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Memorial seeks to become Niagara’s first health home

Niagara Falls Memorial Medical Center has filed an application with the New York State Department of Health to create Niagara County's first-ever Health Home as part of a new state program designed to improve patient outcomes  and control Medicaid costs.

Horizon Health Services and the Eastern Niagara Health System, which operates hospitals in Lockport and Newfane, have agreed to join Niagara Falls Memorial as co-leads of the proposed Niagara Health Home. 

The program’s unprecedented coalition of more than 70 Niagara County-based service providers expects to coordinate care for an initial 2,500 Medicaid clients and up to 6,000 clients when the program is fully established.

 “A Health Home is a care management model under which all of a patient's caregivers communicate with each other to ensure that the individual’s needs are addressed in a comprehensive manner,” Memorial Vice President and Chief Operating Officer Sheila K. Kee said. “The process is overseen by a dedicated care manager who facilitates access to all of the services a patient needs to stay healthy and out of the hospital.”

Services are provided through a network of organizations that collectively form a virtual Health Home, with designated providers appropriately sharing patient information so that services are neither duplicated nor neglected.

“Health Home services include comprehensive care management, care coordination, health promotion, transitional care, referral to community and social supports and the use of health information technology to link services,” Kee said.

The Niagara Health Home service network includes:

• 39 Niagara County-based primary care providers including the five major primary care sites operated by Niagara Falls Memorial, Eastern Niagara Health System and the Community Health Center of Niagara
• Specialty doctors in the fields of cardiology, neurology, urology, obstetrics, gynecology, endocrinology, orthopedics, surgery, optometry and audiology
• 10 mental health agencies providing 51 programs at locations across Niagara County
• Every Niagara County-based outpatient addiction treatment agency in the county
• A hospice provider, two home care agencies, a geriatric mental health program and two nursing homes

Seven emergency, supportive and other housing agencies, four GED and job preparation programs, four self-help programs, three social service groups, two health advocacy groups, the YMCA and Niagara University are also members of the Niagara Health Home network.

“This provider network is broad, deep and diverse and includes dedicated care providers from all across Niagara County,” Kee said. “I have never seen such a large group of providers so willing to work together for the good of the patients they serve.”

"We share a common goal,” said Eastern Niagara Health System CEO Clare Haar. “Working together, I am confident we will make a very positive impact on the health status of the patients and communities we all serve." 

To be eligible for health home services, a person must be covered by Medicaid and have at least two chronic conditions, have one chronic condition and be at risk for another, or have a serious and persistent mental health condition.

Memorial’s application was submitted to the Department of Health in late May.  The state is expected to announce its initial selections in July.  If approved, the Niagara Health Home will be staffed by a project director, care managers and nurse case managers.


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