1. Clinical Project Meeting NYHQ PPS Delivery System Reform Incentive Payment (DSRIP) Project Implementation Plan Development Palliative Care (3gii)

2. Agenda 2 Welcome & IntroductionsPurpose of MeetingPPS UpdatesReview TimelineReview Action ItemsProject Requirement Step DevelopmentNext Steps / Next MeetingQuestions / Open Discussion

3. 3 PPS Updates NYS DSRIP Updates PPS DSRIP Updates

4. 4 Timeline June 15 – June 19 Clinical Development Meeting Develop PIP Requirements June 22 – June 26 Clinical Development Meeting Develop PIP Requirements June 19 – July 3 No Meetings July 6 – July 10 Clinical Development Meeting Develop PIP Requirements July 13 - 17 Meeting: Finalize Draft PIP July 20 – 24 Present PIP(s) to Clinical Integration Committee July 27 – July 31 PMO input PIP into MAPP July 31st PIP’s Due

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6. 6 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. DSRIP Project Review: Meeting #1 PIP Requirement Development

7. 7 DSRIP Project Review: Meeting #2 PIP Risks & Mitigations – 2bv, 2bvii 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 to increase 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.

8. 8 DSRIP Project Review: Meeting #3 PIP Review & Revisions Review Draft Project Implementation Plan Revise Draft PIP

9. Team “Homework” Distribution of Draft PIP Action Item Tracking & Clarification Next Meeting Scheduled Any additional attendees Presentations needed 9 Next Steps / Next Meeting

10. 10 Questions / Open Discussion

11. Website: www.nyhq.org/dsripppswww.nyhq.org/dsrippps Maureen Buglino, VP, Community & Emergency Medicine mabuglin@nyp.org Maria D’Urso, Administrative Director, Community Medicine mda9005@nyp.org Crystal Cheng, Data Analyst, DSRIP crc9038@nyp.org 11 PMO Resources