DSRIP Project Advisory Committee (PAC) Meeting March 29, 2017
Welcome! AMY L. WHITE-STORFER DIRECTOR, PROJECT MANAGEMENT OFFICE
Project & Workstream Updates Our newsletter is available today! With detailed project updates. http://wnycommunitypartners.org/resources/
Current Project Updates always on-line! http://wnycommunitypartners.org/partners/ DSRIP reporting link on right hand navigation (password protected)
Funds Flow Update Spending Update By provider category By project
CPWNY Cumulative Distributed Revenue by PPS Program Category* DY1 to DY2 Q3 PPS Program Category Sum of DY1-DY2Q3 Expense Percentage Case Management $ 1,804,146 18.99% Clinical Transformation $ 87,550 0.92% Community Based Organizations $ 2,470,973 26.00% Hospice $ 754,994 7.95% Hospital $ 1,666,523 17.54% Local Government Unit $ 270,127 2.84% Mental / Behavioral Health $ 289,068 3.04% Physician - Primary Care $ 2,155,605 22.69% Substance Abuse $ 3,214 0.03% Grand Total $ 9,502,201 100.00% *Program category may be different from NYS provider category on MAPP. Total DY2 Budget is $11,020,366.
CPWNY Cumulative Distributed Revenue by PPS Program Category DY1 to DY2 Q3 Partners Receiving Funds PPS Program Category Sum of DY1-DY2Q3 Expense % CHS Care Management Case Management $ 1,208,569 12.72% CHS ED Triage Case Management $ 471,750 4.96% CMP Care Management DY1-DY2 Case Management $ 123,828 1.30% Clinical Transformation Team Clinical Transformation $ 87,550 0.92% Catholic Health System Community Based Organizations $ 396,669 4.17% Catholic Medical Partners (PMO) Community Based Organizations $ 1,872,120 19.70% Chautauqua County Health Network Community Based Organizations $ 42,098 0.44% Compeer Community Based Organizations $ 13,907 0.15% P2WNY Community Based Organizations $ 9,290 0.10% Rural AHEC Community Based Organizations $ 82,484 0.87% Community Health Worker Network Community Based Organizations $ 22,969 0.24% ECCPASA Community Based Organizations $ 31,436 0.33% Chautauqua County Hospice Hospice $ 35,599 0.37% Hospice Buffalo Hospice $ 717,689 7.55% Niagara Hospice Hospice $ 1,707 0.02% Hospital Revenue Loss DY1 Hospital $ 982,378 10.34% Roswell Park Hospital $ 274,711 2.89% WCA Hospital $ 409,434 4.31% Chautauqua County DOH Local Government Unit $ 270,127 2.84% Mental Health Assoc of Erie Cty Mental / Behavioral Health $ 244,615 2.57% Northpointe Council Mental / Behavioral Health $ 6,590 0.07% Spectrum Human Services Mental / Behavioral Health $ 26,359 0.28% Mental / BH Providers P4R Mental / Behavioral Health $ 6,500 0.07% Horizon Health Mental / Behavioral Health $ 5,004 0.05% Provider Payment DY1 Physician - Primary Care $ 1,100,000 11.58% Provider Payment DY2 Physician - Primary Care $ 1,055,605 11.11% Chautauqua Alcohol & Sub Abuse Substance Abuse $ 3,214 0.03% Grand Total $ 9,502,201 100.00%
CPWNY Cumulative Distributed Revenue by PPS Project Category DY1 to DY2 Q3 Project Sum of DY1-DY2Q3 Expense Percentage 2.a.i Integrated Delivery Systems $ 2,801,394 29.48% 2.b.iii Emergency Department Triage $ 972,911 10.24% 2.b.iv Care Transitions $ 1,778,600 18.72% 2.c.ii Telemedicine $ 485,224 5.11% 3.a.i Behavorial Health $ 473,677 4.98% 3.b.i Cardiovascular Health $ 418,018 4.40% 3.f.i Nurse Family Partnership $ 620,593 6.53% 3.g.i Palliative Care $ 1,022,455 10.76% 4.a.i Mental, Emotional, Behaviorial Well being $ 457,693 4.82% 4.b.i Tobacco Use Cessation $ 471,636 4.96% Grand Total $ 9,502,201 100.00%
DY3 Budget Starting April 1, 2017
DY3 Budgeted Expenses 4.a.i MEB, 321,353 4.b.i Tabacco, 566,436 3.b.i Cardio Hlth, 146,006 3.f.i NFP, 834,245 3.g.i Pall Care, 1,035,739 2.a.i IDS, 5,903,116 2.a.i IDS 2.b.iii ED Triage 3.a.i PC Behav, 2,175,072 2.b.iv Care Tran 2.c.ii Telemed 3.a.i PC Behav 3.b.i Cardio Hlth 3.f.i NFP 3.g.i Pall Care 4.a.i MEB 4.b.i Tabacco 2.c.ii Telemed, 797,511 2.b.iv Care Tran, 1,159,740 2.b.iii ED Triage, 1,547,024
CPWNY DY3 Budget 2.a.i 2.b.iii 2.b.iv 2.c.ii 3.a.i 3.b.i 3.f.i 3.g.i 4.a.i 4.b.i Care PC & Behavioral Cardiovascular Maternal & Palliative Promote Tobacco IDS ED Triage Transitions Telemedicine Health Health Child (NFP) Care MEB Cessation Total Revenue $1,709,221 $1,364,273 $1,309,740 $1,067,181 $2,507,002 $2,168,706 $2,254,605 $654,692 $659,043 $791,779 $14,486,241 Expense Admin & Implementation $2,511,575 $1,547,024 $1,159,740 $797,511 $2,175,072 $146,006 $834,245 $1,035,739 $321,353 $566,436 $11,094,700 Provider Engagement Payments $1,200,000 $0 $0 $0 $0 $0 $0 $0 $0 $0 $1,200,000 Revenue Loss $982,500 $0 $0 $0 $0 $0 $0 $0 $0 $0 $982,500 Contingency $1,209,041 $0 $0 $0 $0 $0 $0 $0 $0 $0 $1,209,041 Total Expense $5,903,116 $1,547,024 $1,159,740 $797,511 $2,175,072 $146,006 $834,245 $1,035,739 $321,353 $566,436 $14,486,241
Value Based Payment (VBP)
CPWNY Value Based Payment Activity In DY2, CPWNY formed a Valued Based Payment (VBP) Work Group The work group will provide guidance and education around VBP Initial VBP survey sent to partners in DY2 Q3: Assess partner s familiarity with VBP/Contracting for VBP Assess participation (if any) in pay for performance arrangements VBP Education performed at Project Advisory Committee (PAC) meeting Partners encouraged to participate in NYS VBP webinars/seminars VBP Information posted on CPWNY website
CPWNY Value Based Payment Activity Second VBP survey sent in DY2 Q4 with more detailed questions on: Care Coordination Are partners providing onsite Care Coordinators, sharing information with partners, collaborating with non-clinical community based organizations, etc.? Technology and Data Analytics of Partners Determining the use and investment in electronic medical records, telemedicine, clinical decision support, etc. Additional Education needed on VBP Whether partners have completed any recent VBP education or do they require additional education sessions? What issues around VBP are more concerning to the partners?
CPWNY VBP Follow-up Actions CPWNY will utilize the information collected from both surveys to create a more refined VBP plan for providing education and guidance to include: Education/training sessions to meet identified needs from provider survey, such as contracting/risk sharing arrangements, VBP data and analytics and performance measurement, etc. Assistance with interpreting analytic reports and networking to develop relationships between various providers/community based organizations who may have the potential to collaborate in delivering higher value care Collect and provide feedback on emerging trends, challenges and issues with the transition to VBP to share amongst network providers and community based organizations
Questions?
Workforce Update Valerie Putney Director of Programming WNY Rural AHEC
Milestone Update 1. Target Workforce State: baseline report submitted to State 2. Transition Roadmap: baseline report submitted to State 3. Gap Analysis: baseline report submitted to State Workforce Shortages Nursing staff (RN, LPN, Nurse Managers, etc) Mid-levels (PA/NP) CNAs and Direct Care Staff PCP Psychiatrists and Psychologists 4. Compensation and Benefit: First survey result submitted to State 5. Training Strategy: baseline report submitted to State
January 2017 53 Community Partners of Western NY Metrics of Key Job Titles and Relevant Reported Data 8%+ Vacancy Rate Non-Licensed Emerging Job Titles Job Title # Responding Response # Employees # Vacancies Vacancy Rate Organizations Rate Primary Care Physician 24 25% 75 9 12.00% Primary Care Nurse Practitioner 18 19% 40 4 10.00% Psychiatric Nurse Practitioner 9 9% 30 3 10.00% Staff Registered Nurse 47 48% 3,275 128 3.91% Licensed Practical Nurse 52 54% 743 93 12.52% RN Care Coordinators/Case Managers/Care Transitions 22 23% 277 23 8.30% Psychiatrist 11 11% 50 0 0.00% Psychologist 9 9% 43 0 0.00% Medical Assistant 21 22% 208 14 6.73% Social and Human Service Assistants 11 11% 557 40 7.18% Substance Abuse and Behavioral Disorder Counselors 11 11% 309 9 2.91% Nursing Aide/Assistant 20 21% 1,744 224 12.84% Certified Home Health Aide 8 8% 730 45 6.16% Personal Care Aide 8 8% 1,104 188 17.03% Licensed Clinical Social Worker 18 19% 92 12 13.04% Bachelor's Social Worker 20 21% 120 1 0.83% Licensed Master s Social Worker 22 23% 254 25 9.84% Social Worker Care Coordinator/Case Manager/Care Transition 16 16% 144 3 2.08% Care Manager / Coordinator 23 24% 335 15 4.48% Care or Patient Navigator 9 9% 53 11 20.75% Community Health Worker 14 14% 219 13 5.94% Peer Support Worker 7 7% 55 8 14.55% Most Common Reported Degree Requirement for Non-Licensed Care Coordination Positions: Unreported
January 2017 54 Summary Snapshot: High Vacancy Rates by Job Title Number of PPSs with 8%+ Vacancy Rates, by Job Title Job Title # of PPSs with 8%+ Vacancy Rate Primary Care Physician 12 Primary Care Nurse Practitioner 16 Psychiatric Nurse Practitioner 17 Staff Registered Nurse 8 Licensed Practical Nurse 8 RN Care Coordinators/Case 11 Managers/Care Transitions Psychiatrist 13 Psychologist 4 Medical Assistant 8 Social and Human Service Assistants 5 Substance Abuse and Behavioral 7 Disorder Counselors Job Title # of PPSs with 8%+ Vacancy Rate Nursing Aide/Assistant 9 Certified Home Health Aide 5 Personal Care Aide 6 Licensed Clinical Social Worker 14 Bachelor's Social Worker 3 Licensed Master s Social Worker 9 Social Worker Care Coordinator/Case 6 Manager/Care Transition Care Manager / Coordinator 8 Care or Patient Navigator 12 Community Health Worker 9 Peer Support Worker 16 Fewest PPSs Most PPSs Note: Only 23 PPSs submitted vacancy rate data
Happening now Collecting DSRIP Year 2, Quarters 3 and 4 spending data Collection of Compliance Attestations: used to acknowledge rules, polices, and procedures included in the Community Partners of Western NY Compliance Program Tracking training data to update Training Strategy report Communication Plan for the Governance Milestone 9: will be approved and ready for submission by end of DSRIP Year 2 (March 31, 2017) Year 3 Compensation and Benefit Survey: Projected roll out is late summer (August/September)
Questions?
DSRIP Project Advisory Committee Meeting March 29 th, 2017 HEALTHeLINK Update
Agenda HEALTHeLINK Overview Consent overview HEALTHeLINK Services CPWNY Engagement Partner Organizations CBO 58
Who is HEALTHeLINK? Better Health HEALTHeLINK is the Western New York Clinical Information Exchange. HEALTHeLINK was created to enable the exchange of clinical information in secure and meaningful ways to improve both efficiency and quality, while also helping to control health care costs. HEALTHeLINK allows doctors, with patient consent, to access a patient's clinical data electronically, this allowing the data to follow the patient to whatever health care setting he/she goes to within the eight-counties of Western New York and now across New York State. Because of this, physicians have the ability to query data on patients regardless of where they were treated previously. Better Care Lower Costs 59 59
Health Information Exchange (HIE) The Noun 60 60
What is the SHIN-NY? SHIN-NY is the Statewide Health Information Network for New York. The network of network for Health Information Exchange (HIE) in NY HEALTHeLINK is the certified Qualified Entity (QE) and the western most node of the SHIN-NY supporting 8 counties A collaboration between the QE s, New York ehealth Collaborative (NYeC), and NYS DOH that establishes the governance, policy, technology standards and framework for HIE in the state Statewide Patient Record Lookup now enabled 61
HEALTHeLINK Data Sources Hospital Systems Bertrand Chaffee Brooks Memorial Catholic Health System * Eastern Niagara Hospital ECMC * * Jones Memorial Hospital Kaleida Health System *testing images Lakeshore Hospital Medina Memorial *testing images Mount St. Mary s Hospital Niagara Falls Memorial * * Roswell Park Cancer Institute UMMC/Batavia Upper Allegheny Health System/Olean WCA of Jamestown Westfield Hospital Wyoming County Community Hospital Home Health Agencies Advantage Home TeleHealth Catholic Health/McAuley Seton Home Care Visiting Nursing Association Willcare * Radiology images NOT available * * EKGs ARE available Can deliver images to connected EMRs 62 Regional Radiology Providers Buffalo MRI Dent Neurologic Diagnostic Imaging Associates Great Lakes Imaging Seton Imaging Southtowns Imaging Spectrum Radiology Associates Windsong Radiology Group WNY Imaging Regional Reference Labs ACM Genetic Diagnostic Laboratories Quest Diagnostics X-Cell Laboratories Long Term Care Facilities Beechwood Continuing Care Briody Health Care Facility, LLC Brothers of Mercy Heritage Ministries Medication History Resources Surescripts (rolling 13 months) Buffalo Pharmacy Physician Practice Data Refer to www.wnyhealthelink.com for list 6/22/16 62
Consents by Age Group 63 6/22/16 63
Cultural Diversification Availability of Consent forms English Spanish Arabic Russian Polish Burmese Nepali Bengali Somali Karen 64
HEALTHeLINK Services Consent required Patient Record Look-Up Clinical records from local data sources Practice data collected via CCDs Radiology images No Consent required Interoperability Results Delivery (Including IERD) CCD at the close of an encounter Secure Messaging Medication History via Surescripts Additional data from statewide (SHIN-NY) and national (VA) patient record look-ups Alert Notifications Subscribe to patients Configure event profile Receive event notification Data Repository / Analytics Community data aggregation Data standardization / content validation Specific data extracts (ACO, PPS) Population analytics and metric reporting 65 65
Patient Record Look-up Medication History Laboratories SHIN-NY Hospitals Radiology Centers Physician 66
Real time alerts to providers when a patient is admitted to or discharged from a hospital Facility Admission or Discharge ADT - Admit - Discharge - Transfer HEALTHeLINK Alerts (Notify) Establish Patient Relationship (Subscribe) Care Coordination Systems, Health Homes, ACOs, Practice Care Coordinators 67 67
Results Delivery Eliminates the need for faxes, manual scanning, and attaching clinical records to the patient s electronic chart. Order Test Upload Clinical Results Results Delivered to EMR 68
Patient Data at the close of an encounter EMR Query of datafuture C-CDA Upload EMR Query C-CDA Upload EMR 69 69
Participation Status- CPWNY Partners Partner Class Total Partners HEALTHeLINK Participants % Patient Attribution % Tier 1 135 125 92.6 83.2 Tier 2 91 67 73.6 14.4 Tier 3 316 165 52.2 2.4 Tier 1: All PCP with > 0 Attribution, All other groups with >200 attribution Tier 2: All remaining groups with > 20 Attribution Tier 3: All remaining groups 70
Tier 1 Partner Engagement 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% Percent of Tier 1 Partners Engaged HEALTHeLINK Service 71
Partner Engagement with HEALTHeLINK (125 Tier 1 Participants) 0 Services 1 Service 2 Services Number of Participants 3 Services 4+ Services 0 10 20 30 40 50 60 72
Questions?
Transportation Panel Discussion KELLY DIXON, PRINCIPAL PLANNER GREATER BUFFALO NIAGARA REGIONAL TRANSPORTATION COUNCIL MARY K. COMTOIS, DIRECTOR OF HEALTH INITIATIVES, UNITED WAY OF BUFFALO & ERIE COUNTY
Greater Buffalo Niagara Regional Transportation Council Interagency transportation group which establishes transportation plans, policies and program for the region. Provides a regional decision-making forum for the development of a multimodal, integrated transportation system.
CHALLENGES Graphic via: Streetsblog, P. Fleisher, Empire State Futures, Joe the Planner
Collaboration and Coordination A plan that makes Buffalo Niagara competitive and sustainable 5 Focus Areas Land Use and Development Transportation and Mobility Housing and Neighborhoods Food Access and Justice Climate Change Action
Community Development Manager - KeyBank Buffalo Urban Development Corporation Niagara Wind & Solar Food for All City of North Tonawanda Community Development Department Village of Williamsville Jaeckle Fleischmann & Mugel, LLP Western New York Land Conservancy Hearts and Hands: Faith in Action Southtowns Rural Transit Corporation Inc. Buffalo CarShare Coalition for Economic Justice Singer Farms Cornell Cooperative Extension Alden Chamber of Commerce Erie County Department of Environment and Planning Town of Amherst Planning Department Niagara Falls Office of Community Development NYSERDA ReNU Niagara USA Niagara PUSH Buffalo University District Community Development Association Clean Air Coalition Uniland Development Buffalo Niagara Builders Association Erie County Water Authority Growing Partnerships Steering Committee Working Teams Engaging the private sector, local government officials and members of the community Greater Buffalo-Niagara Regional Transportation Council (GBNRTC) Erie County Niagara County City of Buffalo Niagara Frontier Transportation Authority (NFTA) City of Niagara Falls Niagara Falls Housing Authority VOICE Buffalo New York State Department of Transportation (NYSDOT) Local Initiatives Support Corporation Buffalo University at Buffalo Regional Institute and Urban Design Project (UBRI/UDP) Association of Erie County Governments Niagara County Supervisors Association Daemen College Center for Sustainable Communities and Civic Engagement The John R. Oishei Foundation Buffalo Niagara Medical Campus Belmont Housing Resources for WNY, Inc. Buffalo Niagara Partnership Empire State Development Niagara County Department of Social Services WNY Environmental Alliance Buffalo Niagara RiverKeeper
WHAT THE DATA TELLS US We are developing our land at a staggering rate while losing population in our region. Population loss, 1970-2010 Urbanized Area growth, 1970-2010 Since 1970, our region has sprawled without growth, with implications to our built environment, tax burden, economy, and infrastructure. Source: US Census, 1970, 2010
Source: US Census, 1990, 2010; NYS Comptroller s Office WHAT THE DATA TELLS US
Source: US Census, 1970, 2010 WHAT THE DATA TELLS US
Source: GBNRTC, 2011 WHAT THE DATA TELLS US
Provides the framework for improving transportation services for persons with disabilities, older adults, individuals with lower incomes. Strives for communities to coordinate transportation resources provided through multiple sources.
Identifies geographic and nongeographic gaps in transportation service based on a demographic assessment profile of the two- County area.
Categories - Geographic Gaps Service Time Gaps Information/Awareness Gaps Capacity/Resource Gaps 87
Serves as a mechanism for Section 5310 Enhanced Mobility for Seniors and Individuals w/disabilities Grant Program. NYSDOT Public Transit Division in Albany administers this program
Funding to support vehicle acquisition and provide operating assistance for non-profit organizations Grant distributed annually with at least 55% of funding directed to vehicle (capital) projects.
Smart Growth and investment in existing communities when it comes to how we use our land and where development occurs Promotion and education on transportation options (public transit, ridesharing, bikesharing, etc.) 90
gobuffaloniagara.org
gobuffaloniagara.org
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Go Buffalo Mom DSHRIP Community Partners of WNY Buffalo, NY March 29, 2017
Goal Helping low income pregnant moms get to medical and other appointments will help them meet their goal of a healthy baby.
USING DATA & RESEARCH Preterm Birth Rate Buffalo, 11.4% Rochester, 10.2% Syracuse, 9.0% LISTENING TO CUSTOMERS Women Lacking Prenatal Care in 1 st Trimester 28.2% New York, 8.9% Yonkers, 9.0% Transportation is a key barrier
Buffalo & Erie County City of Buffalo population is 258,959 More than one in two residents lack financial stability: over 30% (75,830) live in poverty 136,574 indicate they are struggling financially
A Unique Cross-Sector Partnership Assessing costs and needs for the program Collect, analyze, and share program data Health Systems Private Insurance Plans Medicare/Medicaid
Human Centered Design Thinking a systematic approach to problem solving. It starts with customers and the ability to create a better future for them. It acknowledges that we probably won t get that right the first time. Design insists that we prepare ourselves to iterate our way to a solution. Designing for Growth: a design thinking tool kit for managers (2011)
Early Research Interviewed 47 pregnant mothers and mothers with young children in clinic waiting rooms and non-profit agencies. Typical transportation issues of bus unreliability, trip length, and affordability are further complicated by pregnancy and growing families.
Savings Behavior The goal is to use existing voucher savings programs to enable young families to afford unlimited monthly transportation passes. Eligible families establish a bank account, review their financial status, attend financial education, and agree to a savings structure. The program will also help build relationships with mainstream financial institutions willing to incentivize financial stability at the prospect of holding future mortgages or loans for clients.
Go Buffalo Mom Customer Desirability Assumptions Outcomes are valued enough by customers to attract participation in savings program. Program requirements match customer commitment level. The savings matching structure is attractive to customers. The incentives appeal to customers Transportation passes are affordable.
Go Buffalo Mom Determining Prototype Existing savings program in place. Feedback required on current transportation expenditures and savings behavior was fairly specific. Based on these factors, a more traditional survey questionnaire was determined to be the best instrument approach.
Transportation Options Personalized trip planning and education program to provide low income, pregnant women with information on access to alternative transportation options. Features a transportation navigator to meet with pregnant women to initially assess their trip needs to develop an individualized trip options plan. Navigators will build the capacity of families to plan trips that are the least expensive, most reliable, and shortest route.
Go Buffalo Mom Customer Desirability Assumptions Low-income Buffalo mothers will be interested in participating in the program Patients will feel the program is needed. The user will be willing to participate in an initial assessment. The first meeting will take place in a comfortable setting for the patient. The navigator will provide an initial plan and follow up.
Go Buffalo Mom Determining Prototype Navigator and personal trip plans key components of program. Storyboard approach was workable for this concept. Cover major points of the program through pictures. Different choices in how customers want to interact with the navigator, receive information, etc. makes this approach very person-centered.
Go Buffalo Mom
GO Buffalo Mom Connect via: with Navigator Create personalized transportation plan Learn and save
Go Buffalo Mom
Go Buffalo Mom
Each premature baby costs employers an additional $49,760 in newborn health care costs. When maternal costs are added, employers and their employees pay $58,917 more. In Buffalo and Erie County, over 1,150 infants are delivered pre-term annually. Cost Savings Over 1 Year ~$59,000
18 Month Pilot Program ~$610,000
TEN BABIES
Questions Kelly Dixon, Principal Planner Greater Buffalo Niagara Regional Transportation Council kdixon@gbnrtc.org Mary K. Comtois, Director of Health Initiatives, United Way of Buffalo & Erie County mary_k.comtois@uwbec.org
Wrap Up RFP Link and Questions
THANK YOU!