The DSRIP Report Richard Bernstock Dennis Maquiling Albert Alvarez Peggy Chan

Transcription

1 The DSRIP Report Richard Bernstock OneCity Health Dennis Maquiling Bronx Health Access Albert Alvarez Bronx Partners for Healthy Communities Peggy Chan NYS Department of Health

2 2 OneCity Health Update to the Bronx Health & Housing Consor8um

3 New York State DSRIP Overview 3 The Delivery System Reform Incen8ve Payment (DSRIP) program is a $6.42B performance- based program that will fund public and safety net providers to transform the NYS health care delivery system. Goals: (1) Transform the safety net system (2) Reduce avoidable hospital use at NYS level by 25% over 5 years (3) Concurrent pursuit of the Triple Aim (beyer care, improved health, reduced cost) (4) Ensure delivery system transforma8on con8nues beyond the waiver period through managed care payment reform Key Program Components: Statewide funding ini8a8ve for public hospitals and safety net providers Only coali8ons of community/regional health providers are eligible (to create a Performing Provider System PPS) DSRIP projects based on a menu of interven8ons approved by CMS and NYS Payments to providers based on their performance in mee8ng outcome milestones and the State achieving statewide metrics

4 Laying The Groundwork For Our DSRIP Journey 4 Collabora8on and engagement among OneCity Health partners, including CBOs, pa8ents and other partners is a guiding principle for our collec8ve efforts. This is an imperfect process; we are all making decisions with the best informa8on available, not necessarily complete informa8on. We made a commitment to work together and engage one another, and that starts with building trust. These efforts may not have been valued in the past, but they are invaluable for our future success. To be successful, we will need to support each other as we address the challenging days ahead.

5 NYC Health + Hospitals Mission with DSRIP 5 Sick care is a thing of the past and the provision of wellcare a hallmark of HHC s Future. Dr. Ram Raju CEO, NYC Health + Hospitals

6 DSRIP and Health Improvement 6 Under the DSRIP Program, HHC and 220+ partner organizaoons formed OneCity Health. We will collaborate like never before to beuer meet the health and social needs of all New Yorkers, regardless of ability to pay. CBOs Clinics InsOtuOons Physicians Home Care OneCity Health Partner CollaboraOon: Step- by- Step ü Form local cononuums of health and social services that our pa8ents need for op8mal health ü Using the voice of the paoent and other informa8on, learn about the specific needs of our communi8es ü Build effecove, collaboraove governance and management processes ü With partners and paoents together, design and implement approaches to improve the health of our populaoons, including new care models, technology infrastructure, and capital project support ü Commit to spirit of cononuous improvement measure our progress in mee8ng needs, and be willing to change

7 OneCity Health ConfiguraOon: Single PPS for Simplicity, Hub- Based Model Designed to Meet Local Needs 7 Community Community Community Community Brooklyn Hub Bronx Hub ManhaUan Hub Queens Hub OneCity Health Centralized Services OrganizaOon ( CSO ) Features of OneCity Health Structure HHC will serve as lead, or fiduciary, of a single PPS The PPS is organized into four (4) borough- based hubs, each of which has a local advisory group, or PAC Each hub is comprised of PPS partners, whose medical and social services span the healthcare cononuum The CSO is owned by HHC and works in service to the PPS

8 OneCity Health s Eleven DSRIP Projects 8 Domain 2: System TransformaOon Common Required Elements of DSRIP Projects Pa8ent- centeredness Iden8fica8on and risk stra8fica8on for right level of evidence- based care Community- based engagement + educa8on Naviga8on and coordina8on across sejngs Cultural competence Meaningful informa8on sharing within and across PPSs Workforce training for new care delivery approaches 2.a. i 2.a. iii 2.b. iii 2.b. iv 2.d. i 3.a. i 3.b. i 3.d. ii 3.g. i Create Integrated Delivery Systems that are focused on Evidence Based Medicine / Popula8on Health Management Health Home At Risk IntervenOon Program Proac8ve management of higher risk pa8ents not currently eligible for Health Homes through access to high quality primary care and support services. ED care triage for at- risk popula8ons Care transioons model to reduce 30 day readmissions for chronic health condi8ons Project 11 : Implementa8on of Pa8ent Ac8va8on Ac8vi8es to engage, educate, and integrate the UI, NU, and LU Medicaid popula8ons into community- based care Domain 3: Clinical Improvement Projects Integra8on of primary care and behavioral health services Evidence- based strategies for cardiovascular disease management in high risk / affected popula8ons (adult only) Expansion of asthma home- based self- management program Integra8on of palliaove care into the PCMH model Domain 4: PopulaOon- Wide Projects OneCity Health Update to the Bronx Health & Housing Consor8um December 4.a. 8, Strengthen 2015 Mental Health and Substance Abuse Infrastructure

9 OneCity Health DSRIP Projects Translated to Care ConOnuum 9 Strengthen Primary Care and Behavioral Health PaOent s Community Enhance Outreach and AcOvaOon o Integra8on of primary care and behavioral health services o Evidence- based prac8ces to improve cardiovascular disease management o Integra8on of pallia8ve care into primary care sejng o Enhancement of asthma self- management in pediatric pa8ents Specialty Care (including behavioral health services) PaOent, Family and Caregiver Family Community- based OrganizaOons/ Social Services o Comprehensive program to ac8vely engage pa8ents in high- quality, pa8ent- centered care, regardless of their insurance status Support Seamless Care TransiOons o Evidence- based care coordina8on and PCP linkages for pa8ents presen8ng to the ED for non- urgent care o 30- day supported post- hospitaliza8on transi8onal care services for pa8ents at- risk for readmission Primary Care Hospital and Emergency Department Post- Acute/Long- term Care Facility Home Health Care Care Manager/ Health Home Ensure Robust, Targeted Care Management o Global risk stra8fica8on o Episodic or longitudinal care management support that meets the pa8ents needs and promotes self- management

10 OneCity Health Partner Network: Bronx Hub- Level View of Local ConOnuum 10 We are currently evalua8ng the strength of our local con8nuums. We seek to build trust and implement programs across the con8nuum to provide beyer- coordinated, pa8ent- centered care. Sample Partners, OneCity Health Bronx Hub Inpa8ent / Hospital q Jacobi Hospital q Lincoln Hospital q North Central Bronx Hospital Primary Care = 31 Gotham Sites: Belvis/Morrisiana LTC / Sub- Acute / Nursing & Rehab q Bronx Park Rehab and Nursing Center q Rebekah Rehab and Extended Care Center Long Term Care, etc. = 36 Community Services = 164 Community Based Social & Support Services q a.i.r. NYC q Odyssey House Primary Care q Access Community Health Center q Rasik Patel, MD PC Behavioral Health = 33 Pharmacy = 21 Hospital / InpaOent = 3 Outpa8ent Behavioral Health q Bronx Psychiatric Center q The PAC Program Pharmacy q Arthur Avenue Pharmacy q Total Care Pharmacy

11 Project ParOcipaOon OpportuniOes : Transparent Process for IdenOfying Project ImplementaOon Partners 11 Project Par8cipa8on Opportuni8es are publicized documents that we may use upon ini8a8on of our DSRIP projects. They are intended primarily for non- HHC partners and, alongside other means of engagement, help us iden8fy qualified and interested partners who will par8cipate in a given project. Project ParOcipaOon Opportunity : Components Descrip8on of partner par8cipa8on role in project Required partner qualifica8ons/criteria Response process and 8meline Ongoing 8meframes for project par8cipa8on iden8fica8on Process Overview 1. Mul8- channel dissemina8on of Project Par8cipa8on Opportuni8es to all partners 2. Submission of responses by interested partners 3. Review of responses by PPS management (within the context of exis8ng partner engagement data from the PRAT and in- person partner visits) 4. Prepara8on of budget/funds flow es8mates for review by Business Opera8ons and IT CommiYee and approval by Execu8ve CommiYee 5. Nego8a8on and execu8on of project contract schedules with selected partners * Note: Project Par8cipa8on Opportuni8es serve as a partner engagement mechanism to iden8fy the universe of poten8al project par8cipants; they do not reflect a formal procurement process

12 Eleven Overlapping PPSs in NYC Share Partners and PaOents 12 SBH/Montefiore- led PPS Citywide CollaboraOon is Key to DSRIP Performance In order to achieve NYS DSRIP goals, we must: q Con8nue and expand leadership in PPS- PPS collabora8ons q Understand that pa8ents seek care in mul8ple PPSs q Work to unify project protocols across PPSs so that partners can more easily implement and sustain performance Maimonides- Led PPS ** Other notable collaboraions include Advocate, Montefiore Westchester, and NY Presbyterian