1 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. NYHQ DSRIP Committee Kick-Off Meeting March 2015

2 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Welcome & Introductions PPS Overview & Organizational Structure DSRIP Updates Progress To Date Implementation Plan Committee Purpose Implementation Plan Draft – Review Revision process Resources Next Steps » Implementation Plan – Final Submission (April 1, 2015) » Next Committee Meetings Agenda

3 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Executive Committee Executive Committee PAC AuditCompliance PPS Organizational Structure *Sub-Committees & Workgroups will be formed as needed. NYHQ NYHQ Lead Hospital Practitioner Engagement NYHQ Board of Directors Cultural Comp & Health Literacy Long Term Care High Risk Population Behavioral Health & Primary Care Integration Communications Workforce IT & Performance Reporting Clinical Integration & Population Health Mgmt Finance PMO PMO

4 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. PPS Org Structure: Committees

5 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. CNA Completed & Projects Selected – DSRIP Updates

6 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. DSRIP Plan – December 2014 Scale & Speed – January 2015 Implementation Plan – April 2015 Actualization of Plans – Begin April 1, 2015 DSRIP Updates Documents Available: -DSRIP Applications -Scale & Speed by Project -Implementation Plan Draft Current State

7 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. DSRIP Updates Distribution Year QuarterReporting PeriodQuarterly Report Due Payment Date Project Plan & Implementation PlanN/AApril 20, 2015 DY1 - Q2April 1, June 30, 2015July 31, 2015October 29, 2015 DY1 - Q3July 1, September 30, 2015October 31, 2015 April 1, 2016 DY1 Q4October 1, December 31, 2015January 31, 2016 DY2 - Q1January 1, March 31, 2016April 30, 2016 October 1, 2016 DY2 - Q2April 1, June 30, 2016July 31, 2016 DY2 - Q3July 1, September 30, 2016October 31, 2016 April 1, 2017 DY2 - Q4October 1, December 31, 2016January 31, 2017 DY3 - Q1January 1, March 31, 2017April 30, 2017 October 1, 2017 DY3 - Q2April 1, June 30, 2017July 31, 2017 DY3 - Q3July 1, September 30, 2017October 31, 2017 April 1, 2018 DY3 - Q4October 1, December 31, 2017January 31, 2018 DY4 - Q1January 1, March 31, 2018April 30, 2018 October 1, 2018 DY4 - Q2April 1, June 30, 2018July 31, 2018 DY4 - Q3July 1, September 30, 2018October 31, 2018 April 1, 2019 DY4 - Q4October 1, December 31, 2018January 31, 2019 DY5 - Q1January 1, March 31, 2019April 30, 2019 October 1, 2019 DY5 - Q2April 1, June 30, 2019July 31, 2019 DY5 - Q3July 1, September 30, 2019October 31, 2019 April 1, 2020 DY5 - Q4October 1, December 31, 2019January 31, 2020 First Due Date

8 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Develop a structure for collaboration to focus on organizational functions and project implementation and outcomes specific to DSRIP deliverables according to the need of PPS partners and the community they serve. Committees will: Committee Purpose Refine & finalize Implementation Plans – Due April 1, 2015 High level milestones / Risks & Mitigations / Financial Milestone Dates Develop plans for actualization of functions or projects Project Plans Budgets Partner Expectations Engage key-stakeholders specific to project or function need Provide guidance for best practice standards & evidence based medicine protocols Recommend strategies or policies to the Executive Committee Establish monthly reporting expectations & communication channels for progress updates Partner with PMO to monitor monthly & quarterly deliverables Create workgroups to continue development or implementation

9 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 2.b.v: Care Transitions Intervention for Skilled Nursing 2.b.vii: Implementing the INTERACT Project (Inpatient Transfer Avoidance Program for SNF) 2.b.viii: Hospital-Home Care Collaboration Solutions 3.g.ii: Integration of Palliative Care into Nursing Homes Long Term Care Projects

10 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Risk 1: Interrelated implementation needs of long term care projects Mitigation: Bundled implementation with 2.b.vii INTERACT with SNF and 2.b.viii Hospital-Home Care Risk 2: Varying levels of EHR systems and interoperability Mitigation: work closely with implementation of the IT Plan to assist in leveling the degree of implementation and moving forward to a position that allows for sharing of transition best practices. Risk 3: Learning curve for members of the care transition teams that will manage this project and the subsequent overlapping projects Mitigation: adapt an incremental approach to care transitions focusing on the current workforce and possible pilot program to switch established case managers to care transition teams to ensure a smooth integration of roles and responsibilities Project 2.b.v- Risks & Mitigations

11 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 2.b.v: Care Transitions Intervention for Skilled Nursing Counting Methodology: A count of patients that meet the criteria over a 1-year measurement period. Duplicate counts of patients are allowed, provided that they meet the criteria more than once. The count is not additive across DSRIP years. Engaged Patient Definition: The number of participating patients with a care transition plan developed prior to discharge who are not readmitted within the 30 day period Engaged Patient Definition

12 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 2.b.v: Project Implementation Speed

13 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 2.b.v: Patient Engagement Speed

14 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Risk 1: Interrelated implementation needs of long term care projects Mitigation: Bundled implementation with 2.b.vii INTERACT with SNF and 2.b.viii Hospital-Home Care Risk 2: Varying levels of EHR systems and interoperability Mitigation: Work closely with implementation of the IT Plan to assist in leveling the degree of implementation and moving forward to a position that allows for sharing of transition best practices. Risk 3: Maximizing day to day requirements of front end staff while integrating training that is required Mitigation: Implement best practice methods and recruitment to identify champions to motivate, educate and engage among peers Project 2.b.vii- Risks & Mitigations

15 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 2.b.vii Implementing the INTERACT Project (Inpatient Transfer Avoidance Program for SNF) Counting Methodology: A count of patients that meet the criteria over a 1-year measurement period. Duplicate counts of patients are not allowed. The count is not additive across DSRIP years. Engaged Patient Definition: The number of participating patients who avoided nursing home to hospital transfer, attributable to INTERACT principles, as established within the project requirements. Engaged Patient Definition

16 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 2.b.vii: Project Implementation Speed

17 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 2.b.vii: Patient Engagement Speed

18 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Risk 1: Hospital financial impact Mitigation: Monitor financial impact and support hospital and other revenue impacted organizations as part of supported beneficiary choice per financial plan Risk 2: Gap between counting readmissions and Medicaid reporting of readmissions Mitigation: Track readmissions within the PPS hospital in addition to tracking sources of readmissions (hospital, types of post-acute care, and home) within the metropolitan city area Project 2.b.viii- Risks & Mitigations

19 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 2.b.viii Hospital-Home Care Collaboration Solutions Counting Methodology: A count of patients that meet the criteria over a 1-year measurement period. Duplicate counts of patients are not allowed. The count is not additive across DSRIP years. Engaged Patient Definition: The number of participating patients who avoided home care to hospital transfer, attributable to INTERACT-like principles, as established within the project requirements. Engaged Patient Definition

20 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 2.b.viii: Project Implementation Speed

21 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 2.b.viii: Patient Engagement Speed

22 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Risk 1: Integration of palliative care processes into nursing homes in a culturally sensitive manner Mitigation: 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 Risk 2: Low provider participation due to lack of reimbursement for palliative care services Mitigation: case management early in the discharge process to incorporate palliative care services to avoid readmission for an issue not previously discussed Risk 3: Low patient engagement due to religious and cultural beliefs about death and dying Mitigation: Linking this with Cultural Competency/Health Literacy Link implementation plan to increase provider ability to treat this patient population in a culturally-sensitive manner Project 3.g.ii- Risks & Mitigations

23 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 3.g.ii Integration of Palliative Care into Nursing Homes Counting Methodology: A count of patients that meet the criteria over a 1-year measurement period. Duplicate counts of patients are not allowed. The count is not additive across DSRIP years. Engaged Patient Definition: The number of participating patients receiving palliative care procedures at participating sites as determined by the adopted clinical guidelines. Engaged Patient Definition

24 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 3.g.ii: Project Implementation Speed

25 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 3.g.ii: Patient Engagement Speed

26 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. NYHQ Project Management Office (PMO) – Maria D’Urso – Louisa Low – Crystal Cheng – NYHQ PPS Website - NYS DSRIP Website Applications - ons/ ons/ Resources

27 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Implementation Plan Revision Committee Feedback KPMG Feedback Committee Meetings Additional Members Implementation Plan Finalization Actualization Planning First Quarter Deliverable – Q2 DY1 Next Steps

PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Questions?