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1 DSRIP Meeting Agenda 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 join/ Conference Line Dial +1 (646) Access Code: Invitees Ilana Avinari (Methodist) Phil Zweiger (ASCNY) Steve Zhou (Village Care) Daniel Johansson (ACMH) Fay Pinto (Elizabeth Seton Center for Pediatrics) David Grayson (ArchCare/Calvary) Alan Wengrofsky (Community Healthcare Network) Diomedes Carrasco (NMPP) Dan Del Bene (SPOP) NYP Co-Chair: Brian Kurz Co-Chair: Jay Gormley (MJHS) Meeting Objectives 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 Time 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) Share PowerPoints from the meeting with the Committee Schedule I. Kastenbaum for upcoming meeting to present on DY1 revenue vs. expenditures J. Gormley/B. Kurz 3/11/2016 4/18/2016 Not started L. Alexander 3/11/2016 4/8/2016 Complete L. Alexander 3/11/2016 4/8/2016 Complete PAGE 1

2 DSRIP Meeting Agenda 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 join/ Conference Line Dial +1 (646) Access Code: Invitees Dr. Elaine Fleck (NYP) Mary Blyth (NYP) Fay Pinto (Elizabeth Seton Center for Pediatrics) David Grayson (ArchCare/Calvary) Carmen Juan (NYP) NYP Co-Chair: Brian Kurz Co-Chair: Jay Gormley (MJHS) Dan Del Bene (SPOP) Meeting Objectives 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 Time 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 PAGE 1

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

4 NYP PPS $97M Guarantee Breakdown Waiver SN Equity HPF W P4R EIP W P4P EPP HPF Likely Guaranteed P4P HPF Only ~$60.8M likely guaranteed 2

5 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 Source: October 2015 NYS Supplemental Programs Webinar 3

6 Safety Net Equity Program Overview 4

7 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

8 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 Measures can be changed year-to-year 6

9 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 7

10 Equity Performance Program Measures EPP Final Measures Children's Access to Primary Care 12 to 24 months Children's Access to Primary Care 7 to 11 years Prenatal and Postpartum Care Postpartum Visits Children's Access to Primary Care 25 months to 6 years Children's Access to Primary Care 12 to 19 years Prenatal and Postpartum Care Timeliness of Prenatal Care Frequency of Ongoing Prenatal Care (81% or more) Childhood Immunization Status (Combination ) Follow-up care for Children Prescribed ADHD Medications Initiation Phase Lead Screening in Children Med. Assist. w/ Smoking & Tobacco Use Cessation Discussed Cessation Strategies Controlling high blood pressure Comprehensive Diabetes screening All Three Tests Diabetes monitoring for persons with schizophrenia Behavioral Health follow up after hospitalization for mental illness (7 day) Initiation and Engagement in Alcohol and Other Drug Dependence Treatment (IET) within 14 days of substance abuse episode Well Care Visits in the first 15 months (5 or more Visits) Follow-up care for Children Prescribed ADHD Medications Continuation Phase Chlamydia Screening (16 24 Years) Med. Assist. w/ Smoking & Tobacco Use Cessation Discussed Cessation Medication Comprehensive Diabetes Care Diabetes screening for persons with schizophrenia Adherence to anti-psychotic medications for individuals with schizophrenia Behavioral Health follow up after hospitalization for mental illness (30 day) Follow-up on Alcohol and Other Drug Dependence Treatment (IET) within 30 days of initial engagement 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. 8

11 Process for Selecting EPP Measures # Reason Impact 1 Changed from P4R- >P4P in later years (Years 3 or 4) Enables PPS to focus on pay-for-reporting / likelyguaranteed funding for a longer period. 2 High-Performance Fund (HPF) Eligible Enables PPS to tap into 3% withhold (~$9M) 3 4 Required smaller annual changes to meet gap-togoal Relative ranking vs. other PPSs Enables PPS to target resources to close smaller gap-to-goals (often <30 beneficiaries per year) Identifies area where PPS is already a strong performer relative to other PPSs 9

12 Equity Performance Program Measures EPP Final Measures Children's Access to Primary Care 12 to 24 months Children's Access to Primary Care 7 to 11 years Prenatal and Postpartum Care Postpartum Visits Children's Access to Primary Care 25 months to 6 years Children's Access to Primary Care 12 to 19 years Prenatal and Postpartum Care Timeliness of Prenatal Care Frequency of Ongoing Prenatal Care (81% or more) Childhood Immunization Status (Combination ) Follow-up care for Children Prescribed ADHD Medications Initiation Phase Lead Screening in Children Med. Assist. w/ Smoking & Tobacco Use Cessation Discussed Cessation Strategies Controlling high blood pressure Comprehensive Diabetes screening All Three Tests Diabetes monitoring for persons with schizophrenia Behavioral Health follow up after hospitalization for mental illness (7 day) Initiation and Engagement in Alcohol and Other Drug Dependence Treatment (IET) within 14 days of substance abuse episode Well Care Visits in the first 15 months (5 or more Visits) Follow-up care for Children Prescribed ADHD Medications Continuation Phase Chlamydia Screening (16 24 Years) Med. Assist. w/ Smoking & Tobacco Use Cessation Discussed Cessation Medication Comprehensive Diabetes Care Diabetes screening for persons with schizophrenia Adherence to anti-psychotic medications for individuals with schizophrenia Behavioral Health follow up after hospitalization for mental illness (30 day) Follow-up on Alcohol and Other Drug Dependence Treatment (IET) within 30 days of initial engagement 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. 10

13 NYP PPS-MCO Pairings 1. Affinity Health Plan 2. Amerigroup 3. HealthFirst 4. Fidelis 11

14 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

15 ADULT AMBULATORY ICU NYP PPS Finance Committee Meeting Friday, April 8 th, pm

16 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)

17 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

18 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

19 How Funds Are Being Spent Personnel 5

20 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

21 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