Broad Scale System Integration STARS System Transformation with Accountability, Results and Satisfaction

Broad Scale System Integration STARS System Transformation with Accountability, Results and Satisfaction TRC s Readiness and Proposal for Health Care Reform Capabilities Statement 2013 Contents Executive Summary...2 Part 1: TRC STARS A Model for Broad Scale System Integration...3 Part 2: The Resource Center Background and Capabilities...7 Part 3. Considerations and Requirements... 12

EXECUTIVE SUMMARY Why STARS? The Affordable Care Act has ensured opportunities to achieve the Triple Aim for better health, better healthcare and greater affordability. The Resource Center, a Safety Net provider is aligned to integrate and operationalize the essential values and functions of the Affordable Care Act by implementing STARS to ensure a new care system is built on integration instead of fragmentation, along with satisfaction, quality and savings. STARS incorporates the expressed aims of the Affordable Care Act for achieving the Triple Aim in conjunction with the critical social determinates of health. What is STARS? The Resource Center (TRC) has developed and is implementing a Broad Scale System Integration model called STARS, which stands for System Transformation with Accountability, Results and Satisfaction. STARS embodies TRC s vision for care delivery and coordination which moves from segregated thinking to an integrated plan for system support that yields better outcomes. STARS is predicated on the Collaborative Care model that includes the provision of mental health, behavioral health and substance use services in primary care. The Agency for Healthcare Research and Quality (AHRQ) indicates the key features of the Collaborative Care models are: Integration of mental health professionals in primary care medical settings, close collaboration between mental health and medical/ nursing providers and a focus on treating the whole person and whole family. The TRC STARS Model is focused on combining the principles of the Collaborative Care model partnered with the Match Model (Kindig) which proposes that the Triple Aim must be paired with multiple determinates, most of which are beyond health care such as social and economic factors, physical environment. The TRC STARS model includes 5 Key Life Dimensions; Health, Behavioral Health, Family Stability, Basic Needs, and Employment. STARS has three central components which include Integration of Team, Plan and Information Technology. Why TRC? The Resource Center (TRC), operating for over half a century as Chautauqua County s leading Safety Net provider, touches over 10 % of the county population at the margins of system dependence by providing an array of comprehensive services and supports including health, mental health and employment services. Because of this comprehensive array of supports and services, TRC is uniquely positioned to accomplish true integration of systems and to drive results for better health, better access and reduced costs. How? TRC has defined 5 Required Strategies that will need to be undertaken to move forward with implementation of Broad Scale System Integration: 1. Integration of STARS Model to include assessment, diagnosis, assessment, and planning in all 5 key life dimensions for individuals and families 2. Research and evidence based moving from current fee-forservice payment to capitated managed care 3. Integration of various providers, extenders, and supports within TRC and the community to include Co-location of key services 4. Integration of all required systems operations, electronic records to include Data Warehousing & Call Center capabilities 5. Integration of various community assets leveraged to better support individuals and reduce costs Time Frame? TRC will strive to implement Broad Scale System Integration over the next 5 years in a 3-Phase process. 2

PART 1. FOUR KEY DIMENSIONS FOR BROAD SCALE SYSTEM INTEGRATION: 1.) Full Integration of STARS Where every individual can become a star The Resource Center has developed a Broad Scale System Integration approach known as STARS, which stands for System Transformation with Accountability, Results and Satisfaction and is intended to reflect the capabilities of TRC under a reformed delivery system. STARS incorporates personal goal attainment with primary healthcare, medical needs with mental health needs, family stability, employment and basic food and shelter needs, along with ensuring satisfaction, quality of life and community inclusion. TRC proposes to: provide health and support needs, personal aspirations, ensuring personal goal and outcome attainment through comprehensive screening and assessment. integrate person-centered services and supports with healthcare treatment within a broader biopsycho-social model which includes all 5 key life dimensions. partner with other support systems, healthcare, education and community support organizations to ensure continuity and comprehensiveness of service. strengthen the focus on independence, selfsufficiency as well as health education and selfcare. In order to achieve improved outcomes the STARS model will provide effective comprehensive supports to an individual. There will be a focus on and subsequent planning in all 5 key life areas. Each point of the star represents a key life dimension that TRC will focus on through an initial assessment that will identify need areas * Basic Needs * Family Stability * Health & Medical Needs * Employment & Meaningful activities * Behavioral Health Each of the 5 key life dimensions has an evidence based practice and measure related to ensuring not only effective and efficient service implementation and delivery, but also measurement of progress, quality and satisfaction. The chart below outlines some of the initial evidence based tools and practices that are being piloted to ensure the 5 key life dimensions are identified, supported and progress is measured. Measure Life Dimension Scale Supports Intensity Scale Healthcare Effectiveness Data and Information Set (HEDIS) Council on Quality and Leadership (CQL) Purpose 1st layer of identification to initiate plan development Develop a baseline across all dimensions, target interventions, measure progress Measure performance on important dimensions of care and service. Measure and improve the quality of life integrate information and data flow through a software overlay to existing electronic records related to residential, day services, employment and health, mental health and any related services. This will include management and administrative data systems, creating robust reporting and a real time care-management dashboard. Social Capital Scale Family Resource Scale Measure community inclusion Measure family resources track all related costs to yield a profile based clustering of outcomes obtained and related cost expenditures. 3

Another key aspect of the STARS model is that it exceeds current thinking regarding integration and pushes it to the next level. TRC recognizes that for a population that has needs that most typically exceed traditional health care service models, the Broad Scale System Integration that TRC is proposing will far exceed what others have started designing. Integral to TRC s design are three critical infrastructure components which are designed into this model: * Integrated Team * Integrated Plan * Integrated Information Systems Architecture and Infrastructure STARS The 5-Point Solution Basic Needs 4. TRC is positioned to track costs, drive results and demonstrate cost savings 2.) Co-Location Integration of medical, dental, mental health and substance abuse services that includes social service and vocational supports is consistent with the various activities being supported by Federal and State initiatives and the Collaborative Care Model. The Resource Center has been strategically aligning itself for many months to respond to these proposed systemic changes and is well positioned to do so. The Resource Center has embarked on a Capital Campaign to help support the renovation and relocation of services, as well as an internal and external campaign aimed at educating the community with regard to the services offered and the struggles we face in the sustainability of the programs. Family Stability Integrated Team Integrated Service Plan Integrated Information System Health and Medical Planning has revolved around not only integrating existing services, but developing new, more comprehensive, patient-centered services such as adding a Care Coordinator to help ensure that the needs of patients are examined from a whole person perspective to include the entire family and other natural and community supports. Also, TRC is adding on-site services, such as diagnostics, in order to improve convenience for patients and enhance follow-through on needed services. Behavioral Health Employment Additional components for this high degree of integration, which is crucial to the overall success of the STARS model, include a global budgeting resource allocation process and ensuring information & data management. These enhanced components of the integrated STARS model will have to be captured in order to break down the current silos that exist with service delivery. In order to meet these increased demands, it is critical that TRC move forward with Co-location of key services for improved access and outcomes along with reduced costs for provision of care. In order to remain a viable provider of health and healthrelated services, TRC must not only ensure that they successfully meet the new regulatory and best practice initiatives that are part of Federal and State initiatives, but must also fully and effectively integrate their mental health, health and health-related services along with their social and vocational services. Core Characteristics of Model: What s Different? 1. Integration of Managed Long Term care and traditional OPWDD services along with Health, Behavioral Health, Employment services and supports 2. Quality of Life Measures 3. Care Management for all 4 The future of TRC as a significant provider of a fullyintegrated and comprehensive provider of health, healthrelated and mental health services is very encouraging. The agency commitment is strong and, as long as efforts to get much-needed community and financial support are maintained and successful, the future of these services will be positive. Much of the emphasis on consolidation and integration of services is driven by the need for providers to better

understand and address the needs of patients in order to improve not only their medical outcomes, but also their life outcomes. Because of the wide array of health and health-related services, combined with employment, care coordination, social work, early intervention, schoolbased health, traumatic brain injury and behavioral health, TRC is uniquely positioned to respond to these initiatives and to integrate services in an effort to better meet the needs of the community. Co-location plans include the integration of waiting rooms and registration staff. The sharing of resources in this manner will lead to reduced overall expenses for all programs involved in the co-location project. These expenses include personnel as well as expenses associated with rent and utilities. Co-located services may also ease some of the transportation burden both on the part of The Resource Center and on the part of the patients. Improved patient follow through is one of the many expected benefits of this project that can also potentially lead to enhanced reimbursement and improved patient health. employment, assistance with securing or maintaining benefits and effectively working with other systems of care. 3.) Data Warehousing & Call Center TRC has extensive investment in Electronic Systems within each service area that are specialized and comprehensive to fit the particular needs of the specific client, funder and regulator. Not satisfied with these typical EMR systems within each silo environment, The Resource Center is planning to move into a Data warehousing solution that could fully integrate all services being received by our service recipients. A Data Warehouse solution would allow for comprehensive integration of all data and information on individuals served by multiple programs within the organization. Furthermore, through our affiliation with our local Rural Health Information Organization (RHIO), TRC will enhance healthcare delivery and outcomes by ensuring that information from all resources associated with our recipients is incorporated into their main record. The proposed project also involves the potential expansion of services to include supportive diagnostic services such EKGs, EEGs, uncomplicated surgical interventions and pathology, therapeutics, and smoking cessation. Integration and co-location of medical, dental and mental health services at The Resource Center needs to be a top priority as a means of maximizing financial incentives that are being made available, as well as allowing The Resource Center to be able to keep up on current trends in health and mental health treatment that are consistent with improved patient outcomes. In addition, co-location will allow for expansion of services consistent with identified needs of the dental and primary care programs. All of these factors will help in enhancing the sustainability of the programs and services. Additional benefits of co-locating services include improved efficiency of staff and reduced operating expenses. Co-location will have a positive impact on patient outcomes and follow through, thereby directly enhancing quality measures and insurance incentive payments. Future development of this service site should include the addition of ancillary services such as Occupational Therapy, Physical Therapy, Speech Therapy, Neurology and Podiatry. Additionally, vocational services will be integrated into the service system along with benefits and financial navigation to assist individuals seeking 5 Key Aspects of Data Warehousing include: Congregate data from multiple sources into a single database so a single query engine can be used to present data. Mitigate the problem of database isolation. Integrate data from multiple source systems, enabling a central view across the enterprise. This benefit is always valuable, but particularly so when the organization is diverse with multiple, seemingly unconnected systems. Improve data quality, by providing consistent codes and descriptions, flagging or even fixing bad data. Present the organization s information consistently. Provide a single common data model for all data of interest regardless of the data s source. Restructure the data so that it makes sense to the business users. Restructure the data so that it delivers excellent query performance, even for complex analytical queries, without impacting the operational systems. Add value to operational business applications. In addition, TRC is seeking to explore Call Center capabilities. TRC offers diverse services and maintains operations at a variety of sites at a variety of times.

Many of our sites, including the Primary care, Dental and Mental health offices, experience heavy influx of telephone calls, with phone lines becoming congested based upon customer need. Customer transactions can suffer because of wait times, complexity of calls and the triage of incoming calls. Developing Call Center functionality can provide TRC essential benefits and a very positive return on investment. The main benefits of a Call Center include: Enhance customer relation Improve efficiency Minimize expenses Display statistics Better communication handling Hospitals COMMUNITY PARTNERSHIPS WCA Brooks Memorial Westfield 4.) Community Partnerships: Key to Success The Resource Center has a significant presence in the community and recognizes that community collaborations are paramount to the success of its programs. Whether formal or informal, we see community partners as instrumental in helping us to meet the needs of those we serve. The innovations anticipated in our proposal continue this tradition of working with other key community agencies and services in creating a truly integrated and pioneering compendium of services meant to improve the overall health and wellness of those we serve. Although The Resource Center already has significant programmatic and service resources from which to draw, we see the development and enhancement of community partnerships as an important aspect of the success of the proposed model. TRC must develop strong networks of collaborations, partnerships and networks to move into the future. TRC must actively engage key community partners in more formal relationships with clearly stated and agreed upon expectations, understandings and agreements. TRC must continually tell our story and be a part of the broader community. TRC plans to seek financial support for Broad Scale System Integration. Hospice Long-term care Regional Behavioral Health Organizations Health Homes Chautauqua County Lutheran New York State Care Coordination Beacon Light Home Health Care New Vision Services Inc. Community Agencies Time Frame: Chautauqua Opportunities Catholic Charities TRC anticipates that the Broad Scale System Integration as described will involve at least 5 years to implement and has developed a 3 phase approach: Phase 1 - Continuation of current STARS initiatives from the last 3 years preparing for full implementation. Phase 2 Key Milestones: Ensure sustainability of Care Coordination and STARS Projects Integration of teams and systems Solidify decisions regarding data warehousing, call center and enhanced co-location Define Developmental Research and evaluation component Phase 3 Begin to interface with Managed Care environments for sub-capitation and potential capitation. 6

PART 2: THE RESOURCE CENTER Background The Resource Center has a long-standing reputation in the Chautauqua County Community as an innovative and comprehensive provider of services to a wide variety of populations. With a successful fifty-four year history, The Resource Center s primary focus has been on managing the often-complex needs of individuals with disabilities and their families. Agency Founded, expanded county-wide First Vocational Services, total of 30 recipients The organization began as a grassroots organization founded in 1958 by a small group of parents looking for help in meeting the needs of their children with disabilities. TRC quickly expanded from serving 5 individuals in a storefront location to now serving over 17,000 individuals at multiple sites across Western New York with a current operating budget in excess of $90 million. TRC draws upon a talented and dedicated Board of Directors consisting of a majority number of family members of persons with disabilities, as well as various community leaders and others. Today TRC employs more than 1600 individuals and is a leader in the community. TRC s estimated economic impact is over $200 million annually. First community residence, Day Treatment established Dental services, Pharmacy established First Health- Related Services Residential and Day Treatment expansion Now serving individuals in a three-county area spanning more than 4,000 square miles, major milestones celebrated by The Resource Center include attaining work center revenues in excess of $50 million, achieving Level 3 Patient Centered Medical Home status in early 2012 and reaching a level of services that touches the lives of nearly 15% of the residents of Chautauqua County. The steady and continued development of The Resource Center is illustrated in the timeline: Psychiatric Services, Primary Care Expansion of employment and business enterprise Pioneer in 1115 Waiver Services & Health Care Reform Level3 PCMH, Serving 17,000 individuals 7

KEY ORGANIZATIONAL CAPABILITIES The Resource Center provides an array of comprehensive services from three primary funding sources OMH, OPWDD and DOH. DOH # Served Profile School Based Health Primary Care & Podiatry Dental Services 4,378 Health Related OT, PT, Speech Audiology Pharmacy 1,625 *Traumatic Brain Injury Waiver *Nursing Home Transition and Diversion Waiver *Licensed Personal Care 695 Middle and high school age students 6,000 Youth, Adults and Seniors with disabilities, medically fragile conditions and behavioral concerns, 730 including dual Mental health Veterans, migrant workers, general population. 22 Adults living at home with a TBI 4 Adults living at home with disabling conditions 27 Adults with a disability living at home *Provided through an affiliated corporation OMH # Served Profile OPWDD #Served Profile Supported Employment Pre-Vocational 106 Medicaid Service Coordination (MSC) Consolidated Supports and Services (CSS) Fiscal Management Services (FMS) Family Education and Training (FET) Chart Continued Employment and Business Enterprise: Supported Employment 85 Youth and Adults with intellectual and developmental disabilities 593 Youth, Adults and Seniors wit intellectual and developmental disabilities 19 Youth and Adults with intellectual and developmental 2 disabilities 17 Families of children with intellectual and developmental disabilities #Served Profile 215 Youth & adults with disabilities OPWDD & ACCES-VR Allied Industries 420 Adults with and without disabilities Government contracting 160 Personalized Recovery Oriented Services (PROS) - 2 sites Counseling & Psychiatric Services ( Article 31) 206 Individuals with mental illness, substance abuse disorders, disabled, veterans, general 987 community population, children, adults As a dynamic organization with significant capabilities to provide a full array of comprehensive services, The Resource Center is well positioned and eager to prove our capabilities as a leader in system transformation. Chautauqua County Jail 400 Inmates OPWDD #Served Profile Residential IRA & ICF Family Care Day Habilitation 425 Senior Adult Day Habilitation Article 16 OT, PT, Speech Waiver Respite 123 Community Habilitation 263 Youth, Adults and Seniors with intellectual and developmental disabilities, medically fragile conditions and 31 behavioral concerns, including dual diagnosis 146 Children, Youth and adults with intellectual and developmental disabilities, medically fragile conditions and 76 behavioral concerns, including dual diagnosis. Services provided in home or community 8 A major component of TRC readiness for Broad Scale System Integration is the fact that we operate a variety of health and health related services that will easily allow individuals to not only access needed services and supports but will also create the platform for integration among traditional long term, community based OPWDD supports and services and health, health related and mental health supports and services. Incorporating new and emerging populations into our existing framework is something we look forward to and are expert at executing. We are prepared to develop new ways of delivering services to individuals in need of improved access, better quality and fully integrated care. The Resource Center has been and continues to be a leader with new initiatives and opportunities.

Care Coordination One of the developing strengths of the organization lies in the area of care coordination, which is instrumental in many of the current, quickly evolving initiatives. TRC has invested in a care coordination model to provide enhanced coordination between existing traditional service environments within our Diagnostic and Treatment Center and mental health services programs. The goal is to ensure that individuals served within those programs, and agency-wide, are given every opportunity to improve their lives and their contributions to society. By developing linkages with all programs operated by The Resource Center, as well as a comprehensive array of community resources, the Care Coordinators assist individuals with needs in all areas of their lives including vocational, medical, dental, mental health, family, and social. Care Coordinators have a significant role in the Broad Scale System Integration of the STARS model by providing necessary guidance and oversight of the personal development planning process for identified service recipients. NYS Regulatory Competence The Resource Center has a high degree of competence and confidence working in diverse regulatory environments. The chart below summarizes the wide variety of programs and associated regulatory bodies within which The Resource Center currently operates. Regulatory Affiliation Department of Health (DOH) Office for People With Developmental Disabilities (OPWDD) Program School Based Health Programs Diagnostic and Treatment Center TBI Waiver Residential IRA & ICF Respite Community Habilitation Article 16 Senior Adult Day Habilitation Implemented: Care Coordination and Management Strategies Supported Employment Pre-Vocational Day Habilitation Patient Centered Medical Home level 3 Multidisciplinary care teams Disease registries Piloting: Office of Mental Health (OMH) Article 31 Outpatient Clinic PROS Programs Jail Program High-risk and complex care management programs Home care for high-risk recipients Discharge management systems Fully integrated Care Coordinators Developing: Co-location of medical, dental, social work, vocational and mental health services with on-site care coordination Administrative support and capabilities The Resource Center has significant capability and investment made in an array of support departments including Staff Training, Human Resources, Information Systems, Finance, and a Quality Assurance division. These support departments play a crucial role in the success of the programs and services offered and will have a critical function in this proposed service delivery system. Human Resources - Training and Workforce Development: The total number of individuals employed by the agency exceeds 1,600. The organization has extensive human resource capabilities including a comprehensive stafftraining program that includes mentoring and coaching, supervisory training and a significant continuing education program. TRC ensures that staff will be appropriately placed in areas that emphasize their strengths by using the Lominger Talent Management system. 9

Human Resources and Staff Training Capabilities Health Information Technology (HIT) Capabilities Implemented: Comprehensive staff training department Lominger talent-management technologies Staff mentoring and coaching Professional development processes including tuition reimbursement programs Physician orientation process Complex electronic data management of human resource information Significant supervisory and leadership training Piloting: Competency based performance reviews Health Information Technology Assets & Record Implementation: The chart below shows the various electronic record (EMR) systems and the significant investment TRC has made to electronic record management area for clients. Health Information Systems Therap Service / Support Area Residential- IRA & ICF Day Habilitation Implemented : Integrated electronic medical & client records Predictive modeling to identify high-risk recipients Provider portal for disease management and prevention Electronic billing Linkages with local RHIO Piloting: Clinical messaging Practice management and clinical dashboards Developing: Patient portal Data warehouse Finances The Resource Center currently has a budget of over $95 million. TRC s current financial viability is very strong with a fund balance of $12.4 M, a current ratio of 1.6 and acid test ratio of 1.0. The agency has an extensive working line of credit of $8.5M and an additional line of credit of $5M for business and enterprise related activities. For the past five years, the average daily borrowing on the line of credit has decreased each successive year. Libera Allscripts Anasazi Epicor Ultipro Kronos Article 16 Respite Community Habilitation MSC Employment Services Diagnostic & Treatment School Based Health Center Health Related Services Article 31 Mental health PROS Finance WorkCenter Human Resources / Payroll Human Resources / Payroll With vast experience billing in a variety of regulatory and reimbursement environments, The Resource Center s financial management division has developed a level of sophistication. Managing the complexities of APGs, Managed Care and a variety of other payers, as well as, providing significant financial analysis and reporting in order to maintain the effective management and oversight for the more than 60 programs and locations operated by the agency, The Resource Center s Finance Department is wellqualified and prepared to use its expertise to support this proposal. TRC has demonstrated continued growth over the years as illustrated in the revenue charts below. The organization has the capability, proven track record and strong desire to continue to be a leader in innovation and service delivery. 10

DOH and OMH Revenue OPWDD Revenue team-based approach to provide health care. This model is consistent with best practices associated with the newly emerging populations that would be served within this proposal. As a potential leader in the reform of the health care system, The Resource Center is actually capable of establishing best practices that can be emulated and replicated by programs in other regions. The flexibility afforded the agency through these newly developing service guidelines provides the exact medium within which the agency thrives and will permit the maximization of the vast resources we have to offer to those we serve. The table below shows the capacity and strength of the agency in terms of continuing to move in the direction of providing accountable care to all populations currently served as well as to emerging populations: Quality and Performance Improvement Strategies Implemented: HEDIS Physician-led care teams Guided care nurses Use of disease registries PCMH Level 3 Recognition TRC Agency Wide Revenue Piloting: Meaningful Use Discharge nurse CQL Measures Supports Intensity Scale Corporate Compliance and Legal: Quality Assurance and Quality Improvement The Resource Center has a centralized Quality Assurance department that provides oversight and policy guidance in all the program environments operated by the agency Demonstrative of The Resource Center s commitment to quality, our Diagnostic and Treatment Center Health Services was recently recognized as a Level 3 Patient Centered Medical Home. The Resource Center s Health Services is a highly capable, physician directed and The Resource Center is dedicated to managing and operating its programs in keeping with the highest business, ethical and moral principals. Each employee agent, member of the Board of Directors, consultant, and volunteer contributes to achieving these principals by conducting business activities for the agency with integrity and high ethical standards. Supervisors and managers also contribute to achieving these principles by exercising exemplary leadership and promoting a workplace environment in which compliance and ethical business conduct are expected. In addition, the department has a Corporate Compliance Officer who works closely with leadership to ensure adherence to all regulatory and other standards of conduct. Our in-house attorney, who oversees 11

contractual relationships and provides legal guidance as needed, also provides support to these efforts. PART 3. CONSIDERATIONS AND REQUIREMENTS FOR THE PROPOSAL: The Resource Center will utilize all current assets and resources to proceed with this proposal. This includes an extensive Information Technology, Financial, Quality Assurance, Human Resource, and Staff Training infrastructure. Required Support to: Expand initiatives and investments relative to individuals requiring multi-systemic interventions and supports and care management for all. Utilize effective intervention, services and supports from key community partners with specific assets and expertise. Achieve overarching systems integration of information technology being utilized for health services, behavioral services and services to support typical residential, day and employment services. Access to all existing cost data to track, monitor and account for all health related services and costs. Ensure analysis, evaluation and system change assessment based on qualification of the three part aim of better health, better health care and reduced costs. CONCLUSION: The Resource Center welcomes the opportunity for additional discussion regarding this proposal and looks forward to ongoing dialogue in order to work together with NYS DOH, OMH and OPWDD to facilitate the personal goal attainment for individuals we support. We invite you to visit The Resource Center and allow us to show our capacity and further outline our expectations and hopes for this initiative. The Resource Center strongly believes that with our broad scope of services and expertise in Health Care and the Developmental Disability Service System, along with the wide array of services and supports in conjunction with our demonstrated capacity for growth and change, that our project redesign proposal will prove to demonstrate efficiency, process and attainment of desired outcomes effectiveness in addition to significant cost saving opportunities to NYS Medicaid and/or Medicare systems of funding. Thank you for your time to review this proposal. For further questions or comments, please feel free to contact: Paul Cesana Executive Director 716-661-1412 Paul.Cesana@resourcecenter.org Ensure collaboration with research, evaluation methods and academia in order to sustain premises, progress and results of TRC STARS Model within a Developmental research approach. Financial Support Required: TRC will be seeking financial support to move forward with each key component of the Broad Scale System Integration plan. Projected costs are outlined on the Project Budget/ Sources and Uses of Funds document. You can visit The Resource Center website at: http://www.resourcecenter.org 12

Project Budget/Sources and Uses of Funds Concept Details Estimated Cost Current Commitments Full STARS Integration Care Coordination $125,000 $25,000 P2Collaboative for SNAPCAP project Integration Pilot projects (Team, Plan) $240,000 $100,000 NYS DOH / OMH via 2013 Budget Appropriation Consultant Support for Practice Management $145,000 Data Warehousing & Call Center Planning and Consultation Hardware & software and Implementation $89,000 $300,000 Call Center Planning and Consultation $80,000 Hardware & software and Implementation $175,000 Co-Location External Façade $400,000 $400,000 Chautauqua Resources Inc. 880 890 E 2nd St. location Internal Re-Design & Integration of Primary Care, Mental Health, Dental and Social Work $800,000 $30,000 The Western New York Foundation new Dental Operatory Research & Academia Support Partner with a University for Research & Evaluation $75,000 Estimate Total for Broad Scale System Integration : $2,429,000 $555,000 Opportunities Under Exploration / Negotiation Vital Access Provider Rural Health Clinic Status Joint Strategic Planning with The Chautauqua Center FQHC July, 2013