Healthfirst Receives Award for Program at High-Volume Substance Use Facilities Supporting Members’ Transition Back to Communities

Critical Program Achieves 14 Percent Reduction in Readmissions Among Members; Seeks to Help Address Ongoing Behavioral Health Crisis in New York

Healthfirst Care Managers and Peer Support Specialists Build Relationships with Members During Inpatient Stays, Providing Support That Overcomes Barriers to Their Recovery

Today, Healthfirst, one of New York’s highest quality health insurers, has received the prestigious Case Management Practice Improvement Award from the Case Management Society of America Foundation. The award recognizes Healthfirst’s Behavioral Health Case Management program which was developed to address the needs of members with substance use disorder as they return to their communities and continue their recovery following inpatient stays. The program has driven a sustained 14% reduction in readmission rates at both 30- and 90-days post-discharge – ensuring that highest risk members receive the compassionate, coordinated care they need to stay out of the hospital and in recovery.

Many of Healthfirst’s members living with substance use disorders face barriers in receiving the outpatient care they need to avoid readmission. In fact, 44% of those admitted to the hospital for substance abuse diagnoses are readmitted within 30 days of discharge, and 50% visit the emergency department. To address these challenges, Healthfirst launched an in-person care model that embeds licensed behavioral health clinicians and certified peer support specialists in the highest-volume substance use treatment facilities in the greater New York City area. These care teams engage with members face-to-face during their inpatient stay and continue working with them after discharge to remove barriers to outpatient care, assess social determinants of health, and help members stay on track with their recovery goals.

“A key element of the Behavioral Health Case Management program’s success is connecting with members face-to-face during their inpatient stay, often at one of the most difficult times in their recovery,” said Stella V. Pappas, Vice President, Behavioral Health Services at Healthfirst. “This in-person engagement is essential to earning our members’ trust and creates a foundation for ongoing support which helps ensure members are not navigating their recovery alone. For example, our care managers and peer support specialists can understand the member’s individual needs and challenges they may face in their recovery and identify solutions that enable them to continue to receive outpatient care and prevent readmission.”

“At a time when the need for behavioral health care is rising, programs like this show what’s possible when innovation is grounded in compassion, accountability, and a deep understanding of our members’ needs,” said Pat Wang, President and CEO of Healthfirst. “At Healthfirst, we know that all healthcare is personal, and it is crucial to meet people where they are in a way that feels authentic to them, which is why this integrated approach to behavioral health case management underpinned by data-driven insights has proven effective in reducing readmissions.”

The CMSA Foundation award highlights Healthfirst’s continued leadership in advancing behavioral healthcare and reinforces its commitment to delivering compassionate, coordinated services that improve outcomes and reduce preventable hospitalizations. For more information or to view the full case study, visit here.

About Healthfirst

Healthfirst believes that every New Yorker deserves access to the best available healthcare. As one of New York’s highest quality health insurers, we make this a reality for more than 2 million members. Founded more than 30 years ago by the leading hospital systems in downstate New York, Healthfirst established a partnership model that enables hospitals, health systems, and physicians in our network to prioritize health outcomes over profits, placing the needs of our members and community first. Healthfirst serves members in New York City, on Long Island, and in Westchester, Rockland, Sullivan, and Orange counties, offering market-leading products to suit every life stage. Our offerings include Medicaid plans, Medicare Advantage plans, Long-Term Care plans, Qualified Health plans, and Essential Plans. For more information on Healthfirst, please visit healthfirst.org.

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