DSRIP Meeting Agenda

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Date and Time 7/10/15, 3-4PM Meeting Title NYP PPS Finance Committee

Location ACMH Office

254 W. 31st Street, 9th floor Facilitator Jay Gormley, Robert Guimento,

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) Fay Pinto (Elizabeth Seton Center for Pediatrics)

Dan Del Bene (SPOP) David Grayson (Arch Care /Calvary)

Phil Zweiger (ASCNY) Alan Wengrofsky (Community Healthcare Network)

Steve Zhou (Village Care) Jay Gormley (MJHS)

Maria Guevera (NMPP) NYP Co-Chairs: Brian Kurz, Robert Guimento

Daniel Johansson (ACMH)

Meeting Objectives Time

1. Review Action Items from Last Committee Meeting 2. CRFP Submission Review 3. Finance Governance Approval 4. Contracting Approach Review 5. Identify Action Steps

a. Financial Health Assessment b. Review Project-Level Budgets

5 mins 20 mins 10 mins 15 mins 5 mins

Action Items

Description Owner Start Date Due Date Status

Schedule review of CRFP requests I. Kastenbaum 6/12 7/1

Review NYP PPS agreement drafts I. Kastenbaum 6/12 7/1

Review NYP PPS contracting process I. Kastenbaum 6/12 7/1

DSRIP Meeting Minutes

PAGE 1

Date and Time 7/10/15, 3-4PM Meeting Title NYP PPS Finance Committee

Location ACMH Office

254 W. 31st Street, 9th floor Facilitator Jay Gormley, Robert Guimento,

Brian Kurz

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

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

Access Code: 809-392-461

Attendees

Ilana Avinari (Methodist) Fay Pinto (Elizabeth Seton Center for Pediatrics)

Phil Zweiger (ASCNY) David Grayson (Arch Care /Calvary)

Steve Zhou (Village Care) Co-Chair: Jay Gormley (MJHS)

Daniel Johansson (ACMH) NYP Co-Chairs: Brian Kurz, Robert Guimento

David Alge (NYP) Sam Merrick, MD (NYP)

Isaac Kastenbam (NYP) David Albert, DDS (NYP)

Action Items

Description Owner Start Date Due Date Status

Review 8/10 as possible meeting date I. Kastenbaum 7/10 8/10

Share agreement drafts with Committee members

I. Kastenbaum 7/10 8/10

Meeting Minutes:

I. Kastenbaum opened the meeting; reviewed the follow-up items from the last meeting

J. Gormley went reviewed the CRFP process and submissions o Mentioned that NYP’s PPS started as a fairly tight network – there were not many submissions that did

not closely align with the work of the PPS o Reviewed the confusion between submission match ($1 for $1) or percent of cost ($1 of $2). o NYP PPS match (~50%) is in-line with other PPS’ submissions o Reviewed the PPS ranking methodology

R. Guimento asked about the CON review process for any submitted CRFP proposals

J. Gormley mentioned that all of the NYP PPS projects should be exempt from CON Public Health Planning Council process with the exception of the MJHS-Isabella proposal.

D. Johansson asked how unspent CRFP funds would be re-allocated; several members compared this process to the HEAL grants where monies were re-released in subsequent funding opportunities

J. Gormley asked the group whether the PPS should have a role in guiding collaborators’ projects through completion, if they are funded?

o Several members responded that they thought there was a small role for monitoring progress, but that the CRFP funds were really the responsibility of the direct recipient

o D. Johansson commented that, if his project’s match isn’t met, that his project, and likely other’s projects, would not move forward

D. Grayson identified four projects that were worth 75% of the overall capital opportunity (Isabella-MJHS, NYP IT, NYP ACN, and Methodist); he suggested that the PPS closely monitor the CRFP process

o D. Grayson also suggested that the PPS dig deeper into the IT CRFP request – if the match isn’t fully made, how is the budget reducible?

I. Kastenbaum reviewed the PPS Finance Committee Charter – called for a motion o P. Zweiger motioned for a vote, Dan Johansson seconded. All members were in-favor.

R. Guimento reviewed the proposed PPS legal agreement framework, including (1) Service Agreement, (2) Quality Agreement, and (3) Participation Agreement.

DSRIP Meeting Minutes

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o The group suggested that the Quality Agreement be renamed “Performance Agreement” to reflect its relationship to receiving performance payments from the bonus pools

o D. Grayson asked whether PPS collaborators would have input into the agreement language; he mentioned that several other PPSs have done this.

D. Johansson agreed with this point – Maimo and Sinai had processes to collect and respond to feedback, even if the agreement was not updated to reflect specific feedback.

o D. Johansson recommended that the performance agreement be made an addendum to the Participation Agreement – this way it seems like a more unified process.

o Committee members suggested a more open review of the agreements. D. Grayson mentioned he would forward some of the approaches of the other PPSs.

I. Kastenbaum closed the meeting. o Committee suggested meeting on August 10

th due to late August vacation plans.

NYP PPS Capital Application July 10, 2015

Overview of Capital Restructuring Financing Program (CRFP) Funds

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CRFP Overall NYS NYC ROS Brooklyn

(part of NYC)

Estimated Original Pool Split (per GNYHA) 50% 50%

Original CRFP Pool $ 1,200,000,000 600,000,000$ 600,000,000$

New CRFP Pool $ 1,000,000,000 700,000,000$ 300,000,000$ 700,000,000$

Total CRFP $ $ 2,200,000,000 1,300,000,000$ 900,000,000$

Medicaid Lives (#) 6,800,000 4,080,000 2,720,000 1,400,000

Medicaid Lives (%) 60% 40% 21%

Matching Capital Per Medicaid Life $ 324 $ 319 $ 331 $ 500

Estimated Matching Percentage (per GNYHA) 50%

NYP PPS: Seeking $26M in CRFP Match on $47.7M in Projects

NYP Capital Projects

($22.4M including $11.2M match)

• ACN Primary Care Expansion ($15.8M)

• PPS IT Infrastructure ($6.6M)

Network Capital Projects

($25.3M including $10.5M match)

• ACMH

• ASCNYC

• Community Healthcare Network

• Harlem United/Upper Room AIDS Ministry

• Hebrew Home at Riverdale

• Isabella

• Methodist Home for Nursing and Rehabilitation

• St. Mary's Center Inc.

3

DSRIP-related Capital Project: IT Infrastructure

$6.6M to support DSRIP Program across PPS

Projects include:

– Data analytics

– Allscripts Care Director roll-out

– Eclipsys/EHR enhancement

– RHIO/SHIN-NY connectivity

– Population health

– Interfaces

– CHW hardware and software

– MyNYP

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8 Network Members submitted 10 capital projects for CRFP grant funding

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Organization Project Name Description Revised Request Proposed

Match %

Proposed

Match $

Funding

Sought

1 ACMH, Inc. West 187th Street Crisis

Respite

8-bed crisis respite unit in Upper

Manhattan for primary psych

3,235,872$ 31% 1,000,000$ 2,235,872$

2 ASCNYC Peer & Community Health

Worker Training Institute

Build Peer Training Center to train CHWs

to serve PPS

600,000$ 50% 300,000$ 300,000$

3 Community Healthcare

Network

Inwood Expansion Project 10k sf primary care clinic (Upper

Manhattan)

3,061,000$ 50% 1,530,500$ 1,530,500$

3 Community Healthcare

Network

Lower East Side Expansion

Project

10k sf primary care clinic (LES) 3,061,000$ 50% 1,530,500$ 1,530,500$

4 Harlem United/Upper

Room AIDS Ministry

Integrated Primary and

Behavioral Health Care

Expansion Project

Clinic renovation/expansion @ West

124th

1,522,865$ 50% 761,433$ 761,433$

4 Harlem United/Upper

Room AIDS Ministry

IT Infrastructure to Support

Care Management

IT infrastructure to support care

management

330,862$ 50% 165,431$ 165,431$

5 The Hebrew Home at

Riverdale

EarlySense bed technology EarlySense bed technology 400,000$ 25% 100,000$ 300,000$

6 Isabella Residential Alternative to

Hospitalization at End of

Life in Northern Manhattan

16-bed Hospice inpatient unit operated

by MJHS

6,458,382$ 25% 1,589,065$ 4,869,317$

7 Methodist Home for

Nursing and Rehab

The Medical Village at

Methodist

Conversion of 40 beds from general

purpose to acute step-down plus 14-bed

dialysis unit and enhanced ancillaries,

including telemedicine

5,800,000$ 52% 3,000,000$ 2,800,000$

8 St. Mary's Center Inc. The Integrated Primary Care

Expansion Project

Clinic renovation @ West 126th to add

Art 28, 31 and 32 capacity

818,268$ 60% 490,960$ 327,308$

25,288,249$ 41% 10,467,889$ 14,820,361$

Prioritization to DOH

1. NYP IT Infrastructure

2. ASCNYC Peer Training Institute

3. NYP ACN Primary and Specialty Expansion

4. Isabella (MJHS) Residential Hospice Unit

5. ACMH Crisis Respite

6. St. Mary’s Center Primary Care/Behavioral Expansion

7. Harlem United Primary Care/Behavioral Expansion

8. Methodist Home Medical Village

9. CHN Inwood Expansion

10. Harlem United Care Management IT Infrastructure

11. CHN Lower East Side Clinic

12. Hebrew Home EarlySense Technology

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\ PPS CRFP Submissions

1

ACMH

$3.2 million; 31% match

Acquire property and construct a five-story, 6,000 square foot community facility for the operation of an

8 bed Short-term Crisis Respite program, a Home and Community Based (HCBS) Medicaid reimbursable

service available to Medicaid members with serious mental illness enrolled in Health and Recovery Plans

(HARPs). Projected to open January 1, 2017, with average respite stays of 10-12 days, the West 187th

Street Crisis Respite (Washington Heights) is projected to serve more than 170 unique Medicaid

members annually with a total of more than 200 stays.

Allied Service Center (ASCNYC)

$0.6 million; 50% match

Develop an innovative Community Health Navigation (CHN) program to train community members to

provide education, psychosocial and behavioral support, outreach, engagement, and other assistance to

individuals who are accessing medical services or in need of links to care within the NYP PPS. The

proposed capital project would enable creation of the program through construction of training and

facilitation space as well as purchase of equipment such as smart boards and laptops.

CHN (Two Projects)

$3.1 million each; 50% match

Proposes to expand access to primary care and preventive services within underserved communities by

opening two new federally-qualified health centers in Inwood (21,000 primary care visits annually) and

the Lower East Side (29,400 primary care visits annually). Services provided at the sites will include adult

and pediatric primary care, family planning and reproductive health care, HIV services including

counseling and testing, treatment, and supportive services, immunizations, pre-and post-natal care,

nutrition counseling, health education, dental, and Health Home care coordination services. The LES

practice will also include a wellness program, providing holistic wellness services including yoga classes,

meditation, and other activities meant to reduce stress and improve patient health.

\ PPS CRFP Submissions

2

Harlem United - 1

$1.5 million; 50% match

Renovate two existing buildings in East and Central Harlem to integrate primary care and behavioral

health services. The renovation will add two additional primary care exam rooms and build out space

for an Article 32 (OASES) substance abuse practice and an Article 31 (OMH) mental health practice.

Harlem United - 2

$0.3 million; 50% match

IT infrastructure to support care management. Specifically, Harlem United will be implementing E-iCare

to enhance the capacity currently available through eClinicalWorks (eCW). The two EHR systems, which

will be interoperable, will facilitate the provision of integrated interdisciplinary care, leading to

improved quality of care and improved health outcomes.

Hebrew Home at Riverdale

$0.4 million; 25% match

Purchase and install a 46-unit patient care monitoring system (EarlySense) to continually monitor

residents for acute changes in vital signs. The system consists of a bed-side unit with an under-mattress

sensor and a bed-side monitor to display vital signs. A central display system at the floor’s nursing

station receives data from multiple bed-side units. A messaging bridge sends texts to clinicians’ pagers.

Isabella Geriatric Center

$6.5 million; 25% match

Create a mix of 16 Hospice Inpatient and Residence beds, operated by MJHS Hospice and Palliative

Care, at Isabella in Northern Manhattan. The space will allow the provision of care in a residential

setting with adequate space for relatives and loved ones to spend the night, cook, and have a home like

setting at end of life. Common spaces will include areas for spiritual quiet reflections, bereavement, and

leisure and arts therapy. All of the spaces will be designed to emphasize a home like environment while

also allowing for the providing of hospital level clinical care.

\ PPS CRFP Submissions

3

Methodist Home

$5.8 million; 52% match

Develop a Medical Village: Take 40 general purpose skilled nursing beds out of service and convert them

to an Acute Care step-down unit to handle higher-complexity patients expected to serve the needs of

the PPS; Add a 16-bed dialysis unit; Reconfigure ancillary services for enhanced responsiveness and

sophistication; Renovate physician suite to welcome NYP practitioners in primary and specialty care;

Add tele-health capability and a Care Transitions program to follow patients across-level-of care with

care management and admission/ED-avoidance protocols.

NewYork-Presbyterian Hospital – 1

$6.6M; 50% match

Develop the infrastructure to support the development of an integrated delivery system for Medicaid

patients in the NYP PPS service area with the goal of reducing avoidable inpatient and emergency

department utilization. The goal of the project is to create the following capabilities: (1) enable all

eligible PCPs to achieve 2014 NCQA Level 3 PCMH and MU certification; (2) aggregate, analyze, and as

appropriate, disseminate patient information; (3) alert providers when relevant patients are receiving

care; (4) support the work flows of care coordinators; (5) engage patients through patient portal; (6)

equip mobile community health workers; and (7) connect members of the healthcare team across the

PPS.

NewYork-Presbyterian Hospital – 2

$15.8M; 50% match

The Ambulatory Care Network (ACN) Expansion Project develops primary care service capacity (including

primary care services co-located with outpatient behavioral health care services) and co-located

ambulatory care services (including specialty care) for the Medicaid population in the NYP PPS service

area. The goal of the project is to renovate and reconfigure space to: (1) create new primary care,

behavioral health, and specialty care capacity; (2) increase throughput and efficiency to optimize

existing capacity; (3) co-locate care management and community health worker resource in practices

with PCPs to enhance patient engagement; (4) improve patient safety, privacy, and confidentiality; (5)

\ PPS CRFP Submissions

4

enable providers to counsel patients and secure RHIO informed consent; and (6) increase opportunities

to enhance health literacy through culturally competent patient education.

St. Mary’s Center

$0.8 million; 60% match

Develop an Article 28 Diagnostic & Treatment Center that will provide co-located and integrated

primary care and behavioral health services in Central Harlem. The practice will serve 1,800 patients

annually when fully ramped up. Clinical services provided include: primary care, cancer screening,

immunizations, TB therapy, Hep C therapy and treatment, PT, podiatry, behavioral health treatment and

counseling, and 24-hour crisis intervention. Non-clinical services provided include: case management,

counseling/assessment, referrals to social services, specialty care, discharge planning and follow up,

eligibility assistance, health education, outreach, transportation, translation, substance abuse treatment

and nutrition.

PPS Contracting Strategy

The NYP PPS will focus on developing the necessary network to support a “collective impact” approach to achieving the overall

DSRIP project-specific goals. In order to accomplish this, NYP, as the PPS fiduciary, will pursue a three-phased contracting process:

# Phase Details

Participation Agreement

All PPS network members will be required to sign the PPS Participation Agreement. This agreement details the general rules for participating in NYP PPS, including: New York State (NYS) requirements, use of the PPS brand, and collaborator reporting requirements. The NYS requirements, including, but not limited to the financial health assessment, committee participation, and participation in provider engagement activities, are non-negotiable. This agreement will be executed in August 2015.

Service Agreement(s)

Only PPS network members employing DSRIP-funded staff will sign the PPS Service Agreement. This agreement will include specific scopes of work for specific DSRIP staff, documentation and reporting requirements, and payment terms. The scopes of work will outline the work activities, responsibilities, and deliverables for specific staff (e.g. Community Health Workers). As the PPS fiduciary, NYP will require service agreements to meet standard Hospital policies and procedures. This agreement will be released in September 2015 to the appropriate collaborators.

Performance Agreement(s)

All PPS network members will be required to sign the PPS Performance Agreement, as appropriate for their provider class. This agreement will define the member’s responsibilities to meeting the reporting, quality, and/or compliance requirements, as defined by the PPS. This agreement will build upon items in the Services and Participation Agreements, as well as define how collaborators will be eligible for bonus funds for their contribution to achieving DSRIP outcomes. The Performance Agreement will be customized for various provider classes (e.g. post-acute, hospital, physician practice, CBO, etc.). This agreement will be executed by fall 2015.

Together, these agreements will provide the foundational framework for the NYP PPS to achieve the DSRIP requirements and goals.