Delivery System Reform Incentive Payment (DSRIP) Community Advisory Committee Meeting April 15, 2015 Maureen Buglino, RN, MPH Vice President for Community Medicine & Emergency Medicine
What is DSRIP? Main mechanism by which New York State will implement the Medicaid Redesign Team (MRT) waiver Addresses critical issues throughout the state, allowing for comprehensive reform through an incentive payment process Promotes community level collaborations and focuses on system reform
Goal 25% reduction in avoidable admissions and emergency department utilization in New York State over a five year period amongst Medicaid recipients
How does it work? Safety net providers collaborate to implement innovative projects through a Performing Provider System (PPS) Each PPS has a designated lead There are 25 leads in New York State The selection and application process began last September and was finalized in December Each PPS selected projects from a prescribed list from the NYS DOH All selected projects by PPS are tied back to identified community needs
What makes it different? DSRIP s focus is on collaboration, which forces competitors to work together to meet prescribed goals PPS s composition includes all segments of the health care delivery system Progressive shift in the health care delivery system to a community based model
Community Needs Assessment (CNA) NYHQ engaged in a 4-month comprehensive and collaborative CNA Quantitative research conducted by Premier, Inc. Qualitative research conducted by NY Academy of Medicine Vast amounts of data were collected, refined and analyzed > 90 community members provided invaluable data and feedback 6
Community Needs Assessment (CNA) Summary / Conclusions: Quantitative NYHQ is home to a large diverse population Poverty is an area of concern a large disparity in poverty rates across the service area. Some portions of our service area sees as much as a quarter of their population living in poverty ~1.6M (43%) people in the service area are Medicaid beneficiaries higher than Queens County as a whole, and higher than all of NYC 7
Community Needs Assessment (CNA) Summary / Conclusions: Quantitative Overall mortality rate is low despite the high poverty rate Mortality from cerebrovascular disease and suicide rank higher in our service area than compared to other geographies Morbidity and disease prevalence for cardiovascular disease and behavioral health are a concern. There are almost 300K admissions associated to these two diseases and another 300K ED visits annually in Queens County 8
Community Needs Assessment (CNA) Summary / Conclusions: Quantitative Service area has a high rate of preventable readmissions Demand ratios indicate that the area is not over-bedded in relation to acute care and SNF s Not enough behavioral resources to meet the demand 9
Community Needs Assessment (CNA) Summary / Conclusions: Qualitative Concerns with tobacco and casino industries targeting Asian Americans Stigmas and lack of cultural and linguistic services are challenges to addressing mental health issues Community is supportive of the concept of community health workers, care coordinators, and health educators 10
Community Needs Assessment (CNA) Summary / Conclusions: Qualitative Affordable housing and transportation considered inadequate compared to population growth Lack of recreational areas, lack of time, and fear of public parks due to violence Strong interest in holistic community based services that promote good health Recommend including community residents in making decisions 11
Community Needs Assessment (CNA) Summary / Conclusions: Qualitative Need for quality dental care that is affordable Mental health is an urgent priority, as well as the need to overcome the social stigma in immigrant communities Suicide is considered a major issue 2014 CDC report indicates that suicidal ideation among Latina adolescents in Queens is up from 11% to 20% / suicidal attempts up from 9% to 15% 12
Community Health Challenges Medicaid rate of 43%; much higher than the state Poverty rate is on par with the state but there are large geographic disparities with 23.8% in the Jamaica area Driving costs of long term care / palliative care attributed to Skilled Nursing Facility admissions / re-admissions Heart disease prevalence is higher than in the state The Prevention Agenda goal for new HIV diagnoses per 100K, Queens is twice as high at 22.6 per 100K Project # 2.a.ii 2.b.v 2.b.vii 2.b.viii 3.a.i 3.b.i 3.d.ii 3.g.ii 4.c.ii Chosen Projects Project Description Increase Certification of Primary Care Practitioners with PCMH Certification and/or Advanced Primary Care Models Care Transitions Intervention for Skilled Nursing Facility (SNF) Residents Implementing the INTERACT Project (Inpatient Transfer Avoidance Program for SNF) Hospital-Home Care Collaboration Solutions Integration of Primary Care and Behavioral Health Services Evidence-Based Strategies for Disease Management in High Risk/Affected Populations (Adults Only) - Cardiovascular Expansion of Asthma Home-Based Self-Management Program Integration of Palliative Care into Nursing Home Increase early access to, and retention in, HIV care (Focus Area 1; Goal #2)
DSRIP Timeline Current State Implementation Plan: May 2015 Plan Actualization: April 2015 Scale & Speed: January 2015 Project Plan Application: December 2014
NYHQ PPS: Governing Structure NYHQ Board of Directors NYHQ Lead Hospital PAC Executive Committee Audit Compliance PMO IT Clinical Integration Population Health Management Finance Asthma HIV Behavioral Health Primary Care, Cardiovascular Long Term Care Workforce Communications Cultural Comp & Health Literacy *Sub-Committees & Workgroups will be formed as needed. Community / Stakeholder Engagement Practitioner Engagement 16
Cultural Competency Strategy Addressing Patient Care Delivery Challenges: Partner with CAC to reach out to multi-ethnic populations Create a staff training program incorporating cultural competency and sensitivity into daily work practices Provide industry best practices to ensure high quality service to all patients across the PPS Leverage NIH Clear Communication Tools Leverage current strengths translation services, incorporating ethnic practices into care, web portals in multilanguages, places of worship Align recruitment of new professional providers and clinical support staff with Cultural Competency Strategy Establish a robust Communication Plan to address partner and patient diversity 17
Health Literacy Strategy Addressing Patient Care Delivery Challenges: Investigate other sources of ESL instruction, and work with CAC to plan and deliver ESL to target neighborhoods Monitor Patient Satisfaction Scores relevant to Patient Understanding and Health Literacy Ask Me 3 Principles of Teach Back encourages patients and caregivers to ask questions Provide Educational Materials in pictogram format to improve patient s compliance with medication and selfmanagement Engage community health workers who have similar cultural backgrounds to help with patient navigation and healthcare comprehension Provide guidelines on best practices for the PPS by standardizing evidence-guided tools Leverage existing resources, e.g. NYHQ Chinese Health Initiative, as a tool and guide for providing care to a diverse population 18
Resources Learn more at: www.nyhq.org/dsrippps 19