Meeting Title. Facilitator. Conference Line

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1 DSRIP Meeting Agenda Date and Time Location 3/21/17, 10-11am Heart Center Room 4, GoTo meeting Meeting Title Facilitator NYP PPS IT/Data Governance Committee Gil Kuperman, Alvin Lin Go to Meeting / Conference Line United States +1 (408) Access Code: Invitees Co-Chair: Alvin Lin (NYC DOHMH PCIP/REACH) Kate Nixon (VNSNY) Steven Lam (CBWCHC) Andres Pereira, MD Todd Rogow (Healthix) Lauren Alexander (NYP) Nelson Mesa (NYP) Co-Chair: Gil Kuperman (NYP) Stuart Myer (VillageCare) Renato Leonel (Isabella) Mitze Amoroso (ArchCare) Patricia Hernandez (NYP) Andrew Missel (NYP) Meeting Objectives 1. Review Action Items from Previous Meeting 2. Interaction with Clinical Operations Committee (Co-Chairs) 3. Shift to focus on performance metrics (Andrew Missel) 4. Healthify presentation (Patricia Hernandez) 5. Identify Next Steps Time 2 mins 15 mins 30 mins 10 mins 2 mins Action Items Description Owner Start Date Due Date Status Invite Committee members to 4/21 PPS Clinical Operations Committee meeting trial of joint committees A. Missel 3/21 3/24 Complete PAGE 1

2 NYP PPS DY3 Strategic Pivot SITUATION BACKGROUND ASSESSMENT RECOMMENDATION SITUATION To date, the New York State Delivery System Reform Incentive Payment (DSRIP) Program has enabled significant change for the NewYork-Presbyterian Performing Provider System (PPS) and the communities it serves, including the recruitment of 100+ people, initiation of over 20 collaborator contracts with a total value of $1.0+ million, support for the roll-out of a care management platform, development of patient registries and the spread of Patient Navigators across multiple emergency departments. The PPS has also enabled further integration of the Health Home into project operations. Participation in DSRIP provides the opportunity to achieve up to $97 million in support of implementing ten community- and ambulatory-based programs to improve the health of an attributed population; this funding opportunity is approximately 50% pay-for-reporting (P4R) and 50% pay-for performance (P4P). The PPS is shifting now from a focus on the implementation of the ten projects to a focus on rapid cycle improvement on the P4P metrics. The PPS project teams have been focused on implementing projects according to the NYS project requirements and the goals established in the original charters. Given this, there has currently been little focus on the pay-for-performance metrics to date. BACKGROUND PPS Metric to Project Alignment New York State has assigned 44 pay-for-performance metrics to the NYP PPS, based on the PPS s choice of projects. These metrics range from avoidable utilization measures to disease management and population health metrics. These metrics are not always aligned with the project requirements; as an example, in the P4P arena, the Behavioral Health Community Crisis Stabilization (3.a.ii) project is responsible for improving the diabetes monitoring rates of schizophrenics while the project requirements are focused on addressing patients acute psychiatric episodes. PPS Revenue Source and Expense Allocation Alignment The NYP PPS has the opportunity to achieve approximately $97 million throughout the five performance years. The potential funding is broken down as follows: Page 1 of 4

3 Evaluation Level Funding Source 5-Year Max Value Portion (%) PPS Pay-for-Performance Performance Metrics $26,012, % PPS Equity Infrastructure Program investments in foundational efforts of PPS $23,628, % PPS Pay-for-Reporting Performance Metrics $19,705, % PPS PPS Organizational Milestones $9,657, % PPS Pay-for-Performance High-Performance Fund* $9,500, % Project Project Implementation Plan Approval (1 time) $4,632, % Project Project Budget Reporting $2,414, % Project Project Patient Engagement Speed $1,585, % Project Project Requirement Achievement $502, % TOTAL $97,637, % *Additional funds available by achieving at least 20% gap-to-goal closure within a given DSRIP measurement year. As shown above, a significant portion of the funding cannot be achieved through Organizational Milestones, Budget Reporting and Pay-for-Reporting activities alone. At the current 5-year $79.5M PPS budget, the NYP PPS is approximately $19.5M at-risk (difference between total five-year expenses and the likely-expected pay-for-reporting revenue of $60M). To receive these pay-for-performance funds, the PPS must demonstrate improvements in patient utilization, clinical quality and patient satisfaction performance metrics designated by NYS. PPS PROJECT MANAGEMENT OFFICE ASSESSMENT The PPS Project Management Office (PMO) conducted a qualitative assessment evaluating whether or not in the current state each project s scope of work, leadership, governance and operations were positioned to maximize direct pay-for-performance (P4P) payments and increase the likelihood of the PPS realizing them. The assessments showed that no project was significantly focused on quality improvement or workflow redesign interventions directly targeting the quality measures specified in the P4P metrics. This results in a reduced probability that the PPS will realize the full P4P revenue opportunities, even for the highest functioning projects. RECOMMENDATION The PPS PMO recommends that the PPS governance and project management structure make a strategic shift away from a project-centric model toward a population-centric model, prioritizing quality improvement and workflow redesign interventions directly targeted at the pay-for- Page 2 of 4

4 performance metrics. The recommendation focuses on reorganizing the PPS efforts into six focus areas, emphasizing the role of each of our provider groups to implement the necessary system changes to affect the P4P metrics: Next Steps Population Initiative Scope (not exhaustive) Aligned Projects Medical Assistance with Tobacco Cessation, Timely Appointments, Primary Care Access, Depression Screening, Antidepressant/Antipsychotic Management, Adult Ambulatory ICU (2.b.i) NYP/ACN Adult CVD/DM Monitoring for Schizophrenics, Substance Use Palliative Care (3.g.i) Medicine Quality Screening & Treatment, Avoidable Utilization, Care BH-PC Integration (3.a.i) Improvement CU Coordination, Cervical Cancer Screening, Chlamydia Tobacco Cessation (4.b.i) Screening, Follow-Up after Hospitalization, Patient Satisfaction NYP/ACN Pediatric Quality Improvement WC and CU NYP/ACN and Collaborator Sexual Health WC and CU Transitions / High- Utilizers All Campus Collaborator Quality Improvement CBO / Social Determinants Timely Appointments, Primary Care Access, ADHD Medication Compliance and Treatment Adherence, Avoidable Utilization, Patient Satisfaction, Chlamydia Screening, Substance Use Screening & Treatment Viral Load Screening and Suppression, Chlamydia and Syphilis Screening, Avoidable Utilization Avoidable Utilization, Transitions, Follow-up for Mental Illness Hospitalizations External PCMH achievement, Medication Assistance with Tobacco Cessation, Depression Screening, Avoidable Utilization, etc. Navigation of community-based psychosocial services, standardized screening and referrals, housing, legal aid, food support, substance use access Pediatric Ambulatory ICU (2.b.i) BH-PC Integration (3.a.i) HIV Center of Excellence (3.e.i) Reducing HIV Morbidity (4.c.i) ED Care Triage (2.b.iii) Transitions of Care (2.b.iv) BH Crisis Stabilization (3.a.ii) ICPs PCMH and QI PPS Education / Cult Competency Provision of Data to Support QI CHWs, Peers, and other Field-Based Staff Healthify Rollout Healthix Rollout This proposed shift in structure will be reviewed with the PPS Governance Committees in order to gather feedback/input aimed at improving the pivot s likelihood for success. Following the integration of the Committees input, the PPS PMO will begin to focus on (and resource with dedicated Project Management and Analytics support) the necessary discovery process to drive initiation and eventual performance across the various population initiatives. If necessary, a new governance structure, or modifications to existing structures, will be introduced to support these efforts. Page 3 of 4

5 Under the guidance of the PPS Governance Committees, the PPS PMO will also begin to focus on making performance data available to the population lines in order to drive quality improvement at a local level. The PPS anticipates using a number of data sources to support these efforts: 1. NYS Medicaid Analytics Performance Portal (MAPP) Tool Year-old, de-identified, adjudicated performance data based on Medicaid claims; limited ability to query by individual provider 2. Salient Interactive Miner (SIM) Tool Timely, de-identified Medicaid claims data with ability to breakdown data by provider and patient attributes 3. NewYork-Presbyterian Hospital EHR/Administrative data Timely, identifiable data with ability to breakdown data by provider, patient attributes; however, limited to NYPH-provided services 4. NYS Raw Medicaid Claims Data Timely, identifiable data with ability to breakdown data by provider, patient attributes As the population initiatives unfold, these data sources will be leveraged to drive dedicated, focused quality improvement efforts. Page 4 of 4

6 Transition to Pay-for-Performance PPS IT / Data Governance Committee March 21,

7 Transformation is Demanding & Complex Flexibility will help us succeed Transformative change requires patience and comfort with ambiguity 2

8 The Shift from P4R to P4P is Baked into DSRIP Project progress milestones Pay-for-reporting Pay-for-performance 20% 15% 80% 60% 25% 40% 15% 45% 15% 65% 85% 20% 15% DSRIP Year 1 DSRIP Year 2 DSRIP Year 3 DSRIP Year 4 DSRIP Year 5 We are here Note: As part of a December 2015 waiver amendment request to the federal Centers for Medicare and Medicaid Services, New York is seeking to slightly modify these percentages. Source: New York State Department of Health, Attachment I NY DSRIP Program Funding and Mechanics Protocol, April

9 P4P Dollars Become Increasingly Important PPS budgeted at $79M over five years; only $60M is likely guaranteed. We must focus on closing the $19M gap by achieving the pay-for-performance gaps. 4

10 Closing the P4P Gap Means Focusing on 44 P4P Metrics Metric Categories Access to primary care and preventive health screenings Utilization (ED visits and inpatient admissions) Tobacco use Subpopulations (behavioral health, HIV, alcohol/drug treatment) Patient satisfaction Example Metrics Adult and Children s Access to Primary Care Potentially Preventable ER Visits; Potentially Preventable Readmissions HIV Viral Load Supression 5

11 DSRIP Years 1-1.5: All about Projects Current State (10 projects): Budgeting and expenses managed through projects Clinical leadership and project management organized by projects Governance Committees have provided guidance for projects Information technology has been developed for projects Collaborators have been engaged in projects PPS communication has been centered on projects 6

12 DSRIP Years 1.5 5: All about Performance Pay for Performance Metrics: Are evaluated on the full 90K attributed beneficiaries Are focused on various provider types Will require work across the care continuum Will focus on the patient Will require distribution of data to providers 7

13 PPS Pivot: Transition to P4P Project-Centric Governance PPS Governance Committees Performance-Driven Governance PPS Governance Committees Integrated Delivery System ED Care Triage BH Primary Care Integration HIV Center of Excellence Ambulatory ICU 30-Day Care Transitions BH Crisis Stabilization Palliative Care in PCMHs Adult NYP NYP Sexual Health Community Providers Transitions / High Utilizers Tobacco Cessation Reduce HIV Morbidity CBO/Social Determinants 8

14 CBO / Social Determinants New PPS Operating Structure PPS Governance Committees Adult NYP Community PPS NYP Sexual PPS Transitions / PPS 9

15 Details on Each Population Line Population Line Adult NYP NYP Sexual Health Community Providers (PC/BH) Transitions / High Utilizers CBO / Social Determ. Scope of Work / P4P Metrics (Not Exhaustive) Medical screenings, tobacco, PCP access, patient satisfaction, substance use, avoidable utilization Medical screenings, PCP access, patient satisfaction, avoidable utilization, ADHD treatment HIV, STI screening, referral, engagement Medical screenings, tobacco, PCP access, patient satisfaction, substance use, avoidable utilization PCMH achievement, FQHCs, Community Providers, BH Providers ED utilization, readmissions, follow-up for BH hospitalizations, transitions to/from ED and inpatient Navigating psychosocial services, standardized screening/referral, housing, legal aid, nutrition support, substance use access, Healthix and Healthify rollout Legacy Project Alignment Tobacco, Palliative Care, Amb. ICU, IDS, BH-PCP Integration Amb. ICU, IDS, BH- PCP Integration HIV Morbidity, HIV Center of Excellence All ED Care Triage, 30- Day Care Transitions, BH Crisis Stabilization All 10

16 Project Structure Hampers Focus on P4P Metrics PPS operations by Projects create silos PPS operations by Population Lines maximize natural overlaps Pre-Pivot, Focus = P4R Post-Pivot, Focus = P4P Mental health needs Mental health needs Children High ED Utilizers Children High ED Utilizers Entire PPS Population (87k people) Entire PPS Population (87k people) 11

17 Proposed PPS Pivot: Population Lines Anticipated Challenges Performance data 1+ year lag (directional) Not directly attributed to single provider/organization Few data sources are identifiable / actionable NYS reporting will remain project-centric Anticipated Opportunities Align funding to performance Reorganizing away from project silos Resource QI in community Enhanced engagement across network Revamp PPS governance to be performance-oriented Immediate Focus: Assessing Quality Improvement Opportunities 12

18 Each Population Line will Have Support by at least 1 Project Manager and 1-3 Leads Robust data analytics and reporting resources Direction to design interventions which cross Population Lines 13

19 Degree of Focus Projects Ramp Down, Population Lines Ramp Up Population Lines Rely on infrastructure built by Projects Legacy Project NYS Milestone reporting Maintain & grow CBO relationships Hardwire QI interventions Zone of Pivot Projects Hardwire infrastructure Staffing sustainability plan Don t continue post-pivot Time 14

20 Transition Timeline Current Project due dates are not changing Majority of NYS Milestones due by 3/31/1017 No new deliverables at the project level Population Line formation in January April 2017 P4P metric scores updated by NYS in March 2017 New P4P Measurement Year begins July 1,

21 Opportunities for IT/Data Governance Committee Which areas of this work are high-risk and need additional guidance? What types of IT and data governance supports are needed for quality improvement work? What IT and data governance supports are needed in the community, in order to be successful? 16

22 Software tool for care managers, community health workers, and social workers to coordinate referrals with communitybased organizations. Comprehensive database of housing, food, psychosocial services, etc. resources social determinants. Healthify Implementation for Collaborations and NYP s ACN Network began in March Inpatient Implementation is slated for late spring/early summer. 1

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