Fidelis Care brings managed long-term care program to CNY [Business Journal, The (Central New York)]

Health insurer Fidelis Care moved quickly to expand its Fidelis Care at Home managed long-term care program into 11 counties in and around Central New York, according to one of its executives.

"It wasn't a hard decision for Fidelis," says Elaine Morgan, a registered nurse who is Fidelis Care's assistant vice president of managed long-term care. "We knew that where we needed to be was every county in New York state, following our other lines of business. We were already operational as a managed Medicaid program, we were in Family Health Plus, Child Health Plus, four lines of the Medicare line."

Fidelis Care announced on Aug. 23 that the state approved Fidelis Care at Home for operation in Broome, Cayuga, Chenango, Cortland, Delaware, Herkimer, Oneida, Onondaga, Oswego, Tioga, and Tompkins counties. The state approved the Onondaga and Cayuga county expansions on May 1 and all other expansions in the Central New York area Aug. 1, according to Morgan.

Managed long-term care is a voluntary option for Medicaid-eligible beneficiaries requiring nursing-home-level care. Beneficiaries who are eligible for and choose managed long-term care programs can remain in their homes, receiving services such as in-home nursing, therapy, adult day care, and delivered meals.

Several types of organizations offer managed long-term care: home-care providers, multi-provider health-care networks, health plans, and nursing homes. Fidelis Care is a Catholic health plan based in Rego Park in the New York City borough of Queens. It has 793,000 members in 59 counties across the state, including 109,491 in Central New York.

It has operated Fidelis Care at Home since 1999, Morgan says. But before May of this year, it only had a state license for the program in Orange and Rockland counties.

Fidelis Care's expansion of the managed long-term care network comes after New York Gov. Andrew Cuomo accepted recommendations from a Medicaid Redesign Team in February, according to Morgan. The recommendations sought to redesign the state's Medicaid program for efficiency and better patient results.

"There's been a flurry of activities surrounding managed long-term care since the Medicaid Redesign Team looked at it," Morgan says. "The existing plans that were operational in the state, they asked the plans to take a look at their business models, take a look at whether it was going to be financially sound for each plan to expand."

Fidelis Care believed it had enough of a statewide footprint and experience in managed long-term care to expand out of Orange and Rockland counties, Morgan continues. So it began applying for permission from the New York State Department of Health to operate in additional counties.

At this point, it has received approval for 50 counties. Fidelis Care also has applications pending in 12 remaining New York counties.

Fidelis Care added staff members at each of its four regional offices to expand Fidelis Care at Home, according to Morgan. The regional offices are in Rego Park, Albany, Getzville in Erie County, and at 5010 Campuswood Drive in DeWitt

At each regional office, Fidelis Care hired about five people: two outreach staff members, a full-time intake staff member, a per diem intake staff member, and an employee to handle marketing. In home care will be provided by subcontractors, while Fidelis Care at Home coordinates enrollees' care, Morgan says.

"It's one-stop shopping," she says. "They call one number here at Fidelis and have all of their care managed through our care management team."

Fidelis Care at Home currently has 601 members, mostly in Orange and Rockland counties, according to Morgan. It received five referrals in Onondaga County since unveiling the program for the area Aug. 23.

Morgan says she cannot provide an exact estimate for the number of people who will sign up for Fidelis Care at Home. But she anticipates it will be in "the thousands" statewide.

She also says she cannot predict the revenue the program will generate. Fidelis will receive a set Medicaid reimbursement program participant per month, based on the region where a participant lives. In a majority of Onondaga County, that sum will likely be about $1,700 per participant per month, although the state has not yet completed rate negotiations, Morgan says.

Fidelis Care, which is a nonprofit organization, had program revenue totaling $1.9 billion in 2010, the most recent year for which its Form 990 is available from www.guidestar.org. It currently employs more than 1,500 people throughout the state.

The health plan's DeWitt office has about 100 workers, according to Thomas Julian, Fidelis Care director of marketing, who heads the office. In addition to the newly hired workers focusing on Fidelis Care at Home, DeWitt based employees work in marketing, provider relations, contracting, and government affairs, he says.

The office is in 8,000 square feet of space Fidelis Care leases from Illinois-based American Landmark Properties, Ltd.

The DeWitt office is using word of mouth as well as contact with community organizations and providers to find potential Fidelis Care at Home members, Julian says.

"We're looking at a lot of hard work to get the program out," he says. "We are currently working with the providers who are going to be a major source of referrals for this line of business - particularly discharge planners, people like that."