NJ Provider of Care for the Disabled Wins Grant to Expand Model

Beth Fitzgerald | June 21, 2012 | Health Care
Developmental Disabilities Health Alliance will expand primary care services that are helping the patients stay out of nursing homes

Developmental Disabilities Health Alliance (DDHA), a provider of primary medical care to people with disabilities, has been awarded a $3.7 million grant under the Affordable Care Act to expand its care model in New Jersey.

Dr. Ted Kastner, founder and president, said DDHA now serves about 500 patients in New Jersey. The grant from the Centers for Medicare and Medicaid Services will add 3,000 patients – 1,500 in New Jersey; and another 1,000 in New York and 500 in Arkansas, where the program will also be replicated.

It’s estimated that DDHA will save Medicaid an estimated $5.4 million over the three years of the pilot program by using teams of nurse practitioners and physicians to deliver patient-centered primary care, the Centers for Medicare and Medicaid Services (CMS) said.

DDHA has a track record of reducing the need for emergency room visits and hospital admissions for its patients with developmental disabilities. “I think that is why CMS found our application compelling. We were able to reduce unnecessary utilization, save money and improve quality, and ultimately we think we’ve kept people out of institutions,” Kastner said.

Since it was founded in 1998, Bloomfield-based DDHA has been providing “an integrated model of primary care delivery, which includes the typical primary care services, in addition to mental health and neurological services,” Kastner said. “Patients have said to us that being able to work with a healthcare provider in their homes allows the individuals to be supported in the community. We support families in their homes all over the state.”

A challenge facing DDHA is to build a financially sustainable organization. About two years ago its contract with a Medicaid managed care company, UnitedHealthcare, ended and Kastner said he is now in discussions with other managed care companies to reimburse DDHA for medical care for patients who belong to Medicaid. Currently, commercial insurers and Medicare reimburse DDHA. Horizon NJ Health, one of the Medicaid managed care companies, said it supported DDHA’s application for the CMS grant.

What Kastner is doing is “breaking new ground, and it’s exciting,” said Robert Stack, president of Princeton-based Community Options, which provides housing and employment for 1,500 individuals with developmental disabilities throughout the country, including 450 in New Jersey.

Individuals with disabilities often have complex medical need, such as “someone who is gastro intestinally tube-fed, or is medically frail,” Stack said. “Unfortunately over the years they have been placed in nursing homes.”

The work Kastner is doing “hopefully will make it so that these individuals are able to live a more vibrant and independent life with some extra care given to their health needs,” he said.

Nicole Brossoie, spokeswoman for the state Department of Human Services, which overees the state’s Medicaid program said it’s good to see New Jersey providers benefiting from the CMS grants. New Jersey is seeking approval from CMS for major changes in Medicaid, which is funded 50/50 by the state and federal government, and these changes include medical home pilots along the lines of the work done by DDHA.