What are the NYS Social Care Networks?

 In January of 2024, the New York State DOH released a Request for Applications (RFA) that will provide a total of $500 million to support new, regionally-based Social Care Networks (SCNs) developed as part of New York’s Health Equity Reform 1115 Waiver amendment. Grant funding awarded through this RFA will support SCN start-up and infrastructure costs in each region during the award period. The contract term for awards will be from August 1, 2024 through March 31, 2027.

SCNs will be responsible for coordinating the delivery of social care services to Medicaid members, including by providing Health-Related Social Needs (HRSN) screening to all Medicaid members and maintaining a comprehensive network of community-based organizations (CBOs) to support the delivery of “Enhanced” HRSN services (also known as Level Two services) to eligible members in need.

CBOs who participate in these networks will have the ability to be reimbursed for providing these services based on a fee schedule to be established by NYS.

Brightpoint Care seeks to form an integrated network of primary care and social care providers in order to advance health equity, improve health outcomes and reduce costs for Medicaid members in the Hudson Valley.  For Medicaid members, who often face complex health challenges compounded by socioeconomic factors, this integrated approach will provide assistance in navigating the healthcare system while addressing underlying issues such as housing instability, food insecurity, and access to transportation. This collaboration between primary care services and health related social needs (HRSN) services facilitates early intervention and preventive care, ultimately reducing the reliance on costly emergency department visits and hospitalizations, thereby optimizing the efficient use of Medicaid resources while improving the quality of care for beneficiaries. 

History of Brightpoint Care:  Brightpoint Care is a long standing care management and social service provider, originally operating as Project Samaritan and focusing on caring for those with HIV through home and community based services.  This decades old institution expanded to care for more patients through the establishment of Health Homes.  Brightpoint Care, through its affiliation with Sun River Health (previously Hudson River HealthCare) has been serving as a care management agency for patients throughout the Hudson Valley, NYC and Long Island since 2018.  Brightpoint Care provides assessment, care management, navigation and support services to Health Home eligible, Medicaid enrolled individuals, acting as a critical link between primary care and social service providers.  

Brightpoint Care is the only proposed SCN in the region that is being organized to truly integrate social care and primary care.  The Brightpoint Care SCN includes:

• Community Health Centers: Sun River Health, Institute for Family Health, Westchester Community Health Center and Cornerstone Family Health.  These health centers collectively service over 200,000 Medicaid members across New York State.  As Community Health Centers, addressing social drivers of health has been central to their mission and model of care throughout their 50 years of service to the Hudson Valley region.  Screening for HRSNs using standardized tools has been a standard practice in Community Health Centers for years, as has collaborating with community partners to facilitate access to key social services and supports.
• Skyward Health is a NYS Health Home that serves over 30,000 Medicaid members and works with over 60 CBOs providing care management.
• Community Health IPA (CHIPA) is a value-based contracting network with expertise in contracting with managed care organizations, data analytics, performance management, network development, and financial management.

And...

• Your organization!

The Brightpoint Care SCN will offer a unique opportunity for your organization to increase referrals to your services, complement the care you deliver with prompt access to high-value medical care for the populations you serve, and access essential infrastructure to sustain Medicaid revenues.

• Primary care is a critical access point for driving referrals to your organization's services

Participating in the Brightpoint Care network means that your CBO will be part of an integrated system where primary care is driving a strong volume of referrals to HRSN providers and helping your CBO to grow this as a new revenue stream for your organization. Collectively the Community Health Centers in Brightpoint Care serve over 200,000 individuals annually which could entail many new clients.

• Brightpoint Care is building the network that will give CBOs the tools and infrastructure they need to sustain Medicaid reimbursement and quality outcomes beyond the waiver period 

As a participant in the Brightpoint Care network, your CBO can expect to receive training and technical assistance on how to conduct the screening using the required tools, tracking results and referrals using the IT platform, how to track performance metrics, and how to properly file for reimbursement.  You’ll also have the opportunity to shape and receive infrastructure funding to help perform HRSN service requirements.

We know that in the last 1115 waiver (which was largely hospital-centric), CBOs, behavioral health organizations, and Community Health Centers were largely left out of the provision of funds and other resources.  A frequent critique of the last waiver was that far too much of the funding went to consultants and to secure the bottom lines of large hospital systems.  The Brightpoint Care network is committed to ensuring that in this waiver, funds are directed to truly meet community needs and are distributed to community-based service providers who can positively impact health outcomes.

• Brightpoint Care is creating a network that aims to break down the historic separation between health and social care – not perpetuate the same silos in which we have always operated.

The number one goal articulated by CMS in its approval letter of the 1115 waiver is as follows:

“The overall goals of this approval include:

1. Investments in HRSN via greater integration between primary care providers and community-based organizations (CBOs) with a goal of improved quality and health outcomes.”

Integration is the vision that CMS and NYS have for this waiver.  We also know that partnership, collaboration and ultimately a more integrated health care system are necessary to advance health equity and improve outcomes for Medicaid members in our region.  By bringing together a network that features a collaboration of primary care and CBOs, we aim to change the service delivery system for the better.