DSRIP Update Managed Care Policy and Planning Monthly Meeting

Dianne Kiernan, DSRIP Deputy Director

June 8, 2017

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1. DSRIP Timeline and Key Benchmarks2. DSRIP Independent Evaluator 2. Current Highlights3. DSRIP Dashboard updates4. Data Sharing within DSRIP (see supporting documentation)

June 8, 2017

Agenda

Q1|Q2|Q3|Q4 Q1|Q2|Q3|Q4 Q1|Q2|Q3|Q4 Q1|Q2|Q3|Q4 Q1|Q2|Q3|Q4

DSRIP Implementation Timeline and Key Benchmarks

June 8, 2017 3

DY0 DY1 DY2 DY3 DY4 DY5

DSRIP is now here

Submission/Approval of Project Plan

• PPS Project Plan Valuation• PPS first DSRIP Payment• PPS Submission of

Implementation Plan and First Quarterly Report

Domain 3: Clinical Improvement P4P Performance Measures begin

Focus on Infrastructure Development/System

Design

Focus on Continued System/Clinical Improvement

Focus on Project Outcomes/Sustainability

Domains 2 & 3 are completely P4P

Domain 2: System Transformation P4P Performance Measures begin

Domain 4: PPS working in collaboration with community and diverse set of service providers to address statewide public health priorities; system improvements and increased quality of care will positively impact health outcomes of total population.

DS

RIP

Mid

poin

t

June 8, 2017

DSRIP Operational TimelinesRelating Demonstration Years, Payments, Quarterly Reporting Periods and Measurement Years

DSRIP Project Plan Drives DY1 Payment 1

Q1 & Q2 Reporting Periods Drive Payment 2

of DY1 (1-2) for D1

MY2 Results Drive Payment 2 of DY2 (2-2) and Payment 1 of DY3 (3-1) for Domains 2-4

EPP lags behind DSRIP by 1 year, because EPP payments rely on the

Measurement Year being fully complete

Dem

onst

ratio

n Ye

ars

(DY)

Paym

ent (

DY

Paym

ent N

umbe

r)Q

uarte

rly R

epor

ting

Perio

d (D

omai

n 1)

Mea

sure

men

t Yea

rs

(MY)

Dom

ains

2-4

Equi

ty P

erfo

rman

ce

Prog

ram

Yea

rs (E

PP)

DSRIP is now here

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DSRIP Independent Evaluator - 5 year research contract

Framework of Research Questions:1. To what extent did PPS achieve health care system transformation, including increasing the availability of BH care?

2. Did health care quality improve as a result of clinical improvements in the treatment of selected diseases and conditions?

3. Did population health improve as a result of implementation of DSRIP initiative?

4. Was avoidable hospital use reduced as a result of DSRIP?

5. Did DSRIP reduce health care costs?

6. Was DSRIP cost effective in terms of NYS and Federal government receiving adequate value for their investments?

7. What were the successes and challenges with respect to PPS planning, implementation, operation, plans for program sustainability from the perspective of DSRIP planners, administrators and providers, and why were they successful or challenging?

June 8, 2017

A team of over 30 researchers from the University at Albany, Boston University and University of Maryland have been awarded the contract to evaluate DSRIP regarding the cost, quality and access to Medicaid services as a result of the sweeping reforms.

Will be conducting qualitative surveys and focus groups with PPS and partners/providers in DY3, DY4 and DY5 and time series analysis and quantitative research simultaneously. Have required reporting timelines.

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Current DSRIP Highlights• PPS DY2 Q3 progress reports have been adjudicated and posted on the DSRIP website

• PPS DY2 Q4 progress reports for activities Jan 1- March 31, 2017 are now under IA review.

• DY2 Q3 and Q4 reports combined will produce a second biannual payment in July

• Midpoint Assessment (MPA) Activities • April 30 IA approved final Action Plans • Sept 30 PPS MPA Action Plans complete, reporting progress in quarterly reports

June 8, 2017

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DSRIP Dashboard Updates

June 8, 2017

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DSRIP Dashboard: Performance, Attribution, Network, Payment and Snapshots

• Salient DSRIP Performance and payment Dashboard presentation was held May 15

• Thank you for sending in your DSRIP contacts lists in April and May

• 59 attendees representing 17 MCPs

• FAQs were sent out May 22 to MCP DSRIP contacts list persons via OMC BML

June 8, 2017

• MY2 results are done• MY3 performance Months 1-4 being updated now in the Dashboards and new rosters

• Performance and Attribution tiles will run on the August 2016 network (MY2)• Network and Snapshot tiles run on the March 2017 network

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DSRIP Dashboard MCP Access in MAPP

June 8, 2017

• MCP rosters of members by PPS were sent 3/31/17 and 5/10/17

• Roster is separate from and processed differently than the 834 enrollment files.

• If your MCP has not yet completed the DEAA you must do so prior to establishing your server connection.

• DOH will work with MCP DEAA Gatekeepers to establish users to connect to a Secure File Transfer server to gain access to the Member Roster

Member Roster File via SFTp

Reminder: The DSRIP Dashboards have PPS Members who have opted out included in aggregate but are not displayed in the drill down. The MCP Member Rosters will include allcurrent members and their currently attributed PPS. Opt out does not apply to the MCP Member roster. It only lists the members’ assigned PPS.

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MCP Status of Access to DSRIP Dashboard in MAPP and Member Roster File via SFTp

June 8, 2017

Mainstream PlanApproved DEAA on file with Privacy Office to gain 

access to DSRIP Dashboards.  

Identified Users for SFTp to pull the 

member roster file.   

Actually Retrieved the 5/10 Member 

Roster File Affinity Health Plan x x xHealthPlus, LLC Amerigroup x x xCDPHP X x ‐ In progressCrystal Run x x xEmblem PendingExcellus BCBS x x  ‐ In progressFidelis Care NY x pending security QHealth Now NYHealth First x x xIndependent HealthMetroplus xMVP Health Plan x  x ‐ In progressTotal Care, Today's Options of NY Inc xUnited HC xVNSNY Choice x x xWellcare x x xYourCare Health Plan x x x

14 10 7

contact :  doh.sm.Medicaid.Data.Exchange@health.ny.gov. DSRIP@health.ny.gov 

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MCP that pulled down the 5/10/17 roster• During the month of May 2017, the DSRIP Dashboards in MAPP were updated with the first three months of

Measurement Year 3 (MY3) data.

• In addition, the rosters of MCP enrollees with the attributed PPS identified were posted to the sFTP server for those seven MCPs that were eligible to access the data files.

• It has been found that the May 2017 activities related to the Dashboard update, the data files released to the eligible PPS and the MCP enrollee rosters required a correction to which network supported those runs.

• It was found that the March 2017 network was prematurely applied instead of the August 2016 network.

• March 2017 networks should be applied to Measurement Year 4 performance and attribution.

• Thus, MY3 data in the MAPP dashboards will need to be recalculated applying the August 2016 network.

• Also, member/claims files to the PPS and the attributed enrollee rosters to the MCP will need to be re-run.

June 8, 2017

June 2017

• The network additions and removals from the mid-point assessment will be reflected for the start of DY3 as of April 2017 and will subsequently impact PPS Performance at the start of MY4 in July 2017.

• As a result, MY3 in MAPP will be adjusted to allow DSRIP Performance to reflect the PPS Network effective in August 2016.

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Network impact on MY3 Data

DSRIP Measurement

Year

DSRIP Measurement Year Timeframe

Date of Network Closure (in MAPP) for PPS Network Used in Measurement Calculations

MY1 July 2014 – June 2015 April 2015MY2 July 2015 – June 2016 December 2015

MY3 July 2016 – June 2017 Incorrect version: March 2017Correct version: August 2016

June 2017

Performance Data Planned ReleaseDSRIP Dashboards MY3 Month 1-3 Friday 6/16/2017DSRIP Dashboards MY3 Month 4 Saturday 6/24/2017MCP Rosters (and PPS Data Files MY3 Months 1- 4) Thursday 6/29/2017

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MY3 Data Re-run Schedule• Because the incorrect network was applied, the data needs to be re-run and re-

applied.• The MAPP data that will be updated is summarized below:

• DSRIP Dashboards Performance Measurement for MY3 (Month 1, 2 and 3)• DSRIP Attribution data and provider network data in the dashboards

• The proposed timeline for producing new performance data is as follows:

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What that means to MCP who have access to their 5/10 rosters

• Seven MCP received rosters run against PPS networks March 2017 when those rosters should have been run against August 2016 networks.

• Data destruction requirements for those seven MCP that pulled down the data files (run off the March 2017 network) and released May 10 are being investigated and are forthcoming.

• This may need to occur in sync with the next roster release on June 29 for those seven MCP that took custody of the 5/10 rosters.

• For newly eligible MCPs that are now SFTP set-up ready, this would not apply, as these are first time releases.

June 8, 2017

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Data Sharing within DSRIP“Guidance Documentation: Privacy and Data Sharing within DSRIP (June 5, 2017)”

Distributed this week to PPS, Qualified Entities (RHIO), OMH and OASAS agencies and MCP today

Please include both BMLs when sending questions:

DSRIP@health.ny.gov

and

doh.sm.Medicaid.Data.Exchange@health.ny.gov.

With the subject line: June 5th Privacy and Data Sharing questions

June 8, 2017

Supersedes all previous guidance

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DSRIP Upcoming Updates

• Integrated Primary Care into Behavioral Health site (Project 3ai Model 2) presentation pending for July meeting

June 8, 2017

For questions regarding DSRIP or the DSRIP Performance Dashboards, please contact the DSRIP team at: DSRIP@health.ny.gov

For questions regarding in how to interpret information in the Dashboards, please contact HHSsupport@salient.com

For questions regarding the DEAA or Privacy regulations, please contact the Privacy office at: doh.sm.Medicaid.Data.Exchange@health.ny.gov.

For all other Managed Care Plan inquiries, please contact: omcmail.health.ny.gov