DSRIP Meeting Agenda Date & Time 8/18/17 @ 9:00 10:00AM Meeting Title IT Clinical Operations Committee Location Go to Meeting NYP Milstein Heart Center Room 4 https://global.gotomeeting.com/j oin/676507237 Facilitator Conference Line Alvin Lin & Elaine Fleck Dial +1 (408) 650-3123 Access Code: 676-507-237 Chair: Elaine Fleck (NYP) Gil Kuperman (NYP) Alissa Wassung (God s Love We Deliver) Susan Wiviott (The Bridge) David Chan (City Drug & Surgical) Jean Marie Bradford, MD (NYPSI) Genevieve Castillo (Methodist) Dan Johansson (ACMH, Inc.) Julissa Nunez (VNSNY) Theo Figurasin (NYSNA) Steven Lam (CBWCHC) Andres Pereira, MD Nelson Mesa (NYP) Isaac Kastenbaum (NYP) Invitees Chair: Alvin Lin (NYC DOHMH PCIP/REACH) Terri Udolf (St. Christopher s Inn) Sandy Merlino (VNSNY) Amy Shah (NYC DOHMH) Maria Lizardo (Northern Manhattan Improvement Corp.) Catherine Thurston (SPOP) Stuart Myer (VillageCare) Renato Leonel (Isabella) Mitze Amoroso (ArchCare) Todd Rogow (Healthix) Priscilla Pena (1199 SEIU) Patricia Hernandez (NYP) Andrew Missel (NYP) Rachel Naiukow (NYP) Meeting Objectives Facilitator Time Start End Welcome & Roll Call Alvin Lin 5 min 9:00 9:05 Vision for the Committee & Review Updated Performance Elaine Fleck, Data Formats Alvin Lin 10 min 9:05 9:15 Adult Medicine Quality Improvement Population Line Presentation Elaine Fleck 30 min 9:15 9:45 Workforce Training & Development Proposed Training Evaluation Plan Rachel Niaukow 10 min 9:45 9:55 Next Steps Andrew Missel 5 min 9:55 10:00 Action Items Description Owner Start Date Due Date Status Present draft integrated committee charter Co-Leads / Andrew Missel 4/21/17 TBD Not Started PAGE 1
Committee Outlook & Approach IT/Clinical Operations Governance Committee August 18, 2017 1
Agenda for 8/18/2017 Meeting Objectives Facilitator Time Start End Welcome & Roll Call Alvin Lin 5 min 9:00 9:05 Vision for the Committee & Review Updated Performance Data Formats Adult Medicine Quality Improvement Population Line Presentation Workforce Training & Development Proposed Training Evaluation Plan Elaine Fleck, Alvin Lin 10 min 9:05 9:15 Elaine Fleck 30 min 9:15 9:45 Rachel Niaukow 10 min 9:45 9:55 Next Steps Andrew Missel 5 min 9:55 10:00 2
Vision: Shift to Pay for Performance (P4P) DSRIP goals have shifted from infrastructure to driving performance Through DSRIP, NYS has prioritized restructuring a healthcare delivery system to reduce avoidable hospital use by 25% over 5 years. By increasing quality of care and collaboration, the system can transform to decrease avoidable costs. Pay for Reporting (P4R) PPS can earn incentive payment for successfully reporting measures to NYS DOH within the timeframes for each measurement year. Pay for Performance (P4P) PPS will receive achievement values for results that meet or exceed the annual improvement target. DRAFT 3
Catalyst for Change: Shift to Pay-for-Performance Project progress milestones Pay-for-reporting Pay-for-performance 20% 15% 80% 60% 25% 40% 15% 45% 15% 65% 85% 20% 15% DSRIP Year 1 DSRIP Year 2 DSRIP Year 3 DSRIP Year 4 DSRIP Year 5 We are here Note: As part of a December 2015 waiver amendment request to the federal Centers for Medicare and Medicaid Services, New York is seeking to slightly modify these percentages. Source: New York State Department of Health, Attachment I NY DSRIP Program Funding and Mechanics Protocol, April 2014. 4
NYP PPS Approach to Supporting the Shift to P4P The approach has shifted to utilize infrastructure for optimal performance Sustain the Effort Implementation Ongoing performance tracking VBP Strategy & Data Quality improvement Care coordination PPS-supported staff Improved Integration Population Lines Data NYP internal + committee integration NYP integration with community partners DRAFT 5
Focusing on Data and Overview of Measures Simplifying the data is key to reducing the noise and meeting performance goals Category Adult Preventive Behavioral Health Pediatric Preventive Sexual Health Utilization On-Track to Meet MY3 Target Metric Name Yes Adults w/ Preventive or Ambulatory Care Visit in Last Year - 65 and older Yes Chlamydia Screening (16-24 Years) No Adults w/ Preventive or Ambulatory Care Visit in Last Year - 20 to 44 years No Adults w/ Preventive or Ambulatory Care Visit in Last Year - 45 to 64 years No Cervical Cancer Screening Yes Antidepressant Medication Management - Effective Acute Phase Treatment Yes Antidepressant Medication Management - Effective Continuation Phase Treatment Yes Diabetes Monitoring (Both LDL-C Test & HbA1c Test) for People with Diabetes and Schizophrenia Yes Engagement of Alcohol and Other Drug Dependence Treatment (Initiation and 2 visits within 44 days) Yes Follow-Up after Hospitalization for Mental Illness - Within 30 Days Yes Follow-Up after Hospitalization for Mental Illness - Within 7 Days Yes Follow-up care for Children Prescribed ADHD Medications - Continuation Phase* Yes Follow-up care for Children Prescribed ADHD Medications - Initiation Phase No Adherence to Antipsychotic Medications for People with Schizophrenia No Cardiovascular Monitoring (LDL-C Test) for People with Cardiovascular Disease and Schizophrenia* No Diabetes Screening for People with Schizophrenia or Bipolar Disease who are Using Antipsychotic Medication No Initiation of Alcohol and Other Drug Dependence Treatment (1 visit within 14 days) Yes Children w/ PCP Visit in the Last Year - 12 to 24 months No Children w/ PCP Visit in the Last Year - 25 months to 6 years No Children w/ PCP Visit in the Last Year (or Prior Year) - 12 to 19 years No Children w/ PCP Visit in the Last Year (or Prior Year) - 7 to 11 years Yes HIV/AIDS Comprehensive Care - Syphilis Screening No HIV/AIDS Comprehensive Care - Engaged in Care No HIV/AIDS Comprehensive Care - Viral Load Monitoring Yes Potentially Avoidable Readmissions Yes Potentially Preventable Admissions - Adults (PQI 90) Yes Potentially Preventable Admissions - Children (PDI 90) No Potentially Preventable Emergency Room Visits No Potentially Preventable Emergency Room Visits (for Persons with BH Diagnosis) DRAFT 6
Potentially Preventable ED Visits for Patients with Behavioral Health Diagnoses (All Ages) Key Take-Aways: 1. To meet its annual target, NYP PPS must have prevented 606 unnecessary ED visits for people with behavioral health diagnoses. 2. 43% (1,746/4,402) of people in this metric use EDs not associated with the NYP PPS network, and an additional 24% (976/4,042) do not have a managed care assigned PCP. Metric Unit of Measurement MY3 Goal Current Performance (Dec. 2016) Gap to Close On-Track to Meet MY3 Target? Potentially Preventable ED Visits (Pts w/ Behavioral Health Diagnoses) Rate per 100 People 3,022 visits (rate = 74.77) 3,628 visits (rate = 89.76) 606 visits (rate = 14.99) No PPS Hub # Pts in Denom. # Preventable ED Visits Measure Result ED Not In Network 1,746 1,648 94.39 No MC PCP Assigned 976 1,107 113.42 NYP West Campus 876 657 75.00 NYP East Campus 176 124 70.45 Charles B Wang CHC 143 12 8.39 Data are current as of: 12/31/2016. Source: NYS (MAPP), accessed 08/09/2017. 7
Geographic Hot Spot in the Bronx: Potentially Preventable ED Visits for Patients with Behavioral Health Diagnoses (All Ages) The 10451 zip code has the highest concentration of NYP PPS patients with BH diagnoses with potentially preventable ED visits. Data are current as of: 12/31/2016. Source: NYS (MAPP), accessed 08/09/2017. 8
Rate of PPV-BH Example: Drill Down on Individual Measures Performance on Potentially Preventable ED Visits for Patients with BH Diagnoses Sources: NYS (MAPP), accessed 8/17/2017. 90.00 Desired direction of change = 89.76 85.00 80.00 75.00 79.64 77.6 77.23 77.73 77.95 79.16 80.72 77.6 77.98 82.12 81.81 74.77 70.00 Jan '16 Feb '16 Mar '16 Apr '16 May '16 Jun '16 Jul '16 Aug '16 Sep '16 Oct '16 Nov '16 Dec '16 Month, Year Monthly Result Target Adult Population Line to address why metric performance has not improved and to guide strategy to meet or exceed target. 9
Committee Role Governance Committee Role Your ongoing participation is needed to achieve our performance goals Provide feedback on strategy Improved Integration Ongoing Define resources needed from PPS Strategy & Data First 6 months Iterative feedback from the field Implementation Over 2 ½ years Defining sustainability Sustain the Effort Last 6 months DRAFT 10
Discussion & Feedback 1. Any general feedback on shifting to the new phased approach? 2. How will data simplification enable you to drive success across practices? 11
NYP PPS Workforce Development & Training Resources Rachel Naiukow Program Coordinator Division of Community & Population Health NewYork-Presbyterian Hospital
Objectives Introduce new Workforce webpage Overview of new training resources and existing training Review opportunities for engagement and new training evaluation strategy
Workforce Webpage http://www.nyp.org/pps/resources/workforce-development NYP PPS Training Center Other Training & Resources Job Board Workforce Strategy Training Request Form
Training Resources NYP PPS Training Center Course information on webpage Additional courses coming soon
Training Resources Other Training and Workforce Resources Center to Advance Palliative Care (CAPC) membership FREE CMEs/CEUs!!! CAPC Designations And more Quality Interactions Resource Center Resource center Cross-Cultural Care course Training demos
Opportunities for engagement Training request form Open call for training and workforce resources to share Engaging collaborator leaders as trainers Training evaluations: 30-day post-training interviews
Training evaluations: 30-day post-training interviews Goals: Meaningful, qualitative feedback Capturing impact on care delivery and/or operations
Previous Post-Training Survey Questions Did you find this webinar to be helpful and relevant to your current work? Did you gain or learn something that you could realistically utilize and implement in your current work? Please rate how likely you are to utilize the skills and techniques presented in the webinar in your daily work. (1-5) On a scale of 1 to 5, 5 being the being the highest and 1 being the lowest, how satisfied are you with this presentation? What topics would you like to see covered in future trainings?
Questions Does the timeframe make sense for follow up regarding impact? Are there any quantitative measures that can and should be collected in this engagement? Is this strategy reasonable to capture outcomes?
Thank you! Rachel A. Naiukow ran9031@nyp.org Mobile: 347-880-1707 Office: 646-317-2069