general assembly - somos · 2017. 6. 7. · summary •omig –office of medicaid inspector general...
TRANSCRIPT
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General
Assembly
June 7, 2017
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WELCOME
Mario J. ParedesChief Executive Officer
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IN SICKNESS AND IN HEALTH:Marrying Social Determinants
to the World of Health Care Delivery
Larry McReynoldsExecutive Director, Family Health Centers at NYU Langone
SVP, Community Health, NYU Langone Health System
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Mary Ellen Connington, Chief Operating Officer
Chloe Cheng, Project Director Equity Programs
Sharif De Los Santos, Project Director, Clinical Projects
Les Halpert, Ph.D, Project Director, Behavioral Health Project
Cindy Klein, Project Director, Community Care Management Projects
PAY-FOR-PERFORMANCE
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Introduction Mary EllenMY 2 CindyMY 3, 4, & 5 ChloeUnique Challenges with BH LesMoving the Needle Shariff
AGENDA
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Doing well, getting tougher
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Doing Well, Getting Tougher!
• DSRIP wants “Proof” that processes are in place and effective
• Detailed workflows
• Achieving OUTCOMES is the proof
• The climb is steeper
• More measures, more $ at risk
• Let’s take a deeper dive
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MY 2
Doing well, getting tougher
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How did we do in MY2?“ACP is a Leading Performer”
June 30, 2016Measurement Year
2July 1 2015
Measurement Year 2:
• 18 P-4-P measures
• ACP scored well compared to other PPSs
• Met Annual Improvement Targets for 50% of Metrics
• $13.5M at risk (P-4-P)
• ACP to collect $7.5M + High Performance
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MY 3, 4, & 5
MY 2
Doing well, getting tougher
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MY3 Closes in 3 Weeks!
6/30/2016Measurement
Year 27/1/2015 6/30/2017
Measurement Year 3
7/1/2016
• Moved from 18 P4P measures in MY2 to 87 P4P measures in MY3
• Mix of HEDIS/QARR and CAHPS measures
• $63M+ at risk in MY3 for P4P measures alone
• We can still improve, but DOS must be by June 30 to count for MY3
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$13.6m
$56.6m
$65.8m
$32.9m
MY 2, 18
MY 3, 87
MY 4, 109 MY 5, 109
0
20
40
60
80
100
120
$-
$10,000,000.00
$20,000,000.00
$30,000,000.00
$40,000,000.00
$50,000,000.00
$60,000,000.00
$70,000,000.00
MY 2 MY 3 MY 4 MY 5
P4P Dollars at Risk Metrics
P4P Dollars vs. Count of Metrics
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Behavioral Health
MY 3, 4, & 5
MY 2
Doing well, getting tougher
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Behavioral Health and Population Health
• Behavioral Health co-occurs across health issues such as:
• Opioid epidemic
• Smoking
• Childhood diabetes
• Medication adherence
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Behavioral Health Opportunities
• PCP integration:
• Screening and referral for behavioral health
• Breaking down silos between medical and behavioral health
• Support Value Based Payments
• Initiate care management programs
• ACP PPS level:
• Meet Performance Metrics – 14 are Behavioral Health
• Coordinate with MCOs
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Moving the Needle
Behavioral Health
MY 3, 4, & 5
MY 2
Doing well, getting tougher
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Moving the Needle!
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ECW Dashboards
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“If it is not in the claim,
it never happened!”
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Soraya SussmanSenior Director of Quality Control
PATH TO QUALITY
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Overview
• What is Quality to you?
• What is Quality?
• Benefits of Quality Improvement (QI)
• Core Principles and Process of Quality Improvement
• Quality Improvement and Drivers of Transformation
Quality = Value / Cost
Patient Experience & Population Health
• 2017 MAX Series Collaborative Partnership Presentation
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What is Quality to you?
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What is Quality?
Outcomes
Cost
Quality
Time
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Benefits of Quality
Increase
• Quality
• Engagement
• Patient Experience
• Sustainability
• Consistency
• Performance
Decrease
• Risk
• Waste
• Adverse Events/Error
• Complaints
• Time
• Variation
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Quality Improvement Core Principles
• Leadership - Embed quality improvement as a core business foundation.
• Continuous Improvement - Review and enhance internal systems.
• Build Organization Culture – Teamwork
Michael Porter, Professor Harvard School of Business
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Core Process…Create a QI Environment
• Identify Provider and Patient Needs
• Collect and Analyze Data
• Team Approach
• Ongoing Quality Improvement
• Sustains Wins
• Incorporate Innovative Ideas
Michael Porter, Professor Harvard School of Business
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Quality Improvement at a Glance
Leadership &
Stakeholder Buy-in
Personnel & Organization Development
Continuously improving
system and process
Reach Best Outcomes
Align Value and cost
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The right path is QUALITY
The right goal is VALUE!
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“Value Thinking”
To create value, it is not the individual services that matter but the collective set of services required to deal with the patient medical problem.
– Total Patient Health Needs
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ACP Jamaica Hospital MAX Series QI Experience
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Advocate Community Providers, Jamaica HospitalMAXimizers – High Utilizer
Care Pathway Overview
Monthly Dashboard 3/1 – 3/31Number of HU Discharges 72
Number of HU Patients 68
% Served Prior to Discharge 93%
% Served Post-Discharge 72%
* Denotes workshop action plan
Identify
• BPA ‘SuperMAX’ Flag in EMR identifies HU.*
• Facilitator, treatment team and RCA team are notified.
Assess
• SW conducts Comprehensive Social Work Assessment.*
• ED Physician reviews current and past medical records of all MAXpatients.
• ED Physician orders consult to Medicine Attending beforeadmission.
Link
• RCA team leverage DOU and comprehensive SW assessment to develop care plan.*
• Facilitator connects HU to HH partner where appropriate; to community partners; and to primary care.
Manage
• HU receives post-discharge call and follow up assistance with care plan from facilitator.
• Facilitator supports HU connection to and compliance with outpatient providers as needed.
Goal: “To improve the quality of life
for our patients and care providers
by education and providing
comprehensive care within an
integrated multidisciplinary
approach to empower our patients
in every way.”
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Enjoy your lunch!
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DATA AND ANALYTICS
Corey MaherChief Technology Officer
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Recent Happenings
Since the last General Assembly…
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Engagement Data Cleaning and Submission For DY2Q4
• Discovered serious data issues from DY2Q2 submission, wrist
slap from IA
• Massive cleanup effort from Ernie, Paul, Bill, Rong, Shariff, et. al
• IA results came back with no indication of quality issues
EngagementDatabase
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Arcadia Project Kickoff
• File transfers setup for five pilot practices
• Server/infrastructure build for Arcadia
• Project management assists from Emma and Tonguc
EMR
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Funds Flow Data Processing
• Chloe setup and manages a process for investigating issues
• Please email [email protected] for issues
• Daily updates of funds flow data for finance available
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In Flight
Things we’re working on now…
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Airflow – Jobs Management
• Current jobs:
• State data
• Engagement data
• 5 ECW pilot practices
• Upcoming jobs:
• 6 health plan feeds with 4-5 files each
• Potentially ~200 more ECW feeds
• Exports to plans
• Pharmacy feeds, lab feeds
• Airflow:
• Apache project from Airbnb
• Manages automated execution of many jobs
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Airflow – Jobs Management
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Physician Scorecards
• Support core DSRIP and VBP metrics
• Prototypes currently in Excel
• Building into Tableau
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Arcadia and eCW Update
• Arcadia – Proof-of-concept project
• eCW –
• Population health dashboard change requests
• Practice onboarding into the portal
• Nightly data dumps
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PREVIEW OF HEALOW
Rakhee LangereClinical Works
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Engage Your Patients Better with the healow suite of products
Presenters:Rakhee Langer
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Healthcare in the digital age
Delivering accurate, accessible, and actionable health information
Empowering the consumer
Shift to value based care – Engagement, Satisfaction and Access
Technology to provide a personalized patient centric experience
• Access to health records
• Remote interactions via telehealth
Paper EMR PE
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ProblemsThat Need Solutions
• How to cater to the Millennials and Seniors
• Resource Availability & Readiness
• Understanding the value of Engagement Products
• Marketing Roadblocks
• Increased Competition
• Sustainability in keeping patients engaged
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Patient Relationship Management
The goal is to transform your practice to one that suits the evolving needs of your patients in the digital world, in turn increasing patient engagement and better health outcomes
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Program Objectives
Serve our customer and provide top class service. At the same time assist in making the provider-patient bond stronger by our product offeringsRelation
Provide your patients better knowledge of all the tools you have to offerEducate
Provide your patients access to their own health via the Patient Portal and the healow AppAccess
Offer changes to your practice to serve in the digital world to market better to your current patients and help bring in new patientsChange
Train and assist your staff to contribute to this change for the futureHelp
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Online Presence and patient engagement
Health Access
- Patient Portal
- Website marketing
- Healow app
Educate and Market
• Digital Marketing
• Education for the staff & Providers
• Patient interaction & assistance
Engaged patients lead to incremental price benefits
Online appointment booking
- Scheduling for appointments- Community health workers
able to book appointments
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healow Health Dial
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healow APP
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healow APP
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healow APP
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Focus on Patients for follow-up or preventive care
Appointment Reminders
Preset Messages
Disease Management RemindersPreventive Reminder
Administrative Reminders
Smart Patient Finder
Multi Modality OutreachMessenger
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✓ Many ways to connect with your Patients
Automatically engage your patientsanywhere, anytime
Voice Text Email Portal App
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Messenger
6200+ Practices
200 Million Annual Messages
25+ Automated Campaigns
Custom Campaigns
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Questions
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Thank you!
We hope you found this helpful
If you have questions or concerns with regards to this, please reach out to the healow team.
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2017 OMIG WORKPLAN
Thomas GimlerChief Compliance Officer
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Summary
• OMIG – Office of Medicaid Inspector General -- oversees investigations, audits, review of Medicaid providers. OMIG has authority to pursue civil and administrative enforcement actions related to fraud, waste and abuse.
• Medicaid is New York state’s largest payer of health care and long-term care. 6+ million New Yorkers receive Medicaid-eligible services through a network of 80,000+ health care providers and 90+ managed care plans.
• Total federal, state, and local Medicaid spending for SFY 2018 is expected to be $65 billion.
• Health care fraud, waste, and abuse can involve physicians, pharmacists, nurses and aides, medical equipment companies, MCOs, transportation providers.
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2017-2018 OMIG Strategic Work Plan
Three overarching goals:
• Enhancing Compliance
• Fighting Fraud, Waste, and Abuse
• Promoting Innovative Analytics
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Goal #1: Collaborate with Providers to Enhance Compliance
Compliance Program Reviews
• Most reviews initiated due to a Medicaid provider’s failure to meet annual program certification obligation.
• Corporate Integrity Agreements are an alternative to termination or exclusion from Medicaid when a provider has committed an act of Medicaid fraud, waste and abuse. Medicaid subsequently monitors providers under CIAs and takes necessary action in the event of a breach of the terms of the CIA.
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Goal #1 Objectives
• Enhance provider outreach and education through engagement and participation efforts.
• Generate policy based on provider collaboration efforts.
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Goal #2: Coordinate with Stakeholders to Identify and Address Fraud, Waste
and Abuse in Medicaid Program
• Prescription Drug and Opioid Abuse: Patients suspected of overuse or abuse are restricted to a single designated provider.
• Home Health and Community Based services: As Medicaid moves from hospitalization and long-term care under value-based payment system, oversight of these services is critical to the Medicaid population.
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Goal #2 Objectives
• Referral and supporting prosecution of cases related to fraud in program integrity partnership with the Attorney General’s Medicaid Fraud Control Unit.
• Managed Care Plan Review, Network Provider Review and Pharmacy Project teams focus on efficient and effective audit processes to enhance integrity of managed care environment.
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Goal #3: Develop Innovative Analytic Capabilities to Detect Fraudulent
or Wasteful Activities
• Data Review Project Team seeks to ensure availability and usability of data from Medicaid Data Warehouse, Salient Data Mining solution, All-Payer Database, Data Mart, and Encounter Intake system. Collaborates with DOH to improve completeness and accuracy of MCO-submitted encounter data.
• Analytics used to review encounter analysis, system match recoveries, third-party liability matches and recovery services.
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Goal #3 Objectives
• Enhances multidisciplinary activities, including improved data access, storage and mining capabilities.
• Utilizes multidisciplinary activities to improve upon audit and investigation efforts to recovery and help preserve Medicaid funds.
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SECURE ID, SECURE PRINTING
Thomas MaruschakDirector of Infrastructure Services
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Secure ID
Secure ID enables staff to enter ACP offices
Security: Badges must be worn in the office at all times by every employee and staff member
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Secure Print with Secure ID
Secure ID will enable printing on any Multi-Functional Printer
Security: Documents are printed only when you log in at the device with your
ID card. This reduces waste and document insecurity.
Easy Use: One quick swipe is enough to unlock the device
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BENEFITS AND PROFESSIONAL DEVELOPMENT
Liz WebbVice President of Human Resources
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Training and Development CalendarGeneral Assembly
• Quarterly, mandatory all-employee meetings
• 10 am to 2 pm
Professional Development Series
• Mandatory all-employee meetings
• 90-minute workshops
• How to Be A Top Performer (July 13)
• How to Communicate Effectively (September)
• How to Present with Clarity and Conviction (November)
• How to Master Time Management (2018)
Lunch & Learns
• All-employees are invited
• Behavioral Health (June 28)
• DASH (July 19)
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Employee Intranet & Calendar
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NEW EMPLOYEEINTRODUCTIONS
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EMPLOYEE RECOGNITIONAWARDS
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Thank You!