DSRIP Meeting Agenda

PAGE 1

Date and Time 4/8/16, 3:00-4:00PM Meeting Title NYP PPS Finance Committee

Location Heart Center Room 3 Facilitators Jay Gormley, Brian Kurz

Go to Meeting https://global.gotomeeting.com/join/809392461

Conference Line Dial +1 (646) 749-3122 Access Code: 809-392-461

Invitees

Ilana Avinari (Methodist) Alan Wengrofsky (Community Healthcare Network) Phil Zweiger (ASCNY) Diomedes Carrasco (NMPP) Steve Zhou (Village Care) Dan Del Bene (SPOP) Daniel Johansson (ACMH) NYP Co-Chair: Brian Kurz Fay Pinto (Elizabeth Seton Center for Pediatrics) Co-Chair: Jay Gormley (MJHS) David Grayson (ArchCare/Calvary)

Meeting Objectives Time

1. Review action items from last meeting 2. Updates:

• Financial Health Assessment • Value-Based Assessment

3. Review of Equity Programs 4. Presentation on Adult Ambulatory ICU, Elaine Fleck 5. Identify Action Items

2 mins 5 mins

10 mins 40 mins 2 mins

Action Items

Description Owner Start Date Due Date Status

Bring to Executive Committee the idea of reimbursing for administrative costs (e.g. completing surveys)

J. Gormley/B. Kurz 3/11/2016 4/18/2016 Not started

Share PowerPoints from the meeting with the Committee L. Alexander 3/11/2016 4/8/2016 Complete

Schedule I. Kastenbaum for upcoming meeting to present on DY1 revenue vs. expenditures L. Alexander 3/11/2016 4/8/2016 Complete

DSRIP Meeting Agenda

PAGE 1

Date and Time 4/8/16, 3:00-4:00PM Meeting Title NYP PPS Finance Committee

Location Heart Center Room 3 Facilitators Jay Gormley, Brian Kurz

Go to Meeting https://global.gotomeeting.com/

join/809392461 Conference Line Dial +1 (646) 749-3122

Access Code: 809-392-461

Invitees

Dr. Elaine Fleck (NYP) NYP Co-Chair: Brian Kurz

Mary Blyth (NYP) Co-Chair: Jay Gormley (MJHS)

Fay Pinto (Elizabeth Seton Center for Pediatrics) Dan Del Bene (SPOP)

David Grayson (ArchCare/Calvary)

Carmen Juan (NYP)

Meeting Objectives Time

1. Review action items from last meeting 2. Updates:

Financial Health Assessment

Value-Based Assessment 3. Review of Equity Programs 4. Presentation on Adult Ambulatory ICU, Elaine Fleck 5. Identify Action Items

2 mins 5 mins

10 mins 40 mins 2 mins

Action Items

Description Owner Start Date Due Date Status

Distribute meeting materials from 4/8/2016 L. Alexander 4/8/2016 4/12/2016 Complete

Review results of Financial Health Assessment at next meeting

B. Kurz/J. Gormley 4/8/2016 5/13/2016 Not started

Provide update on VBP workgroup and survey at next meeting

B. Kurz/J. Gormley 4/8/2016 5/13/2016 Not started

DSRIP Safety Net Equity Program Overview Finance Committee April 8, 2016

1

NYP PPS $97M “Guarantee Breakdown”

2

Waiver SN Equity HPF

HPF

HPF

W – P4R EIP W – P4P EPP

“Likely Guaranteed” P4P

Only ~$60.8M “likely guaranteed”

NYS Addition of “Safety Net Equity Funds” As DSRIP valuation was finalized, it became apparent that inequity

exists between SN PPSs pursuing project 2.d.i and SN PPS who are not approved for project 2.d.i., as well as in some Public PPSs

To mitigate these inequities, the Equity Programs were created. They contain an additional $1.23 billion in potential performance payments to safety net leads not approved for project 2.d.i.

EIP is paid out to PPSs for participating in select DSRIP activities, while the EPP is based on a subset of DSRIP performance metrics

3 Source: October 2015 NYS Supplemental Programs Webinar

Safety Net Equity Program Overview

4

Safety Net Equity: Equity Infrastructure Program EIP payments will be based on the PPS participation in certain

activities and the implementation of predetermined key DSRIP initiatives. The initiatives were chosen based on their status as either:

– Necessary prerequisites to DSRIP project success, and/or

– High-impact activities that were not included in any DSRIP projects

DOH will design a simple blueprint for MCOs to capture PPS activity related to the EIP activities

PPSs will provide the MCOs with evidence of their activities using the DOH-established blueprint

– Once this occurs, MCOs will provide payment to the PPSs on a monthly basis

– Reporting will occur on a regular basis potentially through MAPP

5

Equity Infrastructure Program – Potential Choices

EIP Key Activities: Evidence of… Participation in IT TOM initiatives Participation in one of the MAX Series projects Participation in expanded HH enrolment EHR implementation investment Capital spending on primary / behavioral health integration Participation in a state recognized tobacco cessation program Participation in state efforts to end HIV/AIDS Participation in fraud deterrence and surveillance activities Infrastructure spending related to SHIN-NY / RHIO

6 Measures can be changed year-to-year

Safety Net Equity: Equity Performance Program EPP payments will be based on PPS performance, using a subset of the

existing DSRIP performance metrics. The final metric subset will be chosen based on the following criteria: – Metrics are directly aimed at meeting DSRIP goals – Metrics that are applicable to a significant portion of the PPS

population – Metrics that are related to important subpopulations (e.g., children’s

access to primary care) – Metrics critical to achieving DSRIP goals that are carrying lower

values than other DSRIP measures – Metrics that are in some way connected to VBP activities.

Payment will occur on a monthly basis Reporting will occur on a monthly basis potentially through MAPP;

additional guidance will be provided in the near future

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Equity Performance Program Measures

8

Program size: $642 Million Each PPS participating in EPP must choose 6 out of these 25 measures and at least one measure must be a pay for performance measure in year 2 or 3.

EPP Final Measures Children's Access to Primary Care – 12 to 24 months Children's Access to Primary Care – 25 months to 6 years

Children's Access to Primary Care – 7 to 11 years Children's Access to Primary Care – 12 to 19 years

Prenatal and Postpartum Care – Postpartum Visits Prenatal and Postpartum Care – Timeliness of Prenatal Care

Frequency of Ongoing Prenatal Care (81% or more) Childhood Immunization Status (Combination 3 – 4313314)

Follow-up care for Children Prescribed ADHD Medications – Initiation Phase

Follow-up care for Children Prescribed ADHD Medications – Continuation Phase

Lead Screening in Children Chlamydia Screening (16 – 24 Years)

Med. Assist. w/ Smoking & Tobacco Use Cessation – Discussed Cessation Strategies

Med. Assist. w/ Smoking & Tobacco Use Cessation – Discussed Cessation Medication

Controlling high blood pressure Comprehensive Diabetes Care

Comprehensive Diabetes screening – All Three Tests Diabetes screening for persons with schizophrenia

Diabetes monitoring for persons with schizophrenia Adherence to anti-psychotic medications for individuals with schizophrenia

Behavioral Health – follow up after hospitalization for mental illness (7 day)

Behavioral Health – follow up after hospitalization for mental illness (30 day)

Initiation and Engagement in Alcohol and Other Drug Dependence Treatment (IET) within 14 days of substance abuse episode

Follow-up on Alcohol and Other Drug Dependence Treatment (IET) within 30 days of initial engagement

Well Care Visits in the first 15 months (5 or more Visits)

Process for Selecting EPP Measures

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# Reason Impact

1 Changed from P4R->P4P in later years (Years 3 or 4)

Enables PPS to focus on pay-for-reporting / likely-guaranteed funding for a longer period.

2 High-Performance Fund (HPF) Eligible Enables PPS to tap into 3% withhold (~$9M)

3 Required smaller annual changes to meet gap-to-goal

Enables PPS to target resources to close smaller gap-to-goals (often <30 beneficiaries per year)

4 Relative ranking vs. other PPSs

Identifies area where PPS is already a strong performer relative to other PPSs

Equity Performance Program Measures

10

Program size: $642 Million Each PPS participating in EPP must choose 6 out of these 25 measures and at least one measure must be a pay for performance measure in year 2 or 3.

EPP Final Measures Children's Access to Primary Care – 12 to 24 months Children's Access to Primary Care – 25 months to 6 years

Children's Access to Primary Care – 7 to 11 years Children's Access to Primary Care – 12 to 19 years

Prenatal and Postpartum Care – Postpartum Visits Prenatal and Postpartum Care – Timeliness of Prenatal Care

Frequency of Ongoing Prenatal Care (81% or more) Childhood Immunization Status (Combination 3 – 4313314)

Follow-up care for Children Prescribed ADHD Medications – Initiation Phase

Follow-up care for Children Prescribed ADHD Medications – Continuation Phase

Lead Screening in Children Chlamydia Screening (16 – 24 Years)

Med. Assist. w/ Smoking & Tobacco Use Cessation – Discussed Cessation Strategies

Med. Assist. w/ Smoking & Tobacco Use Cessation – Discussed Cessation Medication

Controlling high blood pressure Comprehensive Diabetes Care

Comprehensive Diabetes screening – All Three Tests Diabetes screening for persons with schizophrenia

Diabetes monitoring for persons with schizophrenia Adherence to anti-psychotic medications for individuals with schizophrenia

Behavioral Health – follow up after hospitalization for mental illness (7 day)

Behavioral Health – follow up after hospitalization for mental illness (30 day)

Initiation and Engagement in Alcohol and Other Drug Dependence Treatment (IET) within 14 days of substance abuse episode

Follow-up on Alcohol and Other Drug Dependence Treatment (IET) within 30 days of initial engagement

Well Care Visits in the first 15 months (5 or more Visits)

NYP PPS-MCO Pairings 1. Affinity Health Plan

2. Amerigroup

3. HealthFirst

4. Fidelis

11

NYP PPS Next Steps Finalize negotiations with MCOs

Prepare substantiation/evidence documentation for DY1 EIP payments ($4.7M)

Review recent performance on EPP measures

12

ADULT AMBULATORY ICU NYP PPS Finance Committee Meeting

Friday, April 8th, 2016

3-4pm

Project Overview

Focus:

1. Identifying and risk-stratifying ACCN (Adults with Complex Care Needs) patients to provide the appropriate level of resources and interventions

2. Maximizing patient care team roles and delivery of care to create a patient focused experience at the PCMH site, linking to community-based organizations and specialties

3. Developing enhanced IS-enabled capabilities to support population management of ACCN population and to enhance connectivity throughout the continuum of care specifically Community Based Organizations

4. Enhance disease management and preventative patient education

Commitment:

– The Ambulatory ICU project will provide 2+ distinct services to our patients annually by the end of DSRIP Year 3. Approximately 8,500 of Adults with ACCN (Adults with complex care needs) with a relationship with the NYP/CU Ambulatory Care Network practices. (54,000 patients in the ACN)

Current State of the Project

Focus on high risk and rising risk patients

• Patients with 2 or more chronic conditions seen in the last 12 months

with a combination of 4 or more ER and INP visits.

Interdisciplinary Rounds

• Weekly Reports of patients hospitalized and in ER

• Entire Staff involved

• RN Care Manager plays key role, primary RN also important

• Evaluate if the candidate for Health Home

• Invite CBOs into IDTs to educate staff and create warm handoffs

• Ensure identified action items occur throughout the week

• Action items discussed with patient care team staff SW, DSME,

CHW, CBO’s (substance abuse, behavioral health), MA, PFA

3

Integrated Visits: Adults with Chronic Care Needs(ACCN)

Comprehensive Plan of Care for High Risk Patients

Goals

– To improve the quality of health of patient with chronic complex care needs by

creating a “one stop” collaboration with patient care team

– To reduce inpatient, emergency room visits, and/or "ambulatory sensitive

admissions"

– To build a network of care providers to include support of providers in the

community.

– To improve patient and care-team satisfaction

Patient Care Team: PFA, MA, RN, BHCM, CM, CHW, SW, Nutritionist, Pharmacist,

Therapist, Physician.

4

How Funds Are Being Spent – Personnel

5

Wins

• Hiring Staff

• Implementing Interdisciplinary Rounds at AIM + maximize

IDT at ACN Sites, in order to focus on high risk patients

• Identifying IT Needs

• SCM

• iNYP Dashboard

• Tableau Population Registry

• Early collaboration with CBO’s; the importance of better

communication strategies

6

Challenges

• Identifying and Focusing on “Rising Risk”

• Hiring Panel Manager to oversee; Maximizing Alerts

• Fulfilling IT Needs. IT solutions lag behind

• Working to Integrate additional staff and

• Maximizing collaboration with CBOs

7