Sheilah McGlone Receives National Award for Her Role in Hudson Health Plan's Integrated Care Program

TARRYTOWN, N.Y. - June 25, 2013 - PRLog -- Chronic disease is putting our nation’s health – and health system costs – at risk. The problem is compounded when patients have multiple chronic conditions. The 27 percent of Americans who live with two or more chronic diseases, which require ongoing medical care, account for 66 percent of total health care spending, according to the U.S. Department of Health and Human Services. So when nurse case managers can coordinate all the care such patients need, it can reduce expensive hospital visits, and make life better for patients.

But the logistics of integrating care from multiple sources into one seamless system is a monumental challenge. That’s why the Case Management Society of America (CMSA) has presented its 2013 National Award of Service Excellence to Sheilah McGlone, RN, CCM, BC, Senior Director of Case Management and Integrated Care Coordination at Hudson Health Plan (Hudson). The prestigious award honors McGlone’s role in coordinating and managing the Westchester Cares Action Program (WCAP), a breakthrough integrated care model. WCAP managed the health and human service needs of 250 high-cost, high utilization fee-for-service Medicaid patients in Westchester County, NY, helping patients regain their lives while reducing the cost of their care.

“Sheilah was the perfect person to coordinate the disparate elements of WCAP,” notes Georganne Chapin, President and CEO of Hudson. “She engaged many types of providers of care – health centers, recovery centers, shelters, services for people with disabilities – and made them partners in the successful coordination of care for WCAP members. Sheilah has been a tireless advocate for patients since she joined Hudson in 1996. Her ability to turn great care management ideas into actionable plans has helped thousands of our members manage their chronic diseases and improve their daily lives.”

Developed as a New York State Chronic Illness Demonstration Project, WCAP highlights how effective integrated care management can be. An analysis of 61 WCAP patients who had been in the program for at least two years showed a 45.9% reduction in total inpatient costs in the two years after enrollment. In addition, emergency room visits by these patients were reduced by 15.4%.

Managing care for WCAP patients, whose health status were exacerbated by both poverty and behavioral health and frequently substance abuse issues, was particularly challenging, notes Alan Boardman, LMSW, New York State Director at Beacon Health Strategies, LLC, a behavioral health managed care organization that partnered with Hudson to manage WCAP. “Behavioral health is a no-man’s land for most physical health case managers, who feel frustrated and helpless when facing a patient’s mental health and substance abuse needs,” he explains. “But Sheilah is unique. She doesn’t avoid or give up on any patients; indeed, she is willing to take on the most complex cases. She has proven that with persistence and good planning, coordinated care management can change most lives for the better.”

McGlone credits Hudson for giving her the opportunity to “push the envelope” in care management. “Our organization is driven to continuously improve what we do, and we are not afraid to break new ground if we can improve the health care system,” she explains.

McGlone joined Hudson in 1996 as a Case Management Specialist and soon was promoted to Supervisor, then Director, of Case Management and Utilization Review.  In 2011 she was named first Director, then Senior Director of Case Management and Integrated Care Coordination. McGlone has been active in the Hudson Valley Chapter of the CMSA since 1999, holding various leadership positions, including Board Member, Chapter President (2004-2006), Education Chair, and Treasurer (2008-2010). She was a recipient of the first Hudson Valley Chapter Case Manager of the Year Award in 2009.

McGlone earned an Associate of Applied Science in Nursing from Orange County Community College, and attended the University of Windsor in Canada. A Registered Nurse, McGlone additionally is a Certified Case Manager (CCM) and is Board Certified (BC) in Nursing Case Management. McGlone is a resident of Warwick, NY.

About Hudson Health Plan

Hudson Health Plan is a community-based not-for-profit health care organization that provides state-sponsored Medicaid Managed Care, Child Health Plus, and Family Health Plus insurance coverage to 120,000 members in New York’s Hudson Valley. Hudson uses every government dollar it receives to fulfill its mission, which is “to promote and provide access to excellent health services for all people.” Hudson improves the health of its members and the communities in which they live through its innovations in integrated care coordination, and by working with more than 5,000 local health providers. Hudson received the national 2012 Medicaid Health Plan Innovation Award for its Westchester Cares Action Program, an innovative integrated care management project. In both 2009 and 2010, Hudson achieved the highest quality incentive scores of any Medicaid plan in New York State, and in 2010, it received the highest overall performance rating of any Medicaid plan in the Hudson Valley. It also has earned the highest ratings in overall satisfaction among Medicaid Managed Care members in the Hudson Valley region since 2003.

Hudson Health Plan is based in Tarrytown, N.Y. Visit Hudson at www.hudsonhealthplan.org, on Facebook at www.facebook.com/hudsonhealthplan, and on Twitter at @HudsonHealth (https://twitter.com/#!/HudsonHealth).