* Name: FLPPS Project Participation Survey- Part 2. Organizational Information. 1. Contact Information for the DSRIP Point of Contact

Transcription

1 Organizational Information * Name: 1. Contact Information for the DSRIP Point of Contact Organization Address: Address 2: City/Town: State: ZIP: Address: Phone Number: The following questions are intended to help the FLPPS team complete the DSRIP Project Plan Application, due on December 1, The majority of the questions are directly linked to information required for the application. Please provide information for each of the DSRIP projects in which your organization plans to participate. All interested providers must submit information for Project 2.a.i Create an integrated delivery system (participation in this project is mandatory for all FLPPS providers). If you are unsure whether your organization will be participating in a project, please provide a detailed explanation. This will help the FLPPS team understand how we may help your organization address potential barriers to participation. For guidance on assessing your organization's intent to participate in the various project, please reference our suggested project selection criteria.

2 Suggested Project Participation Criteria

3 Project 2.b.vi Transitional Supportive Housing Services Project Objective Participating hospitals will partner with community housing providers and home care service organizations to develop transitional supportive housing for high risk patients who, due to their medical or behavioral health conditions, have difficulty transitioning safely from a hospital into the community. Project Requirements 1. Partner with community housing providers and home care service organizations to develop transitional supportive housing for highrisk patients. 2. Develop protocols to identify chronically ill super utilizers who qualify for this service. Once identified, this targeted population will be monitored using a priority listing for access to transitional supportive housing. 3. Establish Memorandum Of Understanding (MOU) and other service agreements between participating hospitals and community housing providers to allow the transitional supportive housing and home care services staff to meet with patients in the hospital and coordinate the transition. 4. Establish coordination of care strategies with Medicaid Managed Care Organizations to ensure needed services at discharge are covered and in place at the transitional supportive housing site.. Develop transition of care protocols to ensure all chronically ill super utilizers receive appropriate health care and community support including medical, behavioral health, post acute care, long term care and public health services.. Ensure medical records and post discharge care plans are transmitted in a timely manner to the patient s primary care provider and frequently used specialists. 7. Establish procedures to connect the patient to their Health Home (if a HH member) care manager in the development of the transitional supportive housing plan or provides a warm referral for assessment and enrollment into a Health Home (with assignment of a care manager). 8. Use EHRs and other technical platforms to track all patients engaged in the project. Do you feel that your patients stand to significantly benefit from your participation in this project? Yes No Does your organization plan to participate in this project? Yes jno please explain in comment box

4 Project 2.b.vi Questions Please list the names and 10 digit NPI#s of the providers who will be participating in this project: Provider Name Provider 1 Provider 2 Provider 3 Provider 4 Provider Provider Provider 7 Provider 8 Provider 9 Provider 10 National Provider ID (NPI) number Provider 1 NPI Provider 2 NPI Provider 3 NPI Provider 4 NPI Provider NPI Provider NPI Provider 7 NPI Provider 8 NPI Provider 9 NPI Provider 10 NPI Project 2.b.vi Transitional Supportive Housing Services Project Objective Participating hospitals will partner with community housing providers and home care service organizations to develop transitional supportive housing for high risk patients who, due to their medical or behavioral health conditions, have difficulty transitioning safely from a hospital into the community. Project Requirements 1. Partner with community housing providers and home care service organizations to develop transitional supportive housing for high risk patients. 2. Develop protocols to identify chronically ill super utilizers who qualify for this service. Once identified, this targeted population will be monitored using a priority listing for access to transitional supportive housing. 3. Establish Memorandum Of Understanding (MOU) and other service agreements between participating hospitals and community housing providers to allow the transitional supportive housing and home care services staff to meet with patients in the hospital and coordinate the transition. 4. Establish coordination of care strategies with Medicaid Managed Care Organizations to ensure needed services at

5 **Note: Please if you have more than 10 providers available. How many beds, if any, can your organization provide as transitional beds for high risk patients by DY4 (1/1/19) or sooner? discharge are covered and in place at the transitional supportive housing site.. Develop transition of care protocols to ensure all chronically ill super utilizers receive appropriate health care and community support including medical, behavioral health, post acute care, long term care and public health services.. Ensure medical records and post discharge care plans are transmitted in a timely manner to the patient s primary care provider and frequently used specialists. 7. Establish procedures to connect the patient to their Health Home (if a HH member) care manager in the development of the transitional supportive housing plan or provides a warm referral for assessment and enrollment into a Health Home (with assignment of a care manager). 8. Use EHRs and other technical platforms to track all patients engaged in the project.

6 FLPPS Project Participation Survey- Part 2 (cont.) Collaboration 1. If your organization plans to collaborate with other organizations within the FLPPS service area on this project, please list the names of the organizations below. Click Here for the FLPPS service area Organization 1 Name: Organization 2 Name: Organization 3 Name: Other Organization 4 Name: Organization Name: Organization Name: Organization 7 Name: 2. Would your organization be interested in leading this project for its Naturally Occurring Care Network (NOCN)? See below for the geographical borders of our NOCNs within the 14 county region. j Yes k l m n j No k l m n j Maybe k l m n If yes, please indicate which NOCNs your organization would be interested in leading.

7 The Five Naturally Occurring Care Networks within the FLPPS Service Area Regulatory relief 3. Does the organization anticipate needing a regulatory relief waiver in order to complete the requirements of this project? Yes No Unsure 4. If yes, please provide the name(s) of the regulation(s):

8 . Please explain why the above regulation(s) need to be waived in order to complete the requirements of this project. Bench strength. Does the organization have any expertise in this project? Yes No 7. If yes, please provide an explanation of the organization's expertise related to this project: 8. Is the organization currently participating in one or more Medicaid initiatives (funded by the US Department of Health and Human Services or other relevant delivery system reform initiatives) relevant to this project s objective? Yes No Unsure If yes, please complete the following information: 9. Medicaid initiative Medicaid initiative Medicaid initiative 3 Name: Brief Description: Start & End Dates: How would this project be different from, expand upon, or enhance the current initiative?

9 Impact on workforce 12. How many employees does the organization anticipate: Hiring? Retraining? Redeploying? 13. Please complete the following table related to anticipated workforce needs in order to complete the requirements of this project. Will it be voluntary? Will this impact current wages and benefits of existing employees? Hiring new employees Retraining existing employees Redeploying existing employees

10 14. If the organization plans to hire new employees as a result of this project, please indicate the type of employees that would need to be hired (check all that apply) Administrative Project Manager Project Director Physician Case Manager Social Worker IT staff Nurse Practitioner Psychiatrist Psych NP Psychologist Community Navigator (or equivalent) Translator Data Analysts Primary Care Provider Other 1. Please describe the processes for hiring new employees:

11 1. Please indicate the estimated cost of new hires to the organization by DSRIP Demonstration Year: DY 1 (April 201 December 201): DY 2 (January 201 December 201): DY 3 (January 2017 December 2017): DY 4 (January 2018 December 2018): DY (January 2019 December 2019): 17. How many of retrained employees will achieve partial placement (between 7% and 9% of previous total compensation) and full placement (9%+ of previous total compensation)? Partial Placement: Full Placement: 18. Please describe the processes for retraining existing employees: 19. Please indicate the estimated cost of retraining existing employees to the organization by DSRIP Demonstration Year: DY 1 (April 201 December 201): DY 2 (January 201 December 201): DY 3 (January 2017 December 2017): DY 4 (January 2018 December 2018): DY (January 2019 December 2019): 20. What will be the ramifications, if any, to existing employees who refuse their retraining assignments?

12 21. Please describe the processes for redeploying existing employees: 22. Please indicate the estimated cost of redeploying existing employees to the organization by DSRIP Demonstration Year: DY 1 (April 201 December 201): DY 2 (January 201 December 201): DY 3 (January 2017 December 2017): DY 4 (January 2018 December 2018): DY (January 2019 December 2019): 23. What will be the ramifications, if any, to existing employees who refuse their redeployment assignments? 24. Please select existing state programs you plan to utilize to support your workforce needs (check all that apply) Doctors Across New York Physician Loan Repayment Physician Practice Support Ambulatory Care Training Diversity in Medicine Support of Area Health Education Centers Primary Care service Corp Health Workforce Retraining Initiative Other (please specify)

13 Project resources The development and execution of DSRIP projects will likely require upfront costs with earned performance payments lagging these expenditures. The following questions are intended to assess the organization s willingness and ability to internally finance these costs pending DSRIP incentive payments. Please note that while we ask for budget estimates in order to complete the Project Plan Application due December 1, we will need final, itemized budgets prior to April 1, We appreciate you being as detailed as possible when describing your operational and capital funding needs, in addition to any anticipated losses in revenue. 2. Please describe the resources and/or assets your organization has that can be mobilized to achieve this project 2. If you expect loss in revenue as a result of this project, please explain why 27. Do you anticipate requiring any Capital Budget funding for this project to be successful? Click Here for the State s requirements regarding Capital Budget funding Yes No Unsure 28. If yes, please provide: Estimated amount of capital funding necessary: $ Percent the organization can provide as a match: % 29. Please explain why the organization anticipates needing capital funding in order for this project to be successful:

14 Project implementation 30. What, if any, challenges does the organization anticipate encountering while implementing this project? Information Technology Workforce Funding Capacity for new patients Communication Other (please specify)

15 31. By what year does the organization anticipate your organization achieving all project metrics? Click Here for a list of project metrics DY 0, Q1/Q2 (January 2014 June 2014) DY 0, Q2/Q3 (July 2014 December 2014) DY 1, Q1/Q2 (January 201 June 201) DY 1, Q2/Q3 (July 201 December 201) DY 2, Q1/Q2 (January 201 June 201) DY 2, Q2/Q3 (July 201 December 201) DY 3, Q1/Q2 (January 2017 June 2017) DY 3, Q2/Q3 (July 2017 December 2017) DY 4, Q1/Q2 (January 2018 June 2018) DY 4, Q2/Q3 (July 2019 December 2019) DY Q1/Q2 (January 2020 June 2020) DY, Q2/Q3 (July 2020 December 2020) Patient engagement 32. Please indicate the number of the organization's patients that are anticipated to benefit from this project. (Click Here to download State's attribution table) Attributed patients Total patients In the table below, please indicate the following:

16 The anticipated number of patients who will be engaged in this project in each quarter 33. Attributable 34. Total DY 0, Q1/Q2 (January 2014 June 2014) DY 0, Q2/Q3 (July 2014 December 2014) DY 1, Q1/Q2 (January 201 June 201) DY 1, Q2/Q3 (July 201 December 201) DY 2, Q1/Q2 (January 201 June 201) DY 2, Q2/Q3 (July 201 December 201) DY 3, Q1/Q2 (January 2017 June 2017) DY 3, Q2/Q3 (July 2017 December 2017) DY 4, Q1/Q2 (January 2018 June 2018) DY 4, Q2/Q3 (July 2019 December 2019) DY Q1/Q2 (January 2020 June 2020) DY, Q2/Q3 (July 2020 December 2020)

17 Financial Matrix Prepared by Date Prepared Executive/Director Sponsor Physician/Clinician Sponsor Finance Representative HR Representative Statistical/FTE Impact Statistic Description (type of employee/contractor, total number of each) DY 1 DY 2 DY 3 DY 4 DY **DY1 is a short year (4/1/201 to 12/31/201) and will involve extensive planning and less implementation.

18 Statistical/FTE Impact: Full Time Equivalents (FTEs cumulative FTE combining full and part time employees/contractors). DY 1** DY 2 DY 3 DY 4 DY Cash outflows: Operating Expenses DY 1** DY 2 DY 3 DY 4 DY SWB Supplies Cash outflows: Services Agreement and other potential vendors Vendor 1 Vendor 2 Vendor 3 DY 1** DY 2 DY 3 DY 4 DY Vendor 4 Cash Inflows: Net Revenue per Statistic FTE DY 1** DY 2 DY 3 DY 4 DY Cash from other sources: DY 1** DY 2 DY 3 DY 4 DY Source 1 Source 2 Source 3 One time Ongoing **DY1 is a short year (4/1/201 to 12/31/201) and will involve extensive planning and less implementation.