BEHAVIORAL/MENTAL HEALTH: Healthfirst partners with Mount Sinai and the Institute for Community Living to expand access to behavioral and physical health services among vulnerable populations

The Challenge: Medicaid beneficiaries with high-need mental health and substance use disorders frequently use emergency and inpatient-level services, which are not always positioned to address the multi-layered physical, behavioral, and psychosocial factors that affect their health and contribute to increased care costs.

Our Goal: To improve access and reduce Medicaid and health plan costs related to emergency care for mental health.

The Healthfirst Solution: In partnership with Mount Sinai Health System and the Institute for Community Living, Healthfirst implemented multi-agency coordinated care interventions, including home- and community-based programs. These included peer support, vocational and educational services, and family counseling, along with housing and transportation assistance. Care managers and community health workers emphasized behavioral and social needs in addition to physical health.

Population Health Improvements: 

  • $50 decrease in overall cost of care per member per month
  • $1.3 million in overall annual Medicaid savings
  • Decreased inpatient medical hospitalizations and emergency room visits
  • Lower medical surgical, behavioral health, and pharmacy costs
  • Improvements to 4 of 6 quality metrics as part of the New York State Value-Based Payment program

Takeaway: The Health and Recovery program demonstrated an ability to achieve savings when providing care to vulnerable populations with substance use disorders, avoiding unnecessary trips to high-acuity venues and engaging community-based workers who can emphasize the behavioral and social needs of these populations.