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OneCity Health Partner Webinar | December 11, 2018 1

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OneCity Health Partner Webinar | December 11, 2018

OneCity Health Partner Webinar

Reviewing our PPS Performance, Gearing up for Phase IV Contracting and the Importance of RHIO Connectivity

December 11, 2018


Today’s Presenters

Rich Bernstock,

Hub Executive Director

Israel Rocha,

CEO, OneCity Health and Vice President, New York City Health + Hospitals

Ismael Carter,

Hub Executive Director

Ben Goldsteen,

Chief Analytics Officer

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4

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Topics for Today’s Webinar

CEO Special Session

Phase IV Contracting

Phase III Metric Reminders and Upcoming Trainings

RHIO Connectivity Update

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CEO Special Session

6


OneCity Health PPS Performance


Note: As part of a December 2015 waiver amendment request to the federal Centers for Medicare and Medicaid Services, New York is seeking to slightly modify these percentages.

Source: New York State Department of Health, Attachment I—NY DSRIP Program Funding and Mechanics Protocol, April 2014.

Slide Source: The Commonwealth Fund

15%

45%

65%

85%

20%

25%

15%

15%

15%

80%

60%

40%

20%

DSRIP Year 1 DSRIP Year 2 DSRIP Year 3 DSRIP Year 4 DSRIP Year 5

Project progress milestones

Pay-for-reporting

Pay-for-performance

DSRIP is shifting from reporting to performance-based payments

In Measurement Year 5, 85% of payment is based on performance

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56

5148

42 4139 38 38 37

35 33

0

10

20

30

40

50

60

New York City PPS MY3 PerformancePercentage of Claims-Based Metrics

Meeting Improvement Target* (%)

PPS achieved 48% of improvement targets for 33 claims-based metrics; 3rd highest

percentage of metrics achieved among downstate peers

How did we perform on our improvement targets in Measurement Year 3?

Management Recommendation

Overall, OneCity Health PPS performed

well on performance improvement targets

relative to downstate peers, however

there is significant room for improvement

on utilization measures.

*Metrics are calculated based on claims as opposed to survey or electronic medical record review. These metrics are available to all PPS through the Salient Interactive Miner tool provisioned by the New

York State Department of Health

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8

OneCity Health PPS saw strong MY3 improvements but additional performance gains needed

to further narrow the gap to All-PPS average

Data Source: New York State Department of Health DSRIP MY3 Performance Summary

Preventable Readmissions(per 100,000 Medicaid members)

1000

900

678.7

575.4

800

700

600

500

400

MY0 MY1 MY2 MY3

1058

856

-18.5%

-15.2%

Preventable ED Visits

(BH Population)(per 100 Medicaid members)

120

98.4

83.7

100

60

40

20

0

MY0 MY1 MY2 MY3

99.5

116-14.2%

-14.9%

Preventable ED Visits(per 100 Medicaid members)

100

80

60

40 34.129.2

20

0

MY0 MY1 MY2 MY3

4248

-12.5%

-14.3%

OneCity Health PPS RateAll PPS Rate

Performance relative to PPS average for utilization measures

Management RecommendationDecreasing potentially avoidable utilization, has been challenging for the majority of NYC PPS. For OneCity Health performance is

improving but off-target and requires additional targeted strategies, including additional access to primary or urgent care services

and coordination of care to address social determinants of health.

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13.9 8.3

17.3

6.5

16.5

-

(24.7)

(6.3)

(51.8)

(6.5)

-

(32.5)

-60

-50

-40

-30

-20

-10

0

10

20

Earned

Unearned

MY3 Results on Pay-for-Performance Metrics

in Earned and Unearned Revenue ($M)

The PPS only earned 34% of pay-for-performance metrics in Measurement Year 3

Where are the biggest opportunities?

Access Behavioral

Health

CAHPS Chronic

Conditions

Project 11 Utilization

% Earned 36% 57% 25% 50% 100% 0%

*MY4 and MY5 revenue include $18.6M in palliative care P4P metrics 11


The Project Approval and Oversight Panel (PAOP) highlighted areas for improvement

Preliminary PPS MY4 results (MY4, Month 9)

High performance On-track Off-track

Pediatric asthma admissions

Adult access to preventive or

ambulatory care (20 – 44 years

old)

Adult access to preventive or

ambulatory care (45 – 64 years

old)

Statin therapy for patients with

cardiovascular disease –

received statin therapy

× Follow-up after psych

hospitalization for mental

illness within 30 days

× Anti-depressant medication

management

× Initiation of alcohol and other

drug dependence treatment

× Prevention quality indicators:

× Younger adult asthma

(18 – 39 years old)

× Heart failure


OneCity Way


The evolving role of OneCity Health



CEO Special Session


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Guiding principles for Phase IV Contracting

It is imperative for OneCity Health to demonstrate rigor in performance provisions and connectivity of our contracting strategy with the New York State Department of Health (NYS DOH) Value-Based Payment (VBP) Roadmap

Phase IV contracting will overlap with last six months of Measurement Year 5 and the final DSRIP program year

Phase IV contract will serve as a test of our sustainability thinking including potential post-DSRIP contracting options with strategic partners

Guiding principles for Phase IV Contracting:

Reflect a continued shift to outcomes and performance

based payments in preparation for value-based

payment

Focus on investing in areas of strategic importance

post-DSRIP

Include standard conditions of participation for all

contracted partners to build necessary capabilities and

infrastructure post-DSRIP and for compliance

purposes

Drive high-value interventions including in the areas of

primary care access and behavioral health

Minimize administrative burden (contract metrics

should be aligned with PPS metrics and there should

be fewer total metrics)

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Contracting methodology aims to maximize performance opportunities for DSRIP MY5

and beyond

Timeline for Phase IV Contracting

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Executive Committee

and Business

Operations

Committee Approval

of contracting

methodology for

Phase IV Part One

Review contracting methodology for Part Two

Amendment with PPS Business Operations

Committee

(pended to Nov 15th)

Review contracting

methodology for Phase

IV Part Two with PPS

Business Operations

and Executive

Committees

Phase IV Part One

contracting

Amendment Issued

Oct 5 Nov 8 Nov 15

Issue

Phase IV Part Two

contracting

amendment

Nov 21 ~ Jan/Feb 2019


Content:

Phase IV Comprehensive Schedule B Part

One

• Extension of term of the Master Services

Agreement (MSA) through end of DSRIP

program and wrap-up of PPS activities

(June 30, 2020)

• Composite of PPS participation

requirements (workforce survey,

compensation and benefits survey,

financial assessment, compliance

attestation)

o Metric due dates: April 2019, October

2019, January 2020

Prerequisites:

MSA

Phase III Comprehensive Schedule B

(if applicable)

Completed 2018 DSRIP Compliance

Attestation

Logistics:

Part One Amendment and Phase III

Comprehensive Schedule B closeout letter

issued on November 21 to 164 partners

30 calendar days to sign Part One

Amendment

Notify OneCity Health immediately of any

changes to your organization’s signatory

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Overview

Phase IV Contracting Part Two

Align performance requirements and

expectations for partners with value-based

purchasing standards

Establish one or more minimum pre-requisites

for participation for applicable partner types:

• Phase IV Part One

• Quality rating

• Connectivity to regional health

information organization (RHIO) / health

information exchange (HIE)

• Meaningful use (MU)-certified electronic

health record

• Connectivity to NowPow PowRx

(closed-loop referral) module

Contract for high-value connections to

care and interventions that are expected

to positively impact priority outcome

measures targeted by OneCity Health

Align fee structure with standard

payment practices to reduce

administrative burden to partners and

PPS

Utilize available data sources to

establish performance baselines,

improvement targets and frequency of

performance measurement

Reflect principles of readiness and the shift to value-based purchasing

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Partner Type

(as applicable)

Impact on

Priority

Outcome

Measures

PPS Required

Pre-requisites

Community-Based

Organization

Health Home

Home Health Care

Hospitals

Mental Health

Nursing Home

Primary Care

Pharmacy

Substance Abuse

Use of

Technology &

Quality Rating

• MU-certified EHR

• RHIO / HIE

• NowPow

• Medicare Star Rating

Content Framework

Examples

Connections

to Care

• Primary care

• Behavioral health

• Care management

• Housing

• Insurance

• Other social and family supports (NowPow)

High-Value

Interventions

• Care management

• Community Health Worker engagement

• Critical time intervention

• Food and nutrition

• Medication delivery

• Medication adherence

• Legal services

• Respite beds

• Transportation

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Overarching funds flow allocation is

commensurate with New York State

Department of Health requirements for PPSs:

• Safety net partners: 95%

• Non-safety net partners: 5%

Types of pricing models:

• One-time

• Fee-for-Service (or hybrid: with incentive)

• Capitation (or hybrid: with FFS)

• Incentive-based

One-time costs for select services or activities

Fee-for-Service (FFS) contracts pay set rates

each time the service is utilized (for example,

pricing for community health worker service is

based on the number of home visits where the

unit of service is the “home visit.”)

Capitation contracts pay a set periodic rate for

each covered person (there is no fixed cap on

the amount of services an individual can receive

during a given period)

Incentive-based also referred to as “pay-for-

performance” or “royalty” models, incentive-

based contracts pay a percentage of resulting

revenues or profits, or a percentage of resulting

cost savings (for example from reduced

hospitalizations of a patient)

Funds Flow and Pricing Framework

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CEO Special Session



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Upcoming Phase III Deadlines

Although the Phase III contract term ends December 31, 2018 and Phase IV begins January 1, 2019, there is no change to the Phase III metrics due in January 2019. These metrics cover reporting for the performance period ending December 31, 2018

Please refer to the OneCity Health Partner Reporting Manual and OneCity Health Partner Portal

for comprehensive information on completing all Phase III Process Metrics

As a reminder, you are only responsible for completing the Process Metrics in your Phase III

Comprehensive Schedule B

The next two slides will detail upcoming metrics

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Upcoming Phase III Deadlines

As Phase III winds down, there are several final process metrics due at the end of December and throughout January 2019

Due December 31, 2018: Process Metric N_011 (Nursing Home partners report on CMS Star Rating)

Due January 15, 2019: Three final process metrics

• Process Metric N_005: VBP Training (We will discuss this requirement more in the next slide)

• Process Metric N_006: PCMH Recognition (For Primary Care partners who have not previously submitted

this metric)

• Process Metric N_007: RHIO Connectivity (For partners who have not previously submitted this metric)

Due January 25, 2019: Seven recurring Process Metrics

Due January 31, 2019: Twelve additional recurring Process Metrics

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Value Based Payment Training: Process Metric N_005 is due January 15, 2019

Attending a Value Based Payment (VBP)

training is a PPS-wide metric that all

partners must meet

There are a wide variety of VBP trainings

available to partners. For the purposes of

completing Process Metric N_005, partners

may attend any relevant VBP training

There are several VBP trainings currently

available on the OneCity Health Learning

Management System (LMS)

You can also register on the LMS for an

upcoming VBP webinar for OneCity Health

partners that will be held on December 13,

2018: Cross-Sector Partnerships as a

Promising Strategy for Health System

Improvement

The New York State Department of Health

also offers VBP trainings, including their VBP

University

When reporting on this metric, partners will

be required to upload to the Portal proof of

training completion in 2018 for at least one

employee. This proof may include:

• Any certificate of completion of a VBP

training from the OneCity Health LMS or

any other external training

• A training sign-in sheet, along with an

agenda and/or copy of training materials

for any VBP training held at your

organization

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For registration and course description information please visit the OneCity Health Learning

Management System at lms.onecityhealth.org

One City Health: Supporting the Learning Needs of our Partners

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Upcoming Training Offerings

December 2018

• 12/13: Advanced Motivational Interviewing Techniques for Clinicians

• 12/13: CBO VBP Webinar #1: Cross-Sector Partnership as a Promising Strategy for Health

System Improvement

• 12/14: Addressing the Housing Needs of Patients

• 12/14: Enabling Safe Living Environments for Clients

• 12/19: Worker Connect

January 2019

• 1/17: CBO VBP Webinar #2: Cross-Sector Partnerships Producing Notable Results

• 1/18: Patient Engagement Strategies

• 1/28: Assessing and Managing Suicide Risk

• 1/28: e-Cigarettes Grand Round

lms.onecityhealth.org



CEO Special Session



RHIO Connectivity Update

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What is the RHIO?

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The State Health Information

Network of NY (SHIN-NY) is a

secure network for sharing

electronic clinical records in New

York State.

The SHIN-NY comprises 8 regional hubs

(RHIOs - Regional Health Information

Organization) and the New York eHealth

Collaborative (NYeC).

NYeC is the technical hub that connects the

RHIOs to allow for cross-RHIO data exchange.

Once OneCity Health partners connect to one

RHIO, then they are connected to the others

through the SHIN-NY.


RHIO Function – Component Map

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RHIO COMPONENTS

Participation

Agreement

(PA)

Consent

Collection

Data

Sharing

Electronic

Medical Record

(EMR)

RHIO

Development

User

Experience/

Analytics

Adoption

FU

NC

TIO

NA

LIT

Y

Point of care clinical

and demographic

reference

X X X X X

Share data

with partnersX X X X

Population

health/registry

development

X X X X X

Alerts/Encounter

notificationsX X X X X

Centralized

analytics/value based

contracting support

X X X X

Referral

managementX X X X X X


OneCity Health RHIO Strategy

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1. Help partners, that request assistance,

build relationships with RHIOs - Participation

Agreement and Connection

2. Support RHIO consent collection process –

Quality and Quantity

3. Drive adoption and integration of RHIO functionality

into workflows through use cases


OneCity Health RHIO Strategy #1: Help partners build relationships with RHIOs

31

Joining a RHIO

NYCIG and Healthix do not charge practices a fee to join them

Data Exchange Incentive Program (DEIP) and other funding available to

cover the cost due to the EMR vendor

Technical assistance is available from RHIOs and OneCity Health to develop

a physical connection


OneCity Health RHIO Strategy #2: Support RHIO consent collection process

Basics:

If provider is connected to RHIO, data

passively flows for ALL patients from

the provider to the RHIO.

Consent is given by a patient to a

provider for the provider to view the

patient’s PHI that might be in a RHIO.

Consent Status:

Yes – Consent is given for the

provider to receive patient’s

information from the RHIO

No – Consent is denied for provider to

receive patient’s information from the

RHIO

Emergency Only – Consent is given

for the provider to receive information

from the RHIO only in emergency

situations

Null – Consent value has not been

collected and communicated to the

RHIO

Carve Outs

Mental Health/Substance Abuse -

Substance Abuse and Mental Health

Services Administration (SAMHSA)

requires that people who have been

treated for substance abuse and

mental health issues sign a separate

consent that covers access to that

information.

Minors (<18 y.o.) – Services related

to sexual assault, pregnancy and

pregnancy related services, family

planning, sexually transmitted

diseases, alcohol and drug abuse, and

outpatient mental health treatment and

counseling.

RHIO Consent Overview

Provider

Providers

32


Case Development - Submission

33

1. Please submit cases to Ben Goldsteen and Diana

Amrom at [email protected] and

[email protected]

2. Submission should include:

a. The specific problem to be addressed

b. Impacted patient population

c. Description of providers involved, including the role of

each provider

d. How the project will address the Triple AIM or DSRIP

goals

3. Examples:

a. Specific Case: Primary care providers should receive

alerts when patients assigned to them by MCOs are

admitted to Emergency Departments with a specific

list of diagnostic codes.

b. Vague Case: We need more alerts.

OneCity Health RHIO Strategy #3: Drive adoption and integration of RHIO functionality

Case Development - Implementation

1. Identify and prioritize for engagement partners

who have relevant data

2. Assess the quality of the data and provide

support for improving data quality at the local

level

3. Assess whether the RHIO has the ability to

address the identified problem

4. RHIO and OneCity Health/NYC Health +

Hospitals teams develop solution to the

identified problem

5. OneCity Health/NYC Health + Hospitals

engages end users to adopt the solution

mailto:[email protected]

mailto:[email protected]


eCW Update

34

1. NYCIG in combination with NYC Health + Hospitals will connect cloud-based

eCW partners to NYCIG (at no charge)

2. NYC Health + Hospitals’ IT function (EITS) will reach out to coordinate next

steps

3. If your organization uses a cloud-based eCW instance, is interested in

connecting to NYCIG, and has not heard from EITS by end of December,

please reach out to your hub representative


RHIO Connectivity - Next Steps

Stay tuned for information from DSRIPSupport on another webinar dedicated to the RHIO, including a more in-depth overview of consent and further discussion on the development of use cases

If your organization uses a cloud-based eCW instance and you are interested in connecting to the NYCIG RHIO, please reach out to us and let us know if you haven’t already

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