Judith Baron trusts the home health workers from Cabrini Eldercare who care for her in her New York City apartment, and she wants to know they'll be back.
Marguerite Falu, left, a member services representative for Cabrini Eldercare, greets home health patient Judith Baron in her Manhattan apartment. The creation of Cardinal Health Partners by Cabrini and four other Catholic home health providers in response to changes by New York state has allowed the agencies to continue tending to their home health clients, such as Baron, who is grateful for the continuity of her care.
It seems like a simple enough wish. But a few years ago New York state changed the way it would pay for home health services and that imperiled long-standing relationships between patients and their home health care providers. Cabrini and four other Catholic health agencies reacted by forming an alliance to adapt and continue serving their clients. That alliance, which aims to protect the heritage of each organization and ensure continuity of care for long-term clients like Baron, will be the subject of an Innovation Forum session at the Catholic Health Assembly in Chicago June 22-24.
Baron, 66, lives with Addison's disease, diabetes and other ailments, and has had numerous surgeries over the years. She hasn't been able to work for more than two decades. Home health nurses and assistants from Cabrini have been caring for Baron in her apartment, on Manhattan's Lower East Side, for nearly 15 years.
"I like them. They are professional and warm, friendly and down to earth," Baron said. "It would be disturbing if a stranger suddenly shows up. With Cabrini, I feel safe."
Those are welcome words to Patricia Krasnausky, president and chief executive of Dobbs Ferry, N.Y.-based Cabrini Eldercare. They also explain why the five Catholic agencies created Cardinal Health Partners, an independent practice association.
"We have long relationships with our clients and those relationships, combined with our heritage of compassionate and quality care, have an impact on helping them stay healthy and well," said Krasnausky, one of the founders of Cardinal Health Partners and vice chair of its board of managers. "New York is trying to do a lot of innovative things, but it's all happening very fast. We had to decide how we could protect our clients from becoming cogs in the new machinery of managed long-term care."
Forging an alliance In 2011, New York's Medicaid Redesign Team, organized by Gov. Andrew Cuomo to reduce Medicaid costs, approved changing home health payments from fee-for-service to managed care, a shift that undermined the model of care that many Catholic providers were using for home health. That summer, about 80 representatives of Catholic health providers began meeting to find ways to continue their services. At one of those meetings, Cardinal Timothy M. Dolan, archbishop of New York, said, "We may have been able to do it separately in the past, but right now we've got to be collaborative."
That larger meeting led to a series of smaller sessions with leaders from five agencies that provide long-term home health care to more than 2,000 clients in the greater New York City area: Cabrini of Westchester of Dobbs Ferry; Dominican Sisters Family Health Service of Ossining, N.Y.; Good Samaritan Regional Medical Center of Suffern, N.Y.; Saint Joseph's Hospital Nursing Home of Yonkers, N.Y.; and Schervier Nursing Care Center of Riverdale, N.Y. All are sponsored by women religious.
Those representatives met weekly and, with the help of a $5,000 planning grant from Catholic Charities of New York and $50,000 from each member agency, formed Cardinal Health Partners in November 2012. Representatives of the five agencies still meet every week, starting their sessions with prayer.
Cardinal Health Partners contracts with ArchCare, the health care ministry of the Archdiocese of New York, to provide care coordination. Cardinal home health workers continue to provide direct care.
Shared lesson Last August, LeadingAge New York, an association of nonprofit providers of services for the elderly, awarded Cardinal Health Partners with its Innovation of the Year Award for 2013. Scott LaRue, president and chief executive of ArchCare, said he believes Cardinal Health Partners has found a way to continue serving its member agencies' clients.
The particular changes are adaptive to state law, but LaRue said the experience of the five home health agencies is instructive to Catholic providers across the country.
"A lot of states are moving in this direction," LaRue said. "By working together, agencies can better ensure the success of their ministries going forward." LaRue will join Krasnausky in leading the Catholic Health Assembly breakout session.
Preserving Catholic care Mother Mark Louis Randall, O CARM, superior general of the Carmelite Sisters for the Aged and Infirm in Germantown, N.Y., applauds the creation of Cardinal Health Partners, especially in the face of an increasingly challenging environment for Catholic institutions.
"All components of the health care system have been affected by rate reductions and the introduction of mandatory managed care, and thus (we) have to think not only strategically but quickly to find ways to survive in this environment," said Mother Randall, who helped to organize the Catholic providers forum in 2011 with Krasnausky and LaRue. "In addition, we are losing Catholic health care institutions and programs left and right. If Catholic providers can band together to not only stay in business but to support the existence of Catholic health care, I would say that's a win-win."
Krasnausky is guardedly optimistic about prospects for success. But without the collaboration, she said, all five agencies would already have been pushed out of home health services in New York.
Funding reform "The (state's) changes amount to a very big steamroller," she said.
The five collaborating agencies used to work independently under rules known as the Lombardi program, named after its sponsor, former state senator Tarky Lombardi of Syracuse, N.Y. Envisioned as a "nursing home without walls," the program provided payments to the agencies for giving care to income-eligible clients who could have qualified for nursing home care. Payments were capped at 75 percent of nursing home allowances.
But the 2011 revisions shifted the service to managed care, putting contracted insurance companies in charge of capitation payments to service providers. Without collaboration, Krasnausky said, "Our clients would have been scooped up right away, and we'd be out of the picture."
Bluntly put, she said, "The insurance companies now control the money."
LaRue said ArchCare is the insurer — the "risk-taking entity" — for Cardinal Health Partners. He said this arrangement provides the five agencies "a sustainable future" for their home health work. "I think their chances are very good," he said. "The concept and operations are feasible and, we believe, have an opportunity to grow."
Even so, said Krasnausky, the state's new system will force the providers to attend to their clients less often, or send aides instead of nurses for some visits. The caseloads of nurses have increased, she said.
"Cabrini no longer makes decisions about how many visits a person gets," she said, speaking of her own agency. "The truth is that services will be reduced. But this allows us to continue serving our patients. I believe we still can provide quality service with the compassion we always have brought to this work. We want to carry on the work of congregations of religious women who served the elderly with their blood, sweat and tears."
And that's a comforting assurance for patient Judith Baron. Without Cabrini's home health services, she said, "I do not know how I would have survived all these years."