PROJECT ADVISORY COMMITTEE (PAC)

PROJECT ADVISORY COMMITTEE (PAC) Thursday, March 31, 2016 9:00am-12:00pm Islandia Marriott Long Island Hosted by the Office of Population Health at Stony Brook Medicine 1

9:00 am 9:10 am Welcome Remarks 9:10 am 9:45 am SCC DSRIP Program Progress Reports 9:45 am 10:00 am BREAK 10:00 am 10:40 am 10:40 am 11:50 am 11:50 am 12:00 pm Integrating Behavioral Health Across the Continuum of Care Primary Care - Behavioral Health Integrated Care Practices Panel Discussion Closing Remarks Question & Answers 2 AGENDA Joseph Lamantia, Chief of Operations for Population Health Stony Brook Medicine Alyssa Scully, Director Project Management Office, Ashley Meskill, RN, Clinical Project Manager, Amy Solar Greco, Project Manager Susan Jayson, LCSW, BH & PC IC Implementation Specialist Kristie Golden, PhD Associate Director of Operations, Neurosciences Neurology, Neurosurgery & Psychiatry Hospital Administration, Stony Brook Medicine Moderator, Kristie Golden, PhD Associate Director of Operations, Neurosciences Neurology, Neurosurgery & Psychiatry Hospital Administration, Stony Brook Medicine Joseph Lamantia, Chief of Operations for Population Health Stony Brook Medicine

WELCOME REMARKS Presented by Joseph Lamantia Chief of Operations for Population Health Stony Brook Medicine 3

DY1 IS IN THE BOOKS! Five Stages of the DSRIP (Apologies to Kubler-Ross) Denial Anger You re kidding right? You want us to do what? Bargaining Depression Acceptance How many meetings do I have to go to? Are the days for fee-for-service really numbered? Where do I sign! 4

KEY THEMES BUILDING A FOUNDATION 2015 PAC mtg Key Themes March 2015 June 2015 October 2015 December 2015 IT Interoperability and Care Management CBO s and PCMH Cultural Competency & Health Literacy and Value Based Purchasing Partner Onboarding Program (Provider Contracting) These key themes have and will continue to shape and provide form, function and purpose to the SCC 5

STAY INFORMED Project Advisory Committee Membership o Membership directory just over 1,100 Communication Strategies: enewsletters o Synergy and DSRIP In Action Website at www.suffolkcare.org guide for partners/providers, community and project stakeholders Quarterly PAC Meeting Participation Text SUFFOLKCARES to 22828 to join our enewsletters!

BEHAVIORAL HEALTH AND PRIMARY CARE INTEGRATION The Burning Platform Approximately 23% of our PPS Medicaid members are defined as behavioral health recipients (member* with 1+ claims with a primary or secondary behavioral health diagnosis) Behavioral health recipients cost, on average, 4.65 times more per recipient and represent 58%of total Medicaid spending Behavioral health recipients drive 48% of all ED visits; Behavioral health recipients represent 58% of admissions to hospital and on average have a 1.65X longer length of stay in hospital than non-behavioral health recipients 32% of all Primary Care visits are attributed to behavioral health recipients Source: CY 2013-2014 Medicaid claims data is the data source

BEHAVIORAL HEALTH AND PRIMARY CARE INTEGRATION PROGRAM This program is aimed at developing collaborative integrated care models between PCPs and behavioral health organizations. BH PC Behavioral Health co-located in Primary Care Practices Model 1 PC BH Primary Care colocated in Behavioral Health Practices Model 2 IMPACT Evidence-based Care Coordination Model for Depression Care Model 3 8

MEETING OBJECTIVES DSRIP Program Progress Reports The office of population health will highlight current status reports on the NYS DSRIP Program efforts, including project-specific updates and achievements to date. Integrating Behavioral Health Across the Continuum of Care Dr. Kristie Golden, Associate Director of Operations, Neurosciences, Neurology, Neurosurgery & Psychiatry, Hospital Administration at Stony Brook Medicine and Project Lead of the SCC DSRIP Project 3ai, will be describing current trends in Primary Care Behavioral Health Integrated Care practices, best practices in screenings, and integrated care implementation strategies. Behavioral Health & Primary Care Integrated Care Panel Discussion A panel of health care leaders representing primary care and mental health will share thoughts and perspective on the Primary Care Behavioral Health Integrated Care Model and discuss what can be leveraged for DSRIP PPS. 9

DSRIP PROGRAM PROGRESS REPORTS Presented by Alyssa Scully, Director Project Management Office, Ashley Meskill, RN, Clinical Project Manager, Amy Solar Greco, Project Manager Susan Jayson, LCSW, Implementation Specialist, Behavioral Health & Primary Care Integrated Care Program 10

PATIENT ENGAGEMENT SCORECARD DY1 Q1 - DY1 Q3 (APRIL 1 - DEC 31, 2015) Target 9,531 Actual 22,397 Target 2,216 Actual 2,400 Target 717 Actual 1,294 Target 7,950 Actual 8,471 Achievement Rate 235% Hospital 2bvi: TOC Achievement Rate 108% Hospital 2bix: OBS Achievement Rate 180% Nursing Home 2bvii: INTERACT Achievement Rate 106% CBO 2di: PAM Target 4,505 Actual 11,473 Target 2,180 Actual 3,609 Target 4,533 Actual 5,246 Target 2,180 Actual 3,081 Achievement Rate 255% PCP & BH 3ai: PCBH Achievement Rate 165% PCP 3bi: Cardio Achievement Rate 115% PCP 3ci: Diabetes Achievement Rate 141% PCP 3dii: Asthma Key: Checkmark means meeting or exceeding target, X=Not on Target SCC Project Management Office Report Template

BUILDING AN INTEGRATED DELIVERY SYSTEM (2AI) Approach Engage groups of SMEs to direct each of the 11 IDS Project Requirements Create an integrated delivery system through clinically integrating network providers aimed at achieving improved population health. Accomplishments Expanded IDS/PHM Workgroup Clinical Integration Needs Assessment Complete IT Clinical Data Sharing & Interoperable Systems Roadmap Complete Initial RHIO Gap Analysis Complete Next Steps Complete Clinical Integration Strategy Complete Population Health Management Roadmap Continue working with safety-net partners on RHIO enrollments Continue technical-onboarding with partners in building the IDS Visit our program page: https://suffolkcare.org/aboutdsrip/projects/2ai1 12

BUILDING AN INTEGRATED DELIVERY SYSTEM (2AI) 2ai Project Committee PHM/IDS Project Workgroup IDS Project Key Themes Integrated Delivery System Population Health Management Transitions of Care Clinical Integration/Clinical Interoperable Systems RHIO/SHIN-NY Connectivity Meaningful Use PCMH Certification PCP access & capacity Care Coordination & Collaborative care practices Care Management Value Based Payment Community Navigation/Engagement 13 TOC Workgroup PM: Ashley Meskil IT Task Force PM: Ned Micelli PCMH Certification Workgroup PM: Althea Williams Care Management & Care Coordination Workgroup PM: Kelli Vasquez Performance Reporting & Management Workgroup PM: Kevin Bozza Value Based Payment Team PM: Neil Shah Community Engagement Workgroup PM: Althea Williams Community Health Activation Program PM: Amy Solar-Greco

ACCESS TO CHRONIC DISEASE PREVENTIVE CARE INITIATIVES (4BII) Approach Support promotional activities to increase prevention and awareness efforts for lung cancer, breast cancer and colorectal cancer screening education, obesity prevention and tobacco cessation in clinical and community settings. Accomplishments Create a first draft community resource directory HITE Online Community Resource Directory website partnership formalized Patient Education materials reviewed & approved by CC & HL workgroup Next Steps Initiate work on online Community Resource Directory on the SCC website Formalize materials for chronic-disease prevention/education programs Visit our program page: https://suffolkcare.org/aboutdsrip/projects/4bii 14

SUBSTANCE ABUSE PREVENTION AND IDENTIFICATION INITIATIVES (4AII): SBIRT Approach Identify & train SBIRT Hospital-based Facility Champions to implement SBIRT Implementation Plan Operationalize PPS-wide SBIRT Training Program for Hospital staff Workgroup & Committee engaged to collaborate on best practices, lessons learned and risk mitigation strategies through Learning Collaboratives Accomplishments SCC Monthly SBIRT Training Program underway Stony Brook Medicine & Brookhaven Hospital golive complete CHS held kick-off for Health System Continue learning from Northwell Health Southside s experiences in SBIRT roll-out Next Steps Continue to host Monthly SBIRT Trainings at all partner hospitals to train staff Next Learning Collaborative scheduled to share collaborative practices implemented by Stony Brook Medicine & Brookhaven Hospital Begin collecting data to support program development efforts Visit our program page: https://suffolkcare.org/aboutdsrip/projects/4aii 15

TRANSITION OF CARE PROGRAM FOR INPATIENT & OBSERVATION UNITS (TOC) (2BIV & 2BIX) Approach Engagement of nationally recognized SME to support TOC Model development Identify & train TOC Hospital-based Facility Champions to initiate TOC Implementation Plan Workgroup & Committee engaged to collaborate on best practices, lessons learned and risk mitigation strategies through Learning Collaboratives Accomplishments TOC Model designed by the Project Committee has been approved by the Clinical Governance Committee & Board of Directors Partnered with two Preventive Medicine Residents from the Stony Brook Medicine School of Preventive Medicine to support Hospital s during Implementation Next Steps TOC Implementation Plan for each Hospital will be initiated Training Curriculum will be designed using the contents of the TOC Model Approved First Learning Collaborative will be scheduled to begin collaboration amongst project stakeholders Visit our program page: https://suffolkcare.org/aboutdsrip/projects/2biv 16

INTERVENTIONS TO REDUCE ACUTE CARE TRANSFER PROGRAM (INTERACT) (2BVII) Approach SNF Facility Champion & Co-Champions obtain INTERACT Training Certification INTERACT Workgroup representative of all SNF DNS engaged in designing content and deploying a SCC INTERACT Implementation Toolkit SNF Facility Champions will be using Performance Logic to report progress against the SNF INTERACT Implementation Plan Accomplishments SNF Facility Champions & co-champions trained & certified SNF INTERACT Implementation Toolkit Complete and adopted by Project Committee SNFs oriented to Technical On-boarding processes to support IDS SCC Project Manager presented our INTERACT Implementation approach at a GNYHA Post-Acute Care Workgroup Meeting Next Steps SNF Facility Champions will initiate INTERACT Implementation Toolkit. First steps include building SNF-based Implementation Teams & Hosting Kick-Off Meetings SCC PMO begins to support development of INTERACT program patient, family and caregiver communication pamphlets Visit our program page: https://suffolkcare.org/aboutdsrip/projects/2bvii 17

CLINICAL IMPROVEMENT PROGRAMS (3BI) & (3CI) Approach Adopt evidence-based guidelines to support training and implementation of clinical improvement practices in medical settings. Operationalize a Stanford Peer Training Program in partnership with our existing community based programs. On-board Provider Relations Managers to monitor Practice Site Implementation Plans and training requirements. Accomplishments Evidence-based guideline summaries are complete. PCP and Non-PCP practice site implementation plan complete. Clinical improvement program materials are in development for the Diabetes and Cardiology in concert with program SMEs. Next Steps Initiate practice site Implementation Plan with our contracted/engaged practice Sites Continue to develop Training Curriculum and program materials to support implementation. Hot-spotting strategies to support implementation in development. Visit our program page: https://suffolkcare.org/aboutdsrip/projects/3bi & https://suffolkcare.org/aboutdsrip/projects/3ci 18

PROMOTING ASTHMA SELF-MANAGEMENT PROGRAM (PASP) (3DII) Approach Through community partnerships initiate an Asthma-Home Environmental Trigger Assessment Program deployed by CHWs in our communities for high risk patients. Promotion of Program to PPS medical practice sites and promote use of Asthma Action Plans at medical practices. Accomplishments Home Environmental Trigger Assessment Program procedures and workflows created. Next Steps Formalize partnerships to operationalize Home Environmental Trigger Assessment Program. Engage workgroups to create communication materials and pamphlets for program for our network of providers. Visit our program page: https://suffolkcare.org/aboutdsrip/projects/3dii 19

COMMUNITY HEALTH ACTIVATION PROGRAM (CHAP) (2DI) Approach Support a CBO-led in-reach and outreach program to identify, engage, educate and integrate the uninsured and low/non-utilizing Medicaid populations into Community Based Care. Identify hot-spot locations across the County to identify individuals. Build community navigation resources and partnerships to connect individuals to primary care, BH, access to health care/enrollment, health home or social service agencies resources. Accomplishments Met 100% DY1 patient engagement survey-targets 1 month early. Identified beneficiaries to attend Project Workgroup discussions to support strategies to further enhance program operations. Next Steps Continue working with partner CBO s and identifying new CBO partnerships for program. Formalize the Coaching for Activation program for surveyed individuals. Baseline and evaluate year 1 survey data to support strategies in year 2. Visit our program page: https://suffolkcare.org/aboutdsrip/projects/2di 20

PRIMARY & BEHAVIORAL HEALTH INTEGRATED CARE PROGRAM (3AI) Approach Partner with Nationally recognized SME to support development of evidence-based program materials and training curriculum for Integrated Care. Design and deploy a Program Toolkit to support implementation of Integrated Care at practice sites. Engage practices sites in a phased approach which includes: current state assessment, model selection, implementation and monitoring. Practice sites will be invited to participate in Learning Collaboratives led by our SMEs. Accomplishments Program Toolkit drafted for Integrated Care (IC) practice sites. Phase 1 practices sites have selected the model they will implement. Next Steps Initiate implementation of IC at Phase 1 practice sites. Partnering with Community Based Organizations for embedded staff resources. Phase 2 practice sites will initiate in July 2016. Visit our program page: https://suffolkcare.org/aboutdsrip/projects/3ai 21

BREAK 22

INTEGRATING BEHAVIORAL HEALTH ACROSS THE CONTINUUM OF CARE Presented by: Kristie Golden, PhD Associate Director of Operations, Neurosciences Neurology, Neurosurgery & Psychiatry Hospital Administration Stony Brook Medicine 23

INTRODUCTION Primary Care-Behavioral Health Integration, also referred to as physical-mental health integration, is an evidence-based approach that supports collaboration between physical health and behavioral health providers to improve the identification and triage of those in need of mental health and/or substance abuse services. Promotes the collaboration between primary care providers, behavioral health specialists and other disciplines Various models of how to integrate services being implemented nationwide

GLOBALLY - WHY INTEGRATE? Individuals/families that are closely connected with a PCP have a trusting relationship with that doctor Individuals/families are more likely to follow up with appointments either in their PCP s familiar location or coordinated by their PCP rather than traveling to a new doctor or initiating an appointment on their own Better communication among all parties, screenings for early intervention and treatment, better individual health and family outcomes, lower healthcare costs, improved work and school performance Opportunity to identify behavioral health conditions and address them when the patient is in the office.

WHY IDENTIFY BEHAVIORAL HEALTH DISORDERS? Research evidence supports that screening for potential medical problems (cancer, diabetes, hypertension, tuberculosis, vitamin deficiencies, renal function) provides preventative services prior to the onset of acute symptoms and delays or precludes the development of chronic conditions Depression is linked to numerous medical conditions such as diabetes and cardiac disease Risky levels of substance use and any level of smoking are also directly linked to numerous medical conditions and chronic disease Co-occurring tobacco use is a significant contributor to the increase in mortality among individuals with psychiatric disorders Screening for depression and substance use has been proven to help identify those individuals at risk who have not previously sought services Source: Barbara E. Warren, Psy. D. LMHC, CASAC, CPP: Stony Brook Presentation 8/20-8/21

SCREENING BENEFITS Primary focus on depression and substance use Does not require a behavioral health specialist to complete the screening Provides approach and language to address issues using motivational interviewing Approach is non-confrontational and puts the responsibility for change on the patient Provides an active systematic way to screen and provide a brief intervention or a referral for more services Source: Barbara E. Warren, Psy. D. LMHC, CASAC, CPP: Stony Brook Presentation 8/20-8/21

HOW DOES THIS RELATE TO DSRIP? Population health efforts seek opportunities for education and intervention at the point of care (i.e. emergency department, hospital unit or PCP/GYN office) Studies indicate that screening, education and brief intervention for substance use reduced future use of substances. Studies indicate that screening and intervention for depression has a positive impact on the management of chronic medical conditions. When depression, alcohol and other drug screening becomes more routine, you typically find: o o Greater patient & family satisfaction Better patient management & follow-up Source: Barbara E. Warren, Psy. D. LMHC, CASAC, CPP: Stony Brook Presentation 8/20-8/21

OTHER BENEFITS Reduces ED visits Reduces readmission rates Improves public health over time Addresses/Treats the whole person Improves family outcomes Improves patient/family satisfaction Reimbursable services in hospitals and doctors offices Promotes a proactive/wellness approach

WHAT HAS HELD UP WIDESPREAD ROLL-OUT IN THE PAST? Fear and a lack of understanding between PCPs and BH Providers often paralyzes forward movement when considering collaboration o Work culture differences o Differences in knowledge-base and/or approach to care PCP s struggle with the many psychosocial needs of their patients and the needs of their families and appreciate the BH support o Older adult-specific issues o Youth-specific issues o Family situation-specific issues o Addiction concerns Screening/Assessment opens the door to a myriad of psychosocial issues which cannot be ignored (collaboration is imperative here) o Case management needs: adequate housing or in home support, safety, nutrition, social isolation, health insurance, medications, managing chronic conditions, etc.

YEARS PAST Problem Identified Go to Doctor Get Treatment All is Well

2016 Problem Identified Go to Doctor (in Your Insurance Network) Get Treatment (Maybe from a Specialist through a Referral from your PCP) Find Out Ideal Treatment is Limited or Not Authorized Doctor Makes Case for Treatment Make Calls to Specialists Find out There are no Appointments for 6 Weeks Go to Appointment Get Prescription Find Out Prescription is not Covered Under Your Plan Call Doctor Back

DSRIP Concepts Promote Solutions

HOW TO SET-UP WITHIN A PCP PRACTICE What discipline(s) is needed? Is more than one person necessary? Social Workers/Mental Health Counselors Psychologists/Neuropsychologists Health Coaches/Peer Specialist Alcohol & Substance Abuse Counselors Psychiatrists/Nurses Care/Case Managers Who is affordable/sustainable?

DEVELOP COLLABORATIVE RELATIONSHIPS SET-UP CONTINUED o Define the collaborative agreement between the PCP/BH Employed? Shared space? Lease agreement? etc.) o Work through issues and set a target start date** o Identify PCP needs: o What does their PCP patient caseload look like? o How many people does the PCP see daily? o Does the PCP have BH experience? Prescribing experience? o Are they comfortable identifying those in need through screening? o What is the insurance mix of his/her patient load? o How will the office staff be involved in the planning? **(2 people collaborating requires time to work through a lot of detail)

The Warm Hand-off Review Potential Arrangements & Work Flow o o o o o o o o o o Identify local BH resources for back-up and other urgent care or specialty care needs (i.e. inpatient units, long-term treatment) Discuss screening tools, i.e. PHQ9, PSC, AUDIT, DAST other screenings, and how this will define when a hand-off is made to the BH Specialist Develop practice specific protocols Screening completed during annual office visit? Paper or EMR? - Who will do it/review it? Who will refer patient for services? Where will services take place? Who does scheduling? How will the services be billed? What coding needs to be considered and understood?

COMMUNICATION BETWEEN DIVERSE DISCIPLINES Communication Process Establish plan to share records, preferably electronically o Who uses what documentation language? Abbreviations? Strength-based or weakness-based notes? Plan communication protocols for ongoing dialogue o o o o How and when will cases get reviewed? How will treatment plan be updated and whose input will be included? How will progress be monitored/measured? How will crisis/emergencies be handled? Plan for use of other communication technology, i.e. smart phones, email Consideration of HIPAA compliance

COMMUNICATION CONTINUED Monitor Outcomes DSRIP Metrics - Design how you will measure health outcomes, i.e. reduced symptoms, better patient engagement, fewer ER visits Design how to measure life outcomes, i.e. living independently, socializing, improved school outcomes, relationship development, etc. Design how, where and by whom data will be collected and analyzed and reported to PPS Utilize EMR to communicate and measure progress Conduct satisfaction surveys- both patient and referral source

LESSONS LEARNED Collaboration does work Patients gain access to services more quickly Symptoms improve PCPs offer more comprehensive treatment to their patients PCPs have a more consistent patient flow People get healthier Creates possibility of high reliability organization

HAPPIER PATIENTS = HAPPIER PROVIDERS Integration improves patient satisfaction. Warm hand-off should reduce patient wait time.

FUTURE FRAMEWORK Establishing PCP and BH collaboration at the start of a practice o Seeing integrated model as routine in areas where it is not yet standard o Teach integration in medical schools and other clinical degree programs o Learn and measure value of routine screening and prevention o Change reimbursement methods to support wellness approach o Population-level change PCPs developing trusting relationship with BH peers o Co-located/Integrated Specialist o Telepsychiatry and Telephone Curb-side Consultations o Project TEACH in NY Reimbursement Models for Sustainability o Short-run Utilizing appropriate billing codes o Long-run.Value-based reimbursement o Reduced or eliminated fee-for-service models

Contact Information Kristie Golden, PhD, CRC, LMHC Associate Director of Operations Stony Brook Medicine (631) 444-2032

PRIMARY CARE - BEHAVIORAL HEALTH INTEGRATED CARE PRACTICES PANEL DISCUSSION Moderator Kristie Golden, PhD, Associate Director of Operations, Neurosciences, Neurology, Neurosurgery & Psychiatry, Hospital Administration, Stony Brook Medicine Panelists Luigi Buono, D.O. Board Certified-American Board Family Practice Prime Care Medical of Long Island d/b/a North Fork Family Medicine Martha A Carlin, Psy.D. Director, Long Island Field Office New York State Office of Mental Health Jeff Steigman, Psy.D. Chief Administrative Officer Family Service League Rajvee Vora MD, MS Director, Ambulatory Behavioral Health for DSRIP Implementation Northwell Health 43

QUESTION & ANSWER www.suffolkcare.org 44

Appendix 45

PAY FOR PERFORMANCE FUNDING SCHEDULE Over the life of the waiver, funding shifts from process milestones (Domain 1) and reporting (P4R) to performance (P4P): Domain Domain 1 Project Process Milestones Domain 2 System Transformation & Financial Stability Milestones Domain 3: Clinical Improvement Milestones Payment Annual Funding Percentages DY 1 DY 2 DY 3 DY 4 DY 5 P4R 80% 60% 40% 20% 0% P4P 0% 0% 20% 35% 50% P4R 10% 10% 5% 5% 5% P4P 0% 15% 25% 30% 35% P4R 5% 10% 5% 5% 5% Domain 4: Population Health Outcomes P4R 5% 5% 5% 5% 5% Source: NYS DOH Presentation Presented June 18 th 2015 DSRIP Incentive Payment Domain 2-4 Achievement Values 46

Demonstration Year & Quarter* DOH DSRIP DEMONSTRATION YEAR TIMELINE & PAYMENT SCHEDULE Reporting Period Quarterly Report Due Payment Due DY 1, Q1 4/1/15 6/30/15 July 31, 2015 DY 1, Q2 7/1/15-9/30/15 October 31, 2015 DY 1, Q3 10/1/15 12/31/15 January 31, 2015 DY 1, Q4 1/1/16 3/31/16 April 30, 2016 DY 2, Q1 4/1/16 6/30/16 July 31, 2016 DY 2, Q2 7/1/16 9/30/16 October 31, 2016 DY 2, Q3 10/1/16 12/31/16 January 31, 2017 DY 2, Q4 1/1/17-3/31/17 April 30, 2017 Table continues through DY 5* Domain 1 AVs are tied to semi-annual payment based on completing all Domain 1 requirements January 2016 July 2016 January 2017 July 2017 Source: Department of Health presentation on April 21, 2015 entitled DSRIP Domain 1 Achievement Values 47

DOH DSRIP DEMONSTRATION YEAR TIMELINE & PAYMENT SCHEDULE Domain 2-4 AVs are tied to semi-annual payment based primarily on measures calculated annually Demonstration Year* DSRIP Year Date Range Payments DY 1 4/1/2015-3/31/2016 Payment 1: Q2 (9/30/2015) Payment 2: Q4 (3/31/2016) DY 2 4/1/2016 3/31/2017 Payment 1: Q2 (9/30/2016) Payment 2: Q4 (3/31/2017) DY 3 4/1/2017 3/31/2018 Payment 1: Q2 (9/30/2017) Table continues through DY 5* Payment 2: Q4 (3/31/2018) Source: NYS DOH Presentation Presented June 18 th 2015 DSRIP Incentive Payment Domain 2-4 Achievement Values 48 Measurement Period Used for Domain 2-3 AVs N/A Measurement Year 1 7/1/2014 6/30/2015 Measurement Year 1 7/1/2014 6/30/2015 Measurement Year 2 7/1/2015-6/30/2016 Measurement Year 2 7/1/2015-6/30/2016 Measurement Year 3 7/1/2016-6/30/2017

DSRIP OVERALL GOALS QUANTIFYING ACHIEVEMENT OF DSRIP GOAL OF 25% REDUCTION IN AVOIDABLE HOSPITAL READMISSIONS OVER 5 YEARS Reduction Bucket Prevention Quality Indicators (PQIs) Potentially Avoidable 25% Reduction 3,651 913 35,540 Denominator Denominator Definition Suffolk County Medicaid admissions age greater than 18 Pediatric Quality Indicators (PDIs) 432 108 3,837 Reduction Bucket Potentially Avoidable 25% Reduction Denominator Avoidable ED (PPV) 86,435 21,609 112,902 Avoidable Readmissions (PPR) 1,612 403 26,714 Suffolk County Medicaid admissions age less than 18; excluding newborns Denominator Definition Emergency department volume by Suffolk County Medicaid members At risk admissions defined by 3M at Suffolk County hospitals Source PQIs and PDIs are computed from the 2013 limited SPARCS data All other measures are based on CY 2012 data GOAL OF 90% PAY FOR PERFORMANCE BY DY 5 49

SUFFOLK PPS AWARD Net Project Valuation Period of Agreement: April 1, 2015 To: December 31, 2020 Net High Performance Fund Additional High Performance Fund Public Equity Guarantee Public Equity Performance Total Valuation $ 181,115,320 $ 4,200,998 $10,045,427 $58,971,622 $44,228,717 $298,562,084 Suffolk PPS Award of funds is contingent on our ability to meet DOH deliverables and performance measure targets. NYS Total Valuation Grand Total $ 7,385,825,815 50

PROJECT IMPLEMENTATION SPEED Suffolk PPS Speed Requirements by Project DY Timeline DY 0 (2014) DY 1 (2015) DY 2 (2016) DY 3 (2017) DY 4 (2018) DY 5 (2019) Projects Q1/Q2 Q3/Q4 Q1/Q2 Q3/Q4 Q1/Q2 Q3/Q4 Q1/Q2 Q3/Q4 Q1/Q2 Q3/Q4 Q1/Q2 Q3/Q4 2A1 - IDS 2B4 - TOC 2B9 - OBS 3A1 - BH-PC 3B1 - CV 3C1 - DIABETES 3D2 - ASTHMA 2D1 - UNINSURED 2B7 - INTERACT X X X X X X X X X We are here Domain 4 Projects do not have Project Speed & Scale Commitments 51

SPEED & SCALE OVERVIEW Project Project Description Providers to be Engaged (Revised 9/30/15) # of Actively Engaged % of Attributed Population Actively Engaged Definition By Year: 2.a.i IDS 3,702 N/A N/A N/A N/A 2.b.iv Transitions of Care 3,278 25,326 17% Care Transition plan developed 2 2.b.vii INTERACT 38 SNFs 1,914 1.3% 2.b.ix 2.d.i 3.a.i Observation Units PAM/ Uninsured PC & BH Integration 52 Avoided hospital transfer due to INTERACT 1,079 8,866 6% Utilizing Observation services 3 350 trained in PAM 45,426 N/A Individuals who completed PAM survey 4 3,432 45,059 30% 3.b.i Cardio 3,538 14,556 10% 3.c.i Diabetes 3,538 12,094 8% 3.d.ii Asthma 3,382 6,751 4.5% 1) PHQ/SBIRT screening at PCMH site 2) Primary care services at BH site 3) PHQ/SBIRT screening at IMPACT site Documented Self-Management goals in Medical records Received a hemoglobin a1c test in previous DSRIP year Registered in home assessment log, patient registry, or other IT platform. 2 4 4 3 2