AMCH PPS PAC Meeting March 22, 2016

Agenda CRFP PAC Deliverables 3/31/16 Committee Updates Sub-Committee Updates Clinical Integration PMO Updates – Staffing Changes and Announcements Questions

Updates Capital Restructuring Financing Program –Only $17 million awarded to our region, between the two PPSs out of $1.5 billion across the State –Concerns about inadequate funding for IT –Concerns about funding for space renovation in skilled nursing facilities

Deliverables due 3/31/16 Workforce Communication and Engagement Plan Performance Reporting Strategy VBP Workgroup Mission Statement Data Security & Confidentiality Plan IT Roadmap IT Change Management Strategy

Finance Funding to partner organizations continues –2ai – Baseline Assessment Addendum: Check requests for $114K have been submitted for 20 partnering organizations –2di – PAMs: Check requests for $42K have been submitted for 1 partnering organization VBP Workgroup Formed The Planning Grant audit information was submitted to the Independent Assessor on 3/4/2016 Valuation Consultant – addressing FMV

Finance - Status of Contracts

Finance Committee Next Meeting 3/28/2016 Status of Contracts June 2016 Deliverables VBP Learning Workgroup Budget by Project – DY1 & DY2 / Valuation Consultant

Audit and Compliance Committee Update Next Audit and Compliance Committee 4/21/16 Compliance Training underway BHNNY Compliance Documents – in process Compliance Plan Code of Conduct Fraud Waste and Abuse Policy Anti-Trust Policy Conflict of Interest

Performance Reporting Workgroup Project staff have completed the Performance & Data Reporting Strategy Strategy incorporates expectations for data reporting for both the PMO and funded participating organizations Will be presented for final approval and submitted to DOH with quarterly report 12

Workforce Coordinating Council The WCC recently disseminated an to partnering providers introducing them to the Compensation and Benefits Survey being conducted by Iroquois.  Invitation letter was sent out by Iroquois to PPS partners with survey link and details, a username and password to access the survey.  Deadline to complete the survey is April 18, Once completed, Iroquois will compile the information and send the aggregated data to the AMCH PPS.  Aggregated data will help determine another Milestone, “Define a Target Workforce State”. Workforce Communication and Engagement Plan was endorsed by the WCC on March 21,  Plan will be presented to PAC Leadership this Thursday, and the PPS Board on Friday for approval. Last WCC meeting was combined with the AFBHC and was held on March 21 st  Agenda items included: Discussion of job titles, descriptions and educational requirements. DSRIP projects that both PPSs have chosen to implement. Learning collaboratives that AMCH and AFBHC could collectively roll out to partnering providers.

Consumer and Community Affairs Last Meeting: Tuesday, March 8th-1275 Broadway, Albany Survey outcomes from Regional Meeting reviewed All 3 PPS Collaboration Meeting with AFBH and AHI in Saratoga. Tentative meeting date: May 5th 6PM-8PM RFP issued to eligible organizations requesting facilitation of consumer listening sessions, 2 responses approved for funding; extended RFP until March 29th for consumer-facing listening sessions to increase number of participating organizations and sessions Conceptual agreement to continue to hold joint regional meetings with overlapping PPSs Next Meeting: Tuesday, April 12th-Location TBD

Technology and Data Management 3 Milestones Complete for 3/31/2016 Committee Endorsement and approval for submission: –IT Roadmap –IT Change Management Strategy –Data Security & Confidentiality Plan EHR Subcommittee in formation Leadership change –George Hickman elected as new Chair, filling slot created by Mary Hand’s resignation De-duplication of data new DOH requirement Next meeting 4/20/2016

AMCH PPS: Clinical and Quality Affairs Committee Updates Project Updates Clinical Integration Project – Accenture Engagement

AMCH PPS: Project Sequence - Update Project nameProject ID Start dateSC 1. Integrated Delivery Systems2.a.iNov/Dec ED Care Triage2.b.iiiNov/Dec Patient Engagement – PAM & CFA2.d.iNov/Dec Asthma Evidence-Based Guidelines3.b.iiiDec 2015/Jan Cardiovascular - Hypertension2.a.iiiDec 2015/Feb Integration of PC & BH – Part I (Models 1 & 3)3.a.iJan 2016/Feb Health Home At-Risk Intervention Program3.b.iJan 2016/Feb BH Community Crisis Stabilization3.a.iiJan 2016/Feb Integration of BH & PC – Part II (Model 2)3.a.iJan 2016/Mar Medical Village – SNF2.a.vApr 2016/Mar Tobacco Cessation4.b.iJun Cancer Screening4.b.iiJun 2016

2.a.iii – Health Home At-Risk Intervention Project Objective: Expanded access to community primary care services (PCMH 2011 Level III certified sites) and develop integrated care teams to meet the individual needs of higher risk patients who do not currently qualify for NYS Health Home services. Key updates: –Introductory webinar held on Feb 19 th –Strong interest among our HH care management downstream organizations Next steps: –First Sub-committee meeting scheduled for March 29th at 1 PM –Project summary and other documents will be sent prior to the meeting –Sub-committee will establish roles and responsibilities and begin reviewing the project implementation plan 18

2.b.iii – ED Care Triage Project Objective: –To develop a care coordination/care transition program that will assist patients to link with a PCP –To provide supportive assistance to transitioning members to the least restrictive environment Key Updates: –ED Care Triage Subcommittee meeting held on March 7 th Discussion of current ED triage process and narcotic prescription guidelines Workflow for Patient Navigators –Chaired by Denis Pauze, MD –Meeting with EmUrgent Care Leadership on March 4 th –ED Diversion and Crisis Stabilization Project Meeting in Hudson on February 29th Next Steps: –Next ED Care Triage Subcommittee meeting on Monday, April 4 th at 10am –Presentation to the CMH ED department on March 23rd 19

3.a.i: Integration of PC and BH Services Project Objective: Integration of mental health and substance abuse with primary care services to ensure coordination of care for both services. Model 1: Co-locate Behavioral Health services at Primary Care practice sites Model 2: Co-locate Primary Care services at Behavioral Health practice sites Model 3: Implement the “Improving Mood - Promoting Access to Collaborative Treatment” (IMPACT) model of depression management at Primary care sites Key updates: –Webinars have been concluded for the project, well received –First subcommittee meeting is scheduled for Thursday, March 24 th with participation from PC Providers, BH Providers, and other key stakeholders –Co-Chaired by Brendon Smith, PhD & Keith Stack, Executive Director, ACCA –Project summary and other documents sent out on 3/21 Next steps: –Sub-committee will establish roles and responsibilities –Address upcoming milestone deliverables 20

3.a.ii: BH Community Crisis Stabilization Services Project Objective: To provide readily accessible behavioral health crisis stabilization services, that allow access to appropriate levels of care and support rapid de- escalation of the crisis. Key updates: –Webinars have been concluded for the project –First formal subcommittee meeting is scheduled for Thursday, March 31 st with participation from Primary Care Providers, Behavioral Health Providers, and crisis-oriented service providers. Next steps: Finalize documents required for the first 3.a.ii subcommittee meeting on 3/31/2016 and continue to address upcoming milestone deliverables as we work through the early implementation phase of the project. 21

3.b.i - Evidence-Based Strategies for Disease Management in High Risk/Affected Populations (Adults Only) Project Objective: To support implementation of evidence-based best practices for disease management in medical practice for adults with cardiovascular conditions. Key updates: –Subcommittee to launch Friday, March 25, 8-9am (WebEx) Chaired by Joseph Wayne, MD, MPH, MACP 3/25 Agenda to include: –Identification of co-chair; Distribution of participant list; Review of draft Subcommittee Charter; Review of Project Summary and performance measures; Identification of opportunities for rapid cycle improvement Next steps: –Future subcommittee meetings proposed for 1 st Friday, 8-9am, starting May 6. 22

3.d.iii: Implementation of Evidence Based Medicine Guidelines for Asthma Management Project Objective: Ensure access for all patients with asthma to care consistent with evidence-based medicine guidelines for asthma management. Key updates: –Subcommittee to launch Monday, March 28, 8-9am (WebEx) Chaired by Ron Dick, MD 3/28 Agenda to include: –Identification of co-chair; Distribution of participant list; Review of draft Subcommittee Charter; Review of Project Summary and performance measures; Identification of opportunities for rapid cycle improvement Next steps: –Future subcommittee meetings proposed for 2 nd Friday of the month. 23

Copyright © 2016 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 24 Draft for discussion Clinical Integration Project Overview

Copyright © 2015 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 25 Draft for discussion AMCH PPS Clinical Integration Milestone Requirements, Goals, and Objectives The CI milestone requires the development of a Clinical Integration (CI) Strategy that needs to meet the following requirements and submitted to DOH by 6/30/16: Specific Care Transitions Strategy that consists of hospital admission, discharge coordination, care transitions, coordination and communication among Primary Care (PC), Behavioral Health (BH) and Substance Use providers Signed off by the Clinical Quality committee Clinical and other information for sharing among the PPS affiliates Data sharing systems and interoperability Implementation plan with a focus on Care Transitions Training for providers across settings (ED, inpatient, outpatient) regarding clinical integration, tools and communication for coordination Training for operations staff on care coordination and communication tools Primary: Define the CI strategy for the AMCH PPS with a focus on the Medicaid population and the DOH requirements Secondary: Define a CI strategy applicable for patient populations to meet today’s CMS’ VBP / Readmissions and future VBC requirements for Care Management / Population Health Management functions AMCH PPS DSRIP Objectives: Define Transitions of Care (ToC) strategy Outline clinical and other information for sharing Outline tools and communication approaches to facilitate coordination among PPS affiliates and engage patients Define training criteria Additional AMC-Defined Objectives: Define the Care Coordination Model (CCM) with governance / structure at the PPS wide / local level Identify CCM functions / processes, protocols, roles and technology enablers Milestone Requirements Project GoalsProject Objectives

Copyright © 2016 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 26 Draft for discussion DY2DY3DY4DY AMCH PPS Projects Q1/2Q3/4Q1/2Q3/4Q1/2Q3/4Q1/2Q3/4 2.a.iCreate an IDS 2.a.iiiHealth Home At-Risk Intervention Program 2.a.v Medical Village/Alternative Housing using existing Nursing Infrastructure 2.b.iiiED Care Triage for At-Risk Population 2.d.i Patient Activation Activities to Engage, Educate and Integrate At-Risk Population 3.a.iIntegrate Primary Health and Behavioral Health 3.a.iiBehavioral Health Crisis Stabilization Services 3.b.i Evidence-based strategies for Disease Management in High Risk Populations 3.d.iiiEvidence-based Guidelines for Asthma Management 4.b.iPromote Tobacco Use Cessation 4.b.ii Increase Access to High Quality Chronic Disease Prevention (Cancer) What is DSRIP? Project Phasing Key Required in 6 Months PriorityLong-term AMCH has chosen 11 projects from the menu of interventions provided by New York State; the CI strategy is foundational to the AMCH projects outlined below

Copyright © 2015 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 27 Draft for discussion Representative Measures by Project P4R / P4P / Engagement metrics depend on operational improvements Measures (P4R or P4P and Pt. Engagement) 2.a.i IDS 2.a.iii At Risk 2.a.v Med. Village 2.b.iii ED Triage 2.d.i PAM 3.a.i I PC / BH 3.a.ii BH Crisis 3.b.i CVD 3.d.iii Asthma 4.b.i Tobacco 4.b.ii Cancer ↓avoidable ED visits ↓avoidable readmissions ↑frequency of ambulatory / preventive visits ↓cost in ED / inpatient / PC / BH ↑alignment to PCP ↑patient satisfaction ↑capture of HCAHPS Care Transition across PPS ↓% of admissions ↑pts. with new / updated CM plan / self mgmt. goals ↑pts. with two+ non-ED services at Medical Village ↑ED pts. with follow-up appointment with PCP ↑pts. with completed PAM / PAM level 3 or 4 ↑pts. with preventive screening & include BH / SA ↑pts. receiving PC services at BH/SA sites ↑pts. screened using PHQ-2 or 9 / SBIRT ↑medication adherence / mgmt. ↑post-D/C follow-up / condition monitoring – for BH pts. ↑% pts. screened for depression with tool / follow-up ↑pts. receiving crisis stabilization /crisis programs ↑adoption of substance dependence treatment ↑Health literacy ↓Premature deaths Total$12M$10M $9M $8M $7M $5M$4M Care Coordination is critical for all projects to accelerate, achieve the results for a value of $89M

Copyright © 2015 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 28 Draft for discussion Governance Structure New Proposed Structure Governance structure to support effective affiliate engagement, stakeholder buy-in / adoption and timely execution of recommendations would consist of: AMCH PPS Oversight Committee:  Receive monthly CI Project status updates  Review / approve CI Project recommendations / plans  Align plans with overall AMCH PPS strategy Clinical and Quality Affairs Committee:  Receive monthly CI Project status updates  Review and approve CI strategy / plans  Key Clinical Quality committee members serve on CI SC AMCH CI Steering Committee (new committee):  Receive bi-weekly CI Project status updates / oversee Project  Review / approve CI strategy / plan, approach / deliverables  Key Clinical Quality committee members, PPS affiliate Executive Sponsors (e.g., hospitals, Tier 1 affiliates, Medical Directors of hospitals, leadership of physician practices, CDPHP, etc.) serve on CI SC CI Project Leadership Team (new committee):  Conduct weekly CI Project reviews / status updates  Manage / monitor Project plan and activities  Provide Project updates to governance committees  Plan and execute right messages at right time to affiliate stakeholders AMCH PPS Oversight Committee Clinical and Quality Affairs Committee AMCH CI Steering Committee (SC) CI Project Leadership Team

Copyright © 2015 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 29 Draft for discussion Project Logistics and Commitment Clinical Integration Strategy Timeline Current State Assessment Future State DesignTraining Define Clinical Integration project scope Identify Tier 1 Affiliates Kick-off Webinar for Tier 1 Affiliates Gain understanding of current state of care coordination, care management (CM), processes, data, and staffing Collect relevant data and documentation Conduct analysis  Develop high-level key findings and recommendations Key Completed  In progress  Not yet started Mobilization Mar 28May 6May 31Jan/Feb Mar 1  Design and refine Clinical Integration processes for discharge and transitions of care (ToC)  Convene work group of stakeholders and Subject Matter Advisors to validate and refine the CI functions / process standards  Define education criteria and implementation / training plan  Conduct training on future state for hospital staff and affiliate partners June 30 th, 2016: Milestone due date; all activities completed, documented and reported to DOH In order to satisfy all milestone requirements by 6/30, the Clinical Integration Strategy project has already begun and will run through the end of May

Copyright © 2016 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 30 Draft for discussion Summary findings for the current state validation Summary findings will be utilized in the future state workgroup session #1 Future State Workgroup Approach A series of workgroup sessions will be conducted in order to create the future state functions and processes 1. Current State Assess care coordination current state against the CI/CCM straw model framework and industry leading practices to identify gaps 2. Draft Future State Accenture to draft future state functions and processes based on findings, straw model and promote cross organizational standardization where possible Begin meeting March 30 for 5 weeks Webinar option available Participants to be discussed 3. Finalize Future State Conduct five workgroup sessions to gather input and validate future state

Copyright © 2016 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 31 Draft for discussion Session 1 3/30 Session 2 4/6 Session 3 4/13 Session 4 4/20 Session 5 4/27 Focus Areas Work group sessions will cover in scope Care Coordination functions / elements and processes Future State Workgroup Proposed Focus Areas by Session ED and Acute Admission Protocols and Assessments Readmission and Transition of Care Planning Discharge to Post Acute, Home and Primary Care Patient Navigation Barriers to Care Alignment of All Processes Review Current State & Set Obj. In scope focus area functions / processes will be covered in two sessions each: Initial session: Introduce straw models for focus area, gather input and feedback, make updates Consecutive session: Review and validate updated models ED / hospital admission function / elements / handoffs / info sharing Care Plan template / elements CM assessments / risk identification Readmission mgmt. / elements / interventions ToC / DC planning (process flow) Process flows: DC to home DC to / OP / clinics/ HH / Primary Care DC to PAC (SNF, Rehab, other facility) Patient navigation functions /elements Barriers to Care management functions Complete any outstanding processes Validate there are no gaps in the end to end patient management Each function will include the following (what / when): 1.Elements / interventions 2.Recommended timeframes to complete activities 3.Required data to support communication sharing 4.Potential recommendations for the who 5.Focus on ToC and CC in community settings between primary care and behavioral health where applicable

Announcements PMO Updates – staffing changes –Evan Brooksby, deputy director, has accepted a position with HANYS as director of policy analysis. He will leave the PMO as of 3/23/16 –Louis Filhour, AMC Sr. Vice President, has joined the PMO, providing new leadership in clinical informatics, clinical integration and IT

PMO Announcements - continued March 31 st is the end of DSRIP Year One Quarterly report due to DOH by 4/29/16 Independent Assessor will conduct a comprehensive assessment of all 25 PPSs starting in July 2016 Numerous important deliverables have to be completed in the next quarter Better Health for Northeast New York incorporated, but not yet approved as a lead applicant Next PAC meeting will be on4/25/16, 11:00 – 2:00 ME

Questions DSRIP Project Management Office Visit us at: 34