DSRIP Project Integration. Janet King Director of Project Management Office and Project Managers FLPPS Summit July 29, 2015

Transcription

1 DSRIP Project Integration Janet King Director of Project Management Office and Project Managers FLPPS Summit July 29, 2015

2 FLPPS Project Integration Objectives Provide insight into how the FLPPS DSRIP projects work together to build the foundation for an Integrated Delivery System Describe key elements of the projects from the patient s perspective FLPPS FINGER LAKES PERFORMING PROVIDER SYSTEM 2

3 CURRENT STATE Fee For Service Non Covered Inpatient Primary Care + Specialty Emergency Medical (MH + SA) Housing, Holistic, Nutrition, Peer to Peer Counseling, Transportation to Pharmacy, etc. Skilled Nursing Transport Home

4 FLPPS Project Integration Integrated Delivery System 1. Integration of Care a) Provider Connectivity b) Patient tracking for Population Management 2. Co-ordination of Care a) Care Management b) Providing Social 3. Engagement & Support a) Patient b) Family c) Community 4. Measurement and quality improvement a) Evidence Based Care b) Patient Centered Medical Home (PCMH) c) Measuring Outcomes System Transformation to Value Based Payment FLPPS FINGER LAKES PERFORMING PROVIDER SYSTEM 4

5 FUTURE Preventive STATE Care Projects: 2.a.i Integrated Delivery System 2.b.iii ED Care Triage Skilled Nursing (SNF) Hospital Emergency & In patient care 2.b.iv Care Transitions 2.b.vi Transitional Housing 2.d.i Patient Activation 3.a.i Integration of Primary Care into BH Homes / Care Management The Patient Support (CBOs) 3.a.ii Stabilization 3.a.v Interventions in SNFs 3.f.i Maternal & Child Primary Care with (adult + peds) OB/GYN (Maternal Child ) Domain 4 Projects (Population ) BH/SA/MH

6

7 FUTURE STATE Projects: 2.a.i Integrated Delivery System 2.b.iii ED Care Triage Skilled Nursing (SNF) Hospital Emergency & In patient care 2.b.iv Care Transitions 2.b.vi Transitional Housing 2.d.i Patient Activation 3.a.i Integration of Primary Care into BH Homes / Care Management Deloris Smith Support (CBOs) 3.a.ii Stabilization 3.a.v Interventions in SNFs 3.f.i Maternal & Child Primary Care with (adult + peds) OB/GYN (Maternal Child ) Domain 4 Projects (Population ) BH/SA/MH

8 FUTURE STATE Projects: 2.a.i Integrated Delivery System 2.b.iii ED Care Triage Skilled Nursing (SNF) Hospital Emergency & In patient care 2.b.iv Care Transitions 2.b.vi Transitional Housing 2.d.i Patient Activation 3.a.i Integration of Primary Care into BH Homes / Care Management Jim Smith Support (Transportation) 3.a.ii Stabilization 3.a.v Interventions in SNFs 3.f.i Maternal & Child Primary Care with (adult + peds) OB/GYN (Maternal Child ) Domain 4 Projects (Population ) BH/SA/MH

9 FUTURE STATE Projects: 2.a.i Integrated Delivery System 2.b.iii ED Care Triage Skilled Nursing (SNF) Hospital Emergency & In patient care 2.b.iv Care Transitions 2.b.vi Transitional Housing 2.d.i Patient Activation 3.a.i Integration of Primary Care into BH Homes / Care Management Annie Smith Support (CBOs) 3.a.ii Stabilization 3.a.v Interventions in SNFs 3.f.i Maternal & Child Primary Care with (adult + peds) OB/GYN (Maternal Child ) Domain 4 Projects (Population ) BH/SA/MH

10 PROJECT INTEGRATION Population (4.b.ii & 4.a.iii) Transitional Housing (2.b.vi) Patient Activation (2.d.i) Primary Care & (3.a.i) Hospital Emergency (2.b.iii) & Inpatient Care (2.b.iv) Skilled Nursing Facilities (3.a.v) Interventions (3.a.ii) Maternal Child (3.f.i)

11 PROJECT INTEGRATION Population (4.b.ii & 4.a.iii) Hospital Emergency (2.b.iii) & Inpatient (2.a.i) Care (2.b.iv) The Integrated System Transitional Housing (2.b.vi) Patient Activation (2.d.i) The Patient Skilled Nursing Facilities (3.a.v) Maternal Child (3.f.i) Primary Care & (3.a.i) Interventions (3.a.ii)

12 Questions: FLPPS FINGER LAKES PERFORMING PROVIDER SYSTEM 12

13 Analysis Project Name PCMH BH HH/Care Mgmt IT Connectivity Community Support/Social 2ai IDS X X X X 2biii ED Care Triage X X X X 2biv Care Transitions X X X 2bvi Transitional Housing X X X 2di Patient Activation X X 3ai Integration of BH and Primary Care X X X X 3aii BH Community X X X X 3av BH Intervention SNF X X 3fi Maternal Child X X X 4aiii 4bii Strengthen MH and SA Infrastructure Increase Access to Preventative Care/Pop. X X X FLPPS FINGER LAKES PERFORMING PROVIDER SYSTEM 13