1. NewYork-Presbyterian/Queens PPS Town Hall Delivery System Reform Incentive Payment (DSRIP) Program

2. DSRIP Program Review Health Transformation program being led by the NYS DOH. Program has progressed from planning to implementation. 2

3. DSRIP Goals  Build a better health care system.  Physicians, clinics and other healthcare providers working together to understand the community and to improve the health of the population.  Reducing the avoidable emergency room visits and hospitalization by 25% over the next five years. 3

4. DSRIP Structure  Groups working together are called PPS’s.  There are 25 PPS’s working together on this in NYS.  Each PPS has a designated lead.  In the planning phase our PPS worked together to understand the needs of our community.  A detailed Community Needs Assessment was conducted. 4

5. DSRIP Structure  NYP/Q PPS is working on 9 projects.  Moving from the planning phase into the implementation phase.  NYP/Q has 1,400 partnering providers.  Smallest PPS in the State.  Unique from the others because of a concentrated focus with Skilled Nursing Facilities to address the needs of the long term care population. 5

6. NYS DOH DSRIP Key Accomplishments  The specific valuations for all 25 PPS’s have been announced.  PPS’s submitted their Domain 1 Project implementation plans, inclusive of the organizational components of the plan, such as Governance, Workforce Strategy, Financial Sustainability, Cultural Competency and Health Literacy. 6

7. NYS DOH DSRIP Key Accomplishments  The DSRIP Independent Assessor (IA), the DOH Office of Health Insurance Programs (OHIP) and DOH partner agencies including the NYS office of Mental health (OMH), NYS Office of Alcohol and Substance Abuse (OASAS) and the NYS Office of People with Developmental Disabilities (OPWDD) reviewed the implementation plans, compiled remediation and/or recommendations to the PPS’s. 7

8.  DOH and its stakeholders hosted stakeholder engagement activities and public events.  DOH released the Implementation Plan and Quarterly Reporting tool on the Medicaid Analytics Portal (MAPP).  This is the tool that all PPS’s utilize to submit reports and plans.  The Roadmap to Value Based Payment was developed, in accordance with CMS guidelines. 8 NYS DOH DSRIP Key Accomplishments

9. NewYork-Presbyterian/Queens PPS Updates  Our first quarter focused on developing an organizational framework to operate the PPS.  Purchased software management tools to assist in project management.  Purchased a population health management tool for the PPS.  Performed a current state of assessment of our PPS, for IT, clinical best practices, care transitions, education and training needs. 9

10. NYP/Q PPS Updates  Project implementation plan submitted was accepted by the IA with minimal feedback.  Operating Standards for our PPS have been developed.  Policies related to data sharing have been developed.  Finance Funds Flow concepts have been developed. 10

11.  Project teams are underway with implementation.  Actively engaged patient counts are being compiled.  Quarterly PAC meeting took place on 9/22/15.  Quarterly report for DY1, Q2 due 10/31/15. 11 NYP/Q PPS Updates

12. NYP/Q PPS FOCUS DY1, Q3 10/1/15 – 12/31/15  Partner agreements specific to projects and deliverables to be signed by the PPS partners.  Funds flow modeling and policy development.  Budget finalization to the project and partner level.  Continued roll out of the project implementation plans.  Cultural competency and health literacy strategy development. 12

13. 13 NYS DOH Key Upcoming Dates October 31 PPS Second Quarterly Report (7/1/15-9/30/15) due November DSRIP Notice and Opt out letters mailed to Medicaid members November 9 & 10 DSRIP Project Approval & Oversight Panel Bi-Annual Meeting December 1 IA provides feedback to PPS on PPS Second Quarterly Reports December 15 Revised PPS Second Quarterly Report due from PPS December 30 Final Approval of PPS Second Quarterly Reports

14. Funds Flow Model 14

15.  No funds will be distributed until funds are received by the PPS from the DOH  Partner expectations will be outlined in detail as an addendum in the provider collaboration agreement(s)  Administrative expense & cost of project implementation are based on expense actuals or benchmark data while revenue loss, non-covered services, and contingency are a calculated based on an allocation (%) of the revenue received  The PPS partner network defined by the New York State DOH will be utilized to define partners and the PMO will define by project or funding category based on previous commitments or budget discussions  An incentive indicator based upon provider contribution to project success will be utilized to ensure incentives of providers most successful at engaging patients  The PPS holds the right to request refund of or reduce future payments of funds on fraudulent, improper, or incorrect reporting of metrics, volume, or requirements 15 Funds Flow Key Principles

16. www.ehanys.com Stacey Mallin, MPA, CPHQ, PCMH CCE, CLSSBB Director, PCMH Advisory Services October 27, 2015 © 2015 HANYS Solutions Patient-Centered Medical Home Advisory Services

17. www.ehanys.com Objectives After today’s presentation, you will – Understand how Patient Centered Medical Home (PCMH) relates to DSRIP – Have a basic understanding of PCMH transformation – Know how the transformation impacts clinical integration, your clients, patients and the care continuum 17

18. www.ehanys.com Source: Medicaid Redesign Team DSRIP Roadmap for PCMH 18

19. www.ehanys.com Eligibility Requirements Source: Medicaid Redesign Team 19

20. www.ehanys.com DSRIP Projects Requiring PCMH Source: Medicaid Redesign Team NYPQ - 3/8 Projects Require PCMH 20

21. www.ehanys.com

22. The “Triple Aim” 22

23. www.ehanys.com Patient-Centered Medical Home (PCMH) Empowers the patient to be an active part of his/her health care team Physician-led team approach – Staff works to the highest capability of license/skill The “cares” 23

24. www.ehanys.com WHY NOW? WHY SHOULD WE? 24

25. www.ehanys.com 25

26. www.ehanys.com Source: http://www.ch-dc.org/programs-initiatives/patient-centered-medical-home/ 26

27. www.ehanys.com Benefits for Patients/Clients Engaged, happier and more satisfied patients Better coordinated, more comprehensive and personalized care Improved access to medical care and services Improved health outcomes, especially for patients who have chronic conditions Source: http://www.aafp.org/practice-management/transformation/pcmh/benefits.html 27

28. www.ehanys.com Benefits for Practices Source: http://www.aafp.org/practice-management/transformation/pcmh/benefits.html Joy in practice: increased physician and staff member satisfaction Physicians and staff members who practice at the top of their licenses Improved safety and quality of care 28

29. www.ehanys.com Benefits for Practice Bottom Line A more efficient use of practice resources, resulting in cost savings Opportunities to participate in payment incentives Better prepared to succeed in a value- based payment arrangements Better prepared to participate in accountable care organizations Source: http://www.aafp.org/practice-management/transformation/pcmh/benefits.html 29

30. www.ehanys.com Source: https://www.pcpcc.org/event/2014/08/2014-mid-atlantic- medical-neighborhood-forum Medical Neighborhood 30

31. www.ehanys.com Benefits to Partners Agreement on and delineation of the roles Sharing of the clinical information Continuity of care Lower costs Co-management Agreements between providers/organizations 31

32. www.ehanys.com NCQA PCMH 2014 Standards Tell us what you do, show us how you do it Team-Based Care Record Review Workbook Aligned with Stage 2 Meaningful Use Quality Improvement (QI) focus Patient-experience-with-care survey 32

33. www.ehanys.com NCQA PCMH 2014 Standards and Must-Pass Elements PCMH 1: Patient-Centered Access – Element A: Patient-Centered Appointment Access PCMH 2: Team-Based Care – Element D: The Practice Team PCMH 3: Population Health Management – Element D: Use of Data for Population Management PCMH 4: Care Management and Support – Element B: Care Planning and Self-Care Support PCMH 5: Care Coordination and Care Transitions – Element B: Referral Tracking and Follow-up PCMH 6: Performance Measurement and Quality Improvement – Element D: Implement Continuous Quality Improvement *Must meet all must-pass elements to obtain any recognition; a 50% score equals pass for a must-pass element 33

34. www.ehanys.com “Pass Go” for DSRIP funding Scoring Considerations Each standard has elements and factors How many and how well they are performed translates into points: – Level 1: 35-59 points – Level 2: 60-84 points – Level 3: 85-100 points 34

35. www.ehanys.com Achieving Transformation Practice Culture People, Process, and Technology – Ensure awareness, desire – Knowledge and ability – Potential obstacles and risks 35

36. www.ehanys.com Change isn’t Easy The transformation process can be a long and difficult journey Teamwork 36

37. www.ehanys.com Improvement Cycles 37

38. www.ehanys.com Health Information Technology An important part of the equation, but not the solution Redesigned workflows Understand data and reporting 38

39. www.ehanys.com Workforce Engagement Inclusive Communication Training Consistently monitor progress and compliance 39

40. www.ehanys.com Recent PCMH Studies Friedberg, M., Rosenthal, M., Werner, R., Volpp, K. & Schnieder, E. (2015). “Effects of the Medical Home and Shared Savings Intervention on Quality and Utilization of Care.” JAMA Internal Medicine, Online Maeng, D., Khan, N. Tomcavage, J. Graf, T., David, D. & Steele, G. (2015). “Reduced Acute Inpatient Care was Largest Savings Component of Geisinger Health System’s Patient-Centered Medical Home.” Health Affairs, 34, No. 4, 636-644 Sandy, L., Halton, H., Metfessel, B., & Reese, C. (2015). “Measuring Physician Quality and Efficiency in an Era of Practice Transformation: PCMH as a Case Study.” Annals of Family Medicine, 13, 264-268 40

41. Contact Information  NYP/Q PPS -Phone: 718-670-1511 -Website: http://www.nyp.org/queens/dsripppshttp://www.nyp.org/queens/dsrippps  Stacey Mallin, Director, PCMH Advisory Services -Email: Smallin@hanys.orgSmallin@hanys.org -Phone: 516-621-2705 -Website: http://www.hanys.org/http://www.hanys.org/ 41

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