Clinical Project Meeting NYHQ PPS Delivery System Reform Incentive Payment (DSRIP) June 12, 2015 Palliative Care (3gii)

Agenda 2 Welcome & IntroductionsClinical LeadershipMeeting PurposeScope of Clinical Sub-CommitteePPS Updates & TimelineDSRIP Project ReviewClinical Case Vision & ExampleClinical PlanningSWOTNext Steps / Next MeetingQuestions / Adjourn

Chair: Cynthia Pan, 3 Clinical Leadership

Initiate the clinical planning process of the NYHQ PPS DSRIP projects in order to complete the Project Implementation Plans due July 31, 2015, develop strategies for actualization of projects, identify operational process, IT, budget, or workforce needs, and ensure all engaged partners are actively engaged in planning & implementation. 4 Meeting Purpose

Engage PPS network partners to operationally plan, develop, and design the clinical program outlined in the DSRIP application submitted in December 2014 Focus on collaborative planning processes that meet project requirements, metrics, and scale & speed expectations associated with the clinical program Complete the Project Implementation Plans due July 31 Inform budgets and operational needs such as workforce & IT Guide partners by becoming a resource and communication channel to ensure effective engagement 5 Scope of Clinical Sub-Committee

Clinical planning will include, but is not limited to: Implement project design to include all committed PPS partners Establish and meet performance reporting expectations Establish expectations for evidence based medicine protocols & best practice standards Communicate internally and externally on program development and progress Explain variances of project requirement or metric progress Ensure success of the project by improving clinical quality and meeting expectations of project requirements, scale & speed, and metrics Work with other committees and sub-committees to ensure cross communication & feedback 6 Scope of Clinical Sub-Committee

 Organization Implementation Plans – Submitted  PPS Valuation Notification – Received  Project Implementation Plans – Due 7/31/2015  Executive Committee Meeting – 6/11/2015  PAC Meeting – 6/19/2015  Workforce Data Due – 10/31/2015  Budgets, Funds Flow, Business Agreements – In Development  Clinical Planning Meetings – Begin week of 6/8/ PPS Updates & Timeline

Clinical Planning & Development Project Implementation Plans Due (7/31/15) DY1 Quarterly Report Due (7/31/15) Workforce Data Due (10/31/2015) 8 PPS Updates & Timeline Organization Development, Budget & Funds Flow Development, Committee & Governance Structure Development, Clinical Planning & Implementation, IT Development, Workforce Planning, Partner Engagement, etc.

99 Bi-annual payments driven by quarterly reports of milestone, metric, & scale & speed achieved deliverables DSRIP Year/Quarter Dates CoveredQuarterly Report DuePayment Date DY1, Q1April 1, 2015 – June 30, 2015July 31, 2015 January 2016 DY1, Q2July 1, 2015 – September 30, 2015October 31, 2015 DY1, Q3October 1, 2015 – December 31, 2015January 31, 2016 July 2016 DY1, Q4January 1, 2016 – March 31, 2016April 30, 2016 DY2, Q1April 1, 2016 – June 30, 2016July 31, 2016 January 2017 DY2, Q2July 1, 2016 – September 30, 2016October 31, 2016 DY2, Q3October 1, 2016 – December 31, 2016January 31, 2017 July 2017 DY2, Q4January 1, 2017 – March 31, 2017April 30, 2017 PPS Updates & Timeline

10 DSRIP Project Review: Project Requirements Integrate Palliative Care into practice model of participating Nursing Homes. Develop partnerships with community and provider resources, including Hospice, to bring the palliative care supports and services into the nursing home. Develop and adopt clinical guidelines agreed to by all partners including services and eligibility. Engage staff in trainings to increase role- appropriate competence in palliative care skills and protocols developed by the PPS. Engage with Medicaid Managed Care to address coverage of services.Use EHRs or other IT platforms to track all patients engaged in this project.

11 DSRIP Project Review: Scale & Speed: Committed Providers NYS Designated Categories Total # committed providers Primary Care Physicians98 Non-PCP Practitioners70 SNF27 Hospice6 CBO0 All Other99 All Committed Providers300

12 Engaged Patient Definition: The number of participating patients receiving palliative care procedures at participating sites as determined by the adopted clinical guidelines. DSRIP Project Review: Scale & Speed: Patient Engagement Total Expected # of actively engaged patients 518 DY1, Q2DY1, Q3DY1, Q4DY2, Q1DY2, Q2DY2, Q3DY2, Q4 Patients Engaged per Quarter DY3, Q1DY3, Q2DY3, Q3DY3, Q4DY4, Q1DY4, Q2DY4, Q3DY4, Q

DSRIP Project Review: Clinical Project Requirements: Metrics 13

DSRIP Project Review: Clinical Project Requirements: Metrics 14

15 DSRIP Project Review: Project Implementation Plan 3.g.ii Integration of Palliative Care into Nursing Homes 1. Measurable milestones and implementation risks Please describe what the major risks are for this project, as well as the actions you plan to take to mitigate them. The highest risk to the integration of palliative care processes into nursing homes is low provider and patient/family participation related to a culturally prominent aversion of care givers, patients and families to the topic of death and dying. For the providers, the PPS and affiliates need to develop training sessions for providers and caregivers to understand the purpose of palliative care services and learn care giving behaviors and language that respects patient / families wishes. As part of the training sessions, the nursing homes have to consider the needs of the workforce to attend trainings, develop compliance tracking tools on educational sessions and incorporate training into mandatory and/or annual updates to be fully effective and impactful for the patients that they serve. Another potential risk is low provider participation due to lack of reimbursement for palliative care services in the acute and/or inpatient setting that would continue upon the care continuum once discharged to nursing homes. Mitigation strategies would be to involve case management early in the discharge process to incorporate palliative care services to avoid readmission for an issue not previously discussed. Make this topic an agenda item for PPS discussions and develop strategies to increase participation in all setting of patient interactions. For the patients and families, a parallel risk exists based on low patient engagement due to religious and cultural beliefs about death and dying. Mitigation strategies would include linking this with Cultural Competency/Health Literacy Link implementation plan toincrease provider ability to treat this patient population in a culturally-sensitive manner. Incorporate training to providers, care givers, and palliative care coaches about beliefs for the predominant cultures in the service area, reflecting all levels of palliative care, including but not limited to fluid, feedings, transfer and other prominent components of the MOLST initiative.

16 DSRIP Project Review: Project Implementation Plan Project 3.g.ii Project Requirements/sub-stepsTarget Completion DateUnit Level Reporting 1. Integrate Palliative Care into practice model of participating Nursing Homes. DY3, Q4 Provider Level: SNF, Hospice Step 1… Step 2… [Please add additional steps based on your plan and timeline] 2. Develop partnerships with community and provider resources, including Hospice, to bring the palliative care supports and services into the nursing home. DY2, Q4Project Level Step 1… Step 2… [Please add additional steps based on your plan and timeline] 3. Develop and adopt clinical guidelines agreed to by all partners including services and eligibility. DY2, Q4Project Level Step 1… Step 2… [Please add additional steps based on your plan and timeline]

17 DSRIP Project Review: Project Implementation Plan 4. Engage staff in trainings to increase role- appropriate competence in palliative care skills and protocols developed by the PPS. DY2, Q4Project Level Step 1… Step 2… [Please add additional steps based on your plan and timeline] 5. Engage with Medicaid Managed Care to address coverage of services. DY2, Q4Project Level Step 1… Step 2… [Please add additional steps based on your plan and timeline] 6. Use EHRs or other IT platforms to track all patients engaged in this project. DY2, Q4Project Level Step 1… Step 2… [Please add additional steps based on your plan and timeline]

Clinical Case Vision & Example 18

19 Space / LocationIT NeedsPatient TrackingBillingClinical ImplementationWorkforce Impact / NeedNon-Covered Services Anticipated Clinical Planning

20 StrengthsWeaknessesOpportunitiesThreats SWOT Analysis

Additional webinar based clinical planning meetings – TBD Project Implementation Plan drafting & distribution Executive Team Development of budgets, funds flow, agreements Executive Committee review & approval Partner agreement completion PAC meeting 6/19/15 21 Next Steps / Next Meeting

22 Questions / Open Discussion

Website: Maureen Buglino, VP, Community & Emergency Medicine Maria D’Urso, Administrative Director, Community Medicine Crystal Cheng, Data Analyst, DSRIP 23 Resources