Evan Brooksby, MBA Director Policy, Analysis, & Special Projects Redesign Update Evan Brooksby, MBA Director Policy, Analysis, & Special Projects 11/18/2018

Agenda DSRIP Quick Department of Health Changes 1115 Waivers & DSRIP in other states Sustainability Planning DSRIP Success – MAX Series New from CMS 11/18/2018

DSRIP Basics $6.5 billion 25% reduction PPSs Project-focused 5 year, $6.5 billion program $6.5 billion Overarching goal of 25% reduction in avoidable hospitalizations and ED visits 25% reduction Collaboration/partnerships is a key theme PPSs Menu of 44 projects designed to improve healthcare delivery Project-focused Payments are performance-based and statewide penalties can be assessed if goals not met P4R to P4P VBP is DSRIP legacy—at least 80% of Medicaid managed care payments must be in VBP by 2019 VBP Quarterly reporting cycle with validation by Independent Assessor Reporting 11/18/2018

25 DSRIP PPSS Across NYS 11/18/2018

Project-Focused System transformation Clinical improvement activities i.e., projects to create integrated delivery system and promote care coordination/transitions System transformation i.e., projects to improve care for specific chronic conditions Clinical improvement activities i.e., projects to promote mental health and prevent substance abuse; access and screening for other chronic disease Population-wide projects 11/18/2018

11/18/2018

Top Projects 5 high-value projects align with state’s vision reflect about 50% of DSRIP funding 11/18/2018

DSRIP in one slide

Department of Health Changes Helgerson will depart on April 6, 2018 to “pursue opportunities in the private sector” “I want to make clear that my departure will have NO impact on this important mission. The Department of Health and its leadership remains 100% committed to the causes of MRT, DSRIP and VBP. “ 11/18/2018

DSRIP in other states 1115 Medicaid Waiver Grants state flexibility NYS 1115 Waiver renewed on January 19, 2017 – 5 year DSRIP Expiration not aligned Similarities beyond D.S.R.I.P. . . . 11/18/2018

California $6.2 Billion Effective 1/2016 – 12/2020 Ambulatory and primary care focus through designated public hospitals (DPHs) Advance alternative payment models(APMs) with Medicaid managed care plans 60% of all managed care beneficiaries receive all or a portion of their care through APM 11/18/2018

Massachusetts $1.8 Billion Effective 07/2017 – 06/2022 Transition to integrated accountable care by: Launching Medicaid accountable care organizations Linking ACOs and certified Community Partners for care coordination Investing in more efficient statewide infrastructure. Medicaid ACOs, Certified Community Partners, and Managed Care Organizations 11/18/2018

Texas $8.5 Billion Effective 10/2017 – 9/2021 Four Categories: Infrastructure development Program innovation and redesign Population-focused improvement Urgent clinical improvements Under the terms of the new Waiver, CMS will temporarily continue DSRIP funding. However, funding is phased down to zero over the five years. Transition from DSRIP to sustainable delivery system reforms that do not require DSRIP funding 20+ regional health provider groups 11/18/2018

Washington $1.125 Billion Effective 1/2017 – 12/2021 Transform Medicaid delivery through Accountable Communities of Health (ACH): Improve data analytics and workforce development; 90% of Medicaid care to be purchased via VBP by 2021; Care delivery redesign with more integration and community linkages; and Prevention focus. Partnership with ACH — partnerships will include both traditional Medicaid providers and a variety of other entities and community-based organizations. 11/18/2018

New Hampshire $150 Million Effective 1/2016 – 12/2020 Use integrated networks and improve access and quality Support behavioral health infrastructure through the state's managed care delivery system using APMs Regional Integrated Delivery Networks (IDNs), led by various entities that meet IDN criteria 11/18/2018

New Jersey $292 Million Effective 10/2012 – 6/2017 Improve care delivery around eight chronic diseases — including asthma, HIV/AIDS, substance abuse, and obesity All acute care hospitals are eligible (total of 63) — 50 have approved DSRIP projects; 11/18/2018

Barriers to Sustainability Planning Uncertainty of future budgetary and regulatory environment Many PPS were hoping for DSRIP 2.0 Lack of clarity regarding future regulatory relief PPS report delays in project implementation have impacted evaluation timelines: currently, there is limited data available to support VBP contracting Almost all PPS cite MCO issues as a significant barrier Access to MCO data, challenges in contracting strategy, lack of MCO support for DSRIP initiatives Local market complexity and competition (particularly downstate) with multiple participation options offered to providers by other PPS Continued skepticism from some partners regarding VBP transition 11/18/2018

Future State Business Models January 2018 January 2018 PPS are exploring future state structures IPA ACO MSO PPS are evaluating providing services under a variety of arrangements: Fee for service Alternative Payment Models Annual membership plus fees for add-on services PMPM for population health technologies or other services

Vision for PPS Sustainability January 2018 Each PPS needs to develop its own vision and plan for sustainability, leveraging the new DSRIP infrastructure The DSRIP workforce will be needed in the future vision for sustainability. Your PPS will play a different role beyond 2020 VBP offers flexibility to Providers and MCOs The infrastructure developed in DSRIP will be needed to support VBP. Performing Provider Systems themselves NYS PCMH Status Connectivity to Qualified Entities and SHIN-NY Coordination with Managed Care Organizations

Medicaid Accelerated eXchange (MAX) Series Program– Success from DSRIP MAX Projects were not part of the original 11 projects Focused on a defined population Utilized Rapid Cycle Improvement Quantified results 11/18/2018

Southside Hospital Defined super-utilizers as 4+ admissions in 12 months Identified an Action Team 10 people from providers to administrators Established baseline – Nothing in place 11/18/2018

Southside Hospital Action period 1 Created a flag to identify super utilizers Develop a tool to assess the “driver of utilization” Pilot a response system to a super utilizer presentation 11/18/2018

Southside Hospital Action period 2 Implement daily huddles to discuss super utilizers and develop a plan of care Mobilize a point person to coordinate follow up for super utilizers Link super utilizers consistently to the partnering social service agency 11/18/2018

Southside Hospital Action period 3 Develop a job description for a resource coordinator Build community resource relationships Articulate a business case for ongoing resources to support the super utilizer care team 11/18/2018

Southside Hospital 11/18/2018

New from CMS: Expanding Patients Access and Control of Their Data MyHealthEData Medicare’s Blue Button 2.0 Calling on Private Plans to Provide Patients Their Data 11/18/2018

New from CMS: Encouraging Patient Access Through CMS Programs Streamlining Meaningful Use (MU) and Quality Payment Program (QPP) Prioritizing Quality Measures That Lead to Interoperability Preventing Information Blocking 11/18/2018

New from CMS: Modernizing Provider Requirements with a Focus on Value-Based Care Requiring Providers to Update Their Systems to Ensure Data Sharing Ensuring Patients Receive Their Data Upon Discharge Streamlining Documentation and Billing Requirements 11/18/2018

Last thoughts 11/18/2018

Evan Brooksby, MBA ebrooksby@hanys.org 518.431.7736 @ejbrooksby 11/18/2018