelves, transportation service providers;
• and various health care provider partners such as hospitals, primary care medical homes, mental health and substance use/abuse service providers (designated mental health agencies, hub/spokes), hospital inpatient/outpatient and ED case managers as well as Community Health Teams (CHTs) funded by Medicaid, to assure coordination among service providers and improved adherence to evidence based care and financial improvement to the system.

· State employed, locally deployed VCCI staff (nurses and licensed mental health, substance abuse counselors and/or clinical social workers) who are embedded in AHS offices, high volume hospitals and/or primary care locations where Medicaid members receive services, in order to outreach/engage and deliver case management support services within the local community where members reside. The VCCI team are skilled in working with high cost members with complex medical, psychosocial and socio-economic need, utilize motivational interviewing and try to develop and maintain trusting relationships to facilitate achievement of common goals.

· Staff co-located within AHS district offices facilitates access to and networking with internal colleagues on behalf of members; and helps facilitate communication, relationship development and offers the opportunity to link members to core programs and services for which they are eligible; and which support sustainable results (3 squares/WIC– toward food security; fuel assistance, VR services, eligibility staff, etc.)

The VCCI saved a net $30.5 million over anticipated costs in SFY 2014.

· VCCI staff align with health care reform goals within DVHA and coordinate with local partners toward joint goals, shared utilization of tools and integrated care management, to facilitate transition between levels of service providers (i.e. Primary Care/Blueprint CHTs refer to VCCI to support high risk/cost population for intensive case management including care coordination, health education/coaching needs via home visiting of co-visits with PCPs and other service providers. Tools are available for standardization and sharing across the system of care (i.e. Action Plans/Self-Management plans).

· DVHA/VCCI leadership are engaged with the Medicaid ACO contracting process and ACO requirements for collaboration with VCCI to prevent/eliminate redundancy in efforts among populations receiving case management; and to assure staff integration and referral systems

· Regular bi-weekly meetings between DVHA Commissioner's office, VCCI and the Blueprint for Health to assure alignment, integration and collaboration centrally and locally.