Delivery System Reform Incentive Payment (DSRIP) Collaboration Kyle Trzaskalski, MPH SHP_20173998

Provider Performance, Superior and DSRIP

Provider Performance: Mission and Vision Superior’s Provider Performance team was created in 2014 by Superior’s Medical Director, Dr. Harmon. Mission: Identify best practices among providers and how to standardize these practices for Superior’s entire provider network. Vision: Collaborate with Superior providers to achieve the highest possible outcomes in population health and health-care efficiency. Provider Performance handles both internal and government incentive programs company-wide.

Provider Performance: Incentive Projects Bridges To Excellence – Diabetes, Asthma Preferred Provider Networks – Durable Medical Equipment, Tenet, Therapy Shared Savings Pay for Performance contracts Centers of Excellence – Pediatric Heart, Pain Management Foster Care Centers of Excellence Network Access Improvement Program (NAIP) Quality, Innovation, Productivity and Prevention (QIPP) Delivery System Reform Incentive Payment (DSRIP)

Superior and DSRIP The Centers for Medicare and Medicaid Services (CMS) expect Managed Care Organizations (MCOs) to take a bigger role in DY6-10, we are awaiting further guidance as to how we should proceed. Where does Superior stand with DSRIP? Monitoring developments to DSRIP to see if MCOs take a larger role like NAIP or possibly QIPP. Developing ways to incentivize individual projects. Claims-based Shared Savings Evaluating individual programs to find collaboration opportunities.

Superior and DSRIP Superior is currently working with several partners at various stages of DSRIP pilot projects. Presently, data-sharing for these projects. DSRIP pilot projects include: Community Paramedic Program Community Health Worker Program

Community Paramedic Program

Williamson County EMS Community Paramedic Specially-trained community paramedics: Conduct home visits to high Emergency Department (ED) utilizers. Monitor medically-complicated patients in their homes to help reduce preventable hospital admissions. Work to connect high ED utilizers to primary health services. Focus on: Chronic Heart Failure Hypertension Diabetes COPD/Asthma Seizures

Williamson County EMS Community Paramedic DSRIP pilot program is underway: Superior provided member lists of high-utilizing ED members by service area, who fall within the scope of the program. 35 members have been identified that would benefit from the program. Williamson County EMS is currently reaching out to these members. Timeline of the program has not been set. Dependent on when these members begin the program. Provider Performance will look for a reduction in ED visits and potentially preventable hospital admissions and readmissions.

Austin-Travis County EMS Community Paramedic Specially-trained community paramedics (9 dedicated paramedics): Develop pre-plans for complicated medical cases. Work with the homeless population in Austin. Assist when needed in the field. Focus on high ED utilizers transported to the ED by EMS. Approximately 80,000 patient contacts each year Approximately 6,700 patient contacts each month 10 patients account for 1% of all contacts 50 patients account for 3% of all contacts

Austin-Travis County EMS Community Paramedic Superior is presently working on: Signing a Business Associate’s Agreement (BAA) to be able to provide data. Data will be similar to Williamson county EMS on high ED utilizers, within the member’s service area. Exploring collaboration between Superior, Austin-Travis County Emergency Medical Services and Williamson County Emergency Medical Services.

Community Health Worker Program

Brazos Valley Care Coordination The Community Health Worker Program aims to: Decrease the number of frequent ED utilizers by ensuring appropriate follow-up care upon discharge from the hospital Connect high ED-utilizing patients to a regular source of primary care and supportive health services.  Provide frequent ED utilizers who do not have a regular primary care provider with a care coordinator, who will help find options for accessing regular primary care and health resources, to achieve and maintain a positive health status.

Brazos Valley Care Coordination The program can help members to: Obtain basic health information Learn how to obtain medical services in the community Find a clinic or medical home to manage condition(s) Communicate with a health-care team Find community resources to help stay healthy (including needed medications) Remember appointments Find transportation to appointments

Brazos Valley Care Coordination DSRIP pilot program is underway: Superior provided a member list which fits the programs goals in Brazos, Grimes, Washington, Burleson, Milam, Robertson, Leon and Madison Counties. 4,120 members fit the Brazos Valley Care Coordination’s criteria Outreach has begun to these members and intend to do a pilot with 200 members in the project. Provider Performance will look for a reduction in ED visits and potentially preventable hospital admission and readmissions.

Additional Key Points Superior is always looking for new and innovative ideas and DSRIP projects encompass this innovation. With the large number of DSRIP projects, reaching out to an MCO is your best bet on looking into collaborative opportunities. High member utilization numbers are important with these projects but are not the only measures reviewed. Impacting several high utilizing members may make the project worth it from the MCO perspective. With the current format of MCO work in DSRIP, do not expect for a project to be completely funded directly. Superior looks for ways to fund mutually-beneficial programs. Superior is establishing a list of measures we are most interested in that will be distributed in the next week or so.

Kyle Trzaskalski Kyle.Trzaskalski@superiorhealthplan.com 512-662-9026 Questions? Kyle Trzaskalski Kyle.Trzaskalski@superiorhealthplan.com 512-662-9026