DSRIP Project Advisory

Committee Meeting

August 29, 2017

Welcome! Amy L. White-StorferDirector, Project Management Office

Project & Workstream Updates▪ Our newsletter is available today!

▪ With detailed project updates.

▪ http://wnycommunitypartners.org/resources/

Current Project Updates always online!http://wnycommunitypartners.org/partners/

DSRIP reporting link on right hand navigation (password protected)

How are we doing? Metrics & MeasurementPhyllis GunningDirector, Clinical Programs

CPWNY Measurement Year 2 Results Summary

▪ Total of 72 quality metrics*▪ 14 measures (19.4%) met MY2 improvement targets▪ 26 measures (36.1%) have no improvement target (MY2 results will serve as baseline for

some)▪ 32 measures (44.4%) did not meet MY2 improvement targets

▪ EPP (Equity Performance Program) measures▪ 1 EPP measure met target▪ 2 EPP measures have no target▪ 3 EPP measures did not meet targets

▪ Estimated revenue higher than the expectation of 50% P4P, 80% P4R.

*variety of sources: claims, medical records review, patient surveys6

7

0.00

20.00

40.00

60.00

80.00

100.00

120.00

PPV PPV (BH)

Efficiency

MY1 Result

MY2 Result

MY3 Target

Potentially Preventable ED Visits/Readmissions(lower is better)

0.00

100.00

200.00

300.00

400.00

500.00

600.00

PPR

Efficiency

MY1 Result

MY2 Result

MY3 Target

MY1

Res

ult

MY2

Res

ult

MY2

Tar

get

MY3

Tar

get

PPV 60.85 35.92 35.71 32.94

PPV (BH) 107.63 63.52 59.85 60.7

MY1

Res

ult

MY2

Res

ult

MY2

Tar

get

MY3

Tar

get

PPR 495.46 326.91 383.6 312.28

78.00

80.00

82.00

84.00

86.00

88.00

90.00

92.00

Adult Access (20-44 yo) Adult Access (45-64 yo) Adult Access (65+)

Preventive Care-Adult

MY1 Result

MY2 Result

MY3 Annual Improvement Target

Adult Access to Preventive or Ambulatory Care(higher is better)

MY1

Res

ult

MY2

Res

ult

MY2

Tar

get

MY3

Tar

get

20-44 82.30 83.08 82.89 83.88

45-64 89.25 90.16 89.49 90.58 65+ 88.23 88.32 89.30 88.93

Child Access to Preventive or Ambulatory Care(higher is better)

75.00

80.00

85.00

90.00

95.00

100.00

Children's Access (12-24 Mo)

Children's Access (25mo-6 yo)

Children's Access (7 -11 yo)

Children's Access (12 -19 yo)

Preventive Care-Child

MY1 Result

MY2 Result

MY3 Target

MY1

Res

ult

MY2

Res

ult

MY2

Tar

get

MY3

Tar

get

12-24mo 97.49 96.42 97.32 96.78

25mo-6y 93.06 92.54 92.22 93.13

7y-11yo 86.82 96.91 97.29 97.2212-19 yo 84.38 95.65 95.39 95.97

-

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

MH Follow-up 7 days MH Follow-up 30 days

Follow-Up After MH Hospitalization

MY1 Result

MY2 Result

MY3 Target

Follow-Up After Hospitalization for Mental Illness(higher is better)

MY1

Res

ult

MY2

Res

ult

MY2

Tar

get

MY3

Tar

get

MH Follow-up 7 days 54.62 53.28 56.58 55.37

MH Follow-up 30 days 70.98 68.77 72.7 70.71

0.00

10.00

20.00

30.00

40.00

50.00

60.00

Antidepr Med Mgmt-Acute Tx Antidepr Med Mgmt -Eff ContPhase Tx

Screening for Clin Depr andFollow-Up Plan

Depression

MY1 Result

MY2 Result

MY3 Target

Depression Screening and Medication Management(higher is better)

MY1

Res

ult

MY2

Res

ult

MY2

Tar

get

MY3

Tar

get

Acute 51.01 53.81 54.99 54.43Cont 36.20 37.68 40.06 38.26Screen 16.35 20.71 20.34 24.26

Prenatal and Postpartum Measures

0

10

20

30

40

50

60

70

Freq of OngoingPren Care

Postpartum Prenatal Care-Timeliness

Perinatal(higher is better)

MY1 Result

MY2 Result

MY3 Target0.00

10.00

20.00

30.00

40.00

50.00

60.00

Low Birth Weight

Low Birth Weight(lower is better)

MY1 Result

MY2 Result

MY3 Target

MY1

Res

ult

MY2

Res

ult

MY2

Tar

get

MY3

Tar

get

Freq Pren 42.24 46.16Postpartum 54.89 46.27 57.56Pren Timeliness 59.90 51.64 63.31LBW (lower better) 36.52 55.32 65.93 52.66

Next Steps

▪DY3 Strategic Performance Plan▪Priority measures▪Focus areas▪Payment structure

Funds Flow & Budget Update

CPWNY Cumulative Distributed Revenueby PPS Program Category DY1 to DY3 Q1

Provider Category Sum DY1 - DY3 Q1 Amount PercentageSubstance Abuse 348,283$ 2.31%Local Government Unit 399,861$ 2.65%Community Based Organizations 3,614,897$ 23.99%Hospice 1,155,255$ 7.67%ED Triage 512,970$ 3.40%Practioner-Primary Care Provider 2,846,374$ 18.89%Care Transitions 1,785,304$ 11.85%Hospital 4,072,583$ 27.03%Clinical Transformation 128,300$ 0.85%Case Management / Health Home 199,164$ 1.32%All Other 5,417$ 0.04%

15,068,410$ 100.00%

CPWNY Cumulative Distributed Revenueby PPS Project Category DY1 to DY3 Q1

Total Revenue Received YTD DY3 Q1 from all sources: $20,213,796

Project Sum of DY1-DY3Q1 Expense Percentage2.a.i Integrated Delivery Systems 6,316,984$ 41.92%2.b.iii Emergency Department Triage 1,082,852$ 7.19%2.b.iv Care Transitions 2,262,671$ 15.02%2.c.ii Telemedicine 637,337$ 4.23%3.a.i Behavorial Health 732,320$ 4.86%3.b.i Cardiovascular Health 464,590$ 3.08%3.f.i Nurse Family Partnership 872,417$ 5.79%3.g.i Palliative Care 1,434,810$ 9.52%4.a.i Mental, Emotional, Behaviorial Well being 553,008$ 3.67%4.b.i Tobacco Use Cessation 711,420$ 4.72%Grand Total 15,068,410$ 100.00%

CPWNY Cumulative Distributed Revenueby PPS Program Category DY1 to DY3 Q1

Partners Receiving Funds Provider Category Sum of DY1-DY3 Q1 Expense PercentageCHS Community Based Organizations 502,993$ 3.34% CHS-Care Management Care Transitions 1,611,066$ 10.69% CHS-ED Triage ED Triage 512,970$ 3.40%CMP Community Based Organizations 2,706,776$ 17.96% CMP-Provider PPS Pymt DY1 Practioner-Primary Care Provider 1,100,000$ 7.30% CMP-Provider PPS Pymt DY2 Practioner-Primary Care Provider 1,368,225$ 9.08% CMP-Provider PPS Pymt DY3 Practioner-Primary Care Provider 362,416$ 2.41% CMP-Revenue Loss DY1 Hospital 982,378$ 6.52% CMP-Revenue Loss DY2 Hospital 1,983,666$ 13.16% CMP-Revenue Loss DY3 Hospital -$ 0.00% CMP- Care Management Care Transitions 174,238$ 1.16% CMP-Clinical Transformation Team Clinical Transformation 128,300$ 0.85% CMP-Rural AHEC Community Based Organizations 114,557$ 0.76% CMP-P2 Community Based Organizations 23,790$ 0.16% CMP-Community Hlth Worker Ntwk Community Based Organizations 41,870$ 0.28%

CPWNY Cumulative Distributed Revenueby PPS Program Category DY1 to DY3 Q1, con’t.

Partners Receiving Funds Provider Category Sum of DY1-DY3 Q1 Expense PercentageBuffalo Urban League Community Based Organizations 83,785$ 0.56%CASA Chautauqua Community Based Organizations 6,417$ 0.04%Catholic Charities Case Management / Health Home 76,993$ 0.51%Chautauqua Alcohol & Sub Abuse Substance Abuse 8,560$ 0.06%Chautauqua County DOH Local Government Unit 399,861$ 2.65%Chautauqua County Health Network Community Based Organizations 67,638$ 0.45%Chautauqua County Hospice Hospice 84,621$ 0.56%Compeer Substance Abuse 15,782$ 0.10%ECCPASA Community Based Organizations 56,449$ 0.37%Hope Treatment & Counseling Center Substance Abuse 32,111$ 0.21%Horizon Health Case Management / Health Home 16,212$ 0.11%Hospice Buffalo Hospice 1,066,075$ 7.07%Housing Options Made Easy Community Based Organizations 938$ 0.01%Jay Bolnick MD Primary Care Physician 15,733$ 0.10%Lakeshore Behavioral Health Case Management / Health Home 56,050$ 0.37%Mental Health Assoc of Erie Cty Substance Abuse 284,303$ 1.89%Native American Comm Services Community Based Organizations 938$ 0.01%Niagara Hospice Hospice 4,560$ 0.03%Northpointe Council Substance Abuse 7,528$ 0.05%Prevention Focus All Other 5,417$ 0.04%Roswell Park Hospital 514,495$ 3.41%Spectrum Human Services Case Management / Health Home 49,910$ 0.33%WCA Hospital 592,045$ 3.93%WNY Independent Living Community Based Organizations 1,313$ 0.01%WNY United Against Drug and Alcohol AbuseCommunity Based Organizations 7,435$ 0.05%Grand Total 15,068,410$ 100.00%

Upcoming:Compensation and Benefit SurveyIndependent Evaluator SurveyEvents to note!

Update: DSRIP Year 3 Compensation and Benefit Survey Timeline

▪ August 21 to 25: Emails go out to facilities to alert them to upcoming survey

▪ September 6 to 8: Individualized surveys are sent to identified partners

▪ September 18 – October 6: Weekly teleconferences to answer questions and assist with problems

▪ October 6th: DUE DATE

▪ October 16 to January 16: Aging of collected information, aggregation of materials, reports developed

Compensation and Benefit Survey Example

Facility NameFacility AddressFacility TypeFacility Phone numberName of Parent Organizationif applicableContact nameContact titleContact addressContact emailContact phone number

Job TitleEmployment Status # of Individuals

employed# of vacancies

to fillAverage cash

compensation rate in dollars

Benefits, as a percentage

of compensation

CBA* Status, Y or N

Administrative Staff: Executive Staff Fulltime YAdministrative Staff: Executive Staff Part time YAdministrative Staff: Executive Staff Fulltime NAdministrative Staff: Executive Staff Part time NAdministrative Staff: Financial Fulltime YAdministrative Staff: Financial Fulltime NAdministrative Staff: Human Resources Fulltime YAdministrative Staff: Human Resources Fulltime NAdministrative Staff: Human Resources Part time NAdministrative Staff: Other Fulltime YAdministrative Staff: Other Part time YAdministrative Staff: Other Fulltime NAdministrative Staff: Other Part time N

INSTRUCTIONS WILL GO HERE

*Collective Bargaining Agreementreturn survey to dsrip@r-ahec.org

Select one from the drop down list

These fields will be prepopulated with facilities' information

Compensation & Benefit Survey:Who will be surveyed?

Compensation and Benefit Survey: Between September 6-8, WNY Rural AHEC (R-AHEC) will send out an EXCEL spread sheet survey in order to capture required compensation and benefit information on behalf of your PPS which will be submitted to the NYS DOH in aggregate form at the end of DSRIP Year 3.

Approximately 143 partners will be solicited for the survey, including Primary Care.

Partners who overlap with Millennium Care Collaborative (MCC) only fill this out once.

We solicit a good number of Primary Care and network direct care providers as well as our major hospital systems that encompasses data from the majority of the workforce in the hospitals.

Independent Evaluator Activities▪ Independent Evaluation State Survey: Between September 11 and October 27, 2017, The Center of Human

Services Research (on behalf of the NYS DOH) will send out a Web-Based Partner Survey in order tocapture PPS partner-level insights about DSRIP and project implementation. The survey will be delivered using email and a survey link tool to PPS partners across the state.

▪ The DSRIP Independent Evaluation is from SUNY Albany.

▪ Over DY 3-5, the evaluation reviews the implementation and outcomes of the NYS DSRIP program. This research study is distinct from the role of the Independent Assessor (IA), who evaluates our regular quarterly reports

▪ Upcoming in September 2017:

▪ Randomly selected CPWNY partners receive a survey about their project participation

▪ If you are randomly selected you will receive a introductory letter to the survey

▪ The survey will be conducted online.

▪ Please contact team at CPWNY if you have questions.

Upcoming Events▪ Screening; Brief Intervention, Referral to Treatment (SBRIT): What Medical Offices Need to Know &

How to Code & Bill

▪ Tuesday, September 12, 2017, 5:30 pm

▪ Erie County Medical Society Conference Center, 1317 Harlem Road

▪ http://wnycommunitypartners.org/wp-content/uploads/2017/08/SBRIT-Flyer.pdf

▪ Learn to be a “Congregational Health Promoter”

▪ Two Saturdays, Sept 16th and 23rd. Registration due 9/11

▪ For lay leaders in the faith community, learn about community education and linkages to health care related resources

▪ Further information: http://wnycommunitypartners.org/2017/08/18/be-a-congregational-health-promoter-bring-health-to-your-faith-community/

Also…

▪ “PPS Report to Community” A collaborative update with Millennium PPS & CPWNY▪ SAVE THE DATE October 5, 2017, 8:30am to 11:00 at WNED-TV, Buffalo NY

▪ PPS metrics, detail presentation on behavioral health collaborations plus a panel taking your Q&A

▪ Registration can be found at http://www.p2wny.org/events.html

Value Based Purchasing (VBP)Update

Barry StelmachCatholic Medical Partners, Chief Financial Officer

Agenda Review

• Update on NYS VBP Initiatives• Update on CPWNY VBP Initiatives• Managed Care Organizations VBP Goals• Summary of Topics Discussed

Update on NYS VBP Initiatives

NYS VBP Initiatives

VBP University:The Curriculum Overview

▪ Semester I

▪ Background and foundational information on VBP

▪ Semester II, topics include

▪ governance models

▪ stakeholder engagement

▪ business strategy

▪ financial structures and support

▪ Data and analysis Strategy.

▪ Semester III (September)

▪ VBP Contracting

▪ Semester IV (October, November)

▪ VBP Boot-camps

▪ VBP Boot-camps will take place in October and November 2017 in locations throughout the state.

Graduation from VBP University

▪ Semesters one through three conclude with a quiz on the topics covered.

▪ Those who pass all three quizzes will receive a certificate of completion.

▪ If you attend a boot camp, you will receive a printed copy of your certificate.

▪ If you are unable to attend a boot camp, a copy of your certificate will be e-mailed to you. ▪Attending boot camp is not required to obtain graduation

▪ Additional updates at: www.health.ny.gov/VBP

Update on CPWNY VBP Initiatives

CPWNY VBP Initiatives

▪ Survey the PPS to evaluate the current state of VBP in the PPS

▪ VBP Education – Course Catalogue

▪ Collaboration with Millennium Collaborative Care PPS to host VBP conference

▪ Small group Q & A sessions

▪ Online training and links to training on CPWNY website

Featured on CPWNY website-Shared VBP Resources

▪ http://wnycommunitypartners.org/partners/training-and-tools/vbp-education/

▪ Stay tuned, this is where updates will be posted from now until DY5 2020

Managed Care Organizations VBP Goals

Medicaid Managed Care Organizations VBP Goals▪ Reminder, managed care organizations (MCOs) have DSRIP related goals

for VBP contracting▪End of DY 3 (April 1, 2018): at least 10% of total MCO expenditures in Level 1 or above.▪End of DY 4 (April 1, 2019): at least 50% of total MCO expenditure in Level 1 or above of which at least 15% of which are in Level 2 or higher.▪End of DY 5 (April 1, 2020): 80-90% of total MCO expenditures in Level 1 or higher of which At least 35% of total payments contracted through Level 2 VBPs or higher for fully capitated plans and 15% contracted in Level 2 or higher for not fully capitated plans.

Summary▪ Get familiar with the language and concepts. It will help you better understand

▪ Understand the value your organization can bring to the triple aim*▪ High patient satisfaction▪ Improved health care quality▪ Cost Efficiency

▪ MCOs have motivations to work with community based providers and non-Medicaid billing organizations who deliver services to Medicaid beneficiaries.

▪ State based incentives and penalties, plus…▪ MCO will be required to include non-Medicaid billing CBOs in future contracts,

Level 2 and above▪Payment reform happening at Federal level as well. MACRA (MIPS & APM)

Tobacco Project Quit Line and Health Systems

Change

CPWNY PACDSRIP Project Advisory

Committee Meeting

Patricia Bax, RN, MS, CC, TTSMarketing and Outreach Coordinator

Outline

• Welcome• New York State Tobacco Control Plan• Roswell Park Cancer Institute Tobacco

Control• Services and Programs • NYS Smokers’ Quitline• Meet Annie• Questions and Answers• Conclusion

Smoking Prevalence Disparities

Smoking by Income, Education, and Mental Health in NYS, 2015The smoking rate amongadults in NYS is 15.2%,according to data from the2015 BRFSS. Higher ratesof smoking persist amongadults with: Household incomes

under $25k per year (21.7%)

Less than a high school (H.S.) degree (22.2%)

Poor mental health (28.1%)

15.2%

21.7%

13.2%

22.2%

14.0%

28.1%

13.5%

0%

5%

10%

15%

20%

25%

30%

35%

All Adults Less than$25,000

$25,000 andabove

Less thanH.S.

H.S. andabove

Poor MentalHealth

GoodMentalHealth

New York State Department of Health Bureau of Tobacco Control

New York Statewide Plan:• Vision: All New Yorkers living in a tobacco-free

society.

• Mission: To reduce disease, disability and death, and alleviate the societal, health care system and economic burdens that tobacco use and secondhand smoke exposure cause in New York State.

New York Statewide Plan

Roswell Park Cancer Institute: Tobacco Control Program

Over 60 years of local, state, national and international work

Operates the Cancer Information Services hotline, NYS AIDS Hotline, and NYS Smokers’ Quitline

In 2008, RPCS initiated vendor services for health plans. Presently, Roswell Park Cessation Services provides cessation services for 2 state Quitlines, 5 health plans, and a multi-state large food market.

Health Systems for a Tobacco-Free WNY

Our Mission: • Support health care organizations to implement

system changes• Ensure that all patients are routinely screened for

tobacco use • Current tobacco users are offered evidence-based

treatment for nicotine dependence.

Population Focus: Low socioeconomic status and mentally ill patients

Catchment: Niagara, Erie, Orleans, Genesee, Wyoming, Chautauqua, Cattaraugus, Allegany

Services offered: Assist with creating formal written

policies Assist in implementing tobacco

use screening systems Provide education Provide cessation resources Feedback to providers Assist with evidence-based referrals

Health Systems for a Tobacco-Free WNY

Advancing Tobacco-Free CommunitiesTobacco-Free Western New York

Tobacco-Free WNY

Work Areas in Nine WNY Counties:

• Reduce Tobacco at Retail• More Tobacco-Free Air• Smoke-Free Multi-Unit Housing• Tobacco-Free Media

Everyone Has the Right to Breathe Clean Air!

Smoke-free housing policies are:…about allowing everyone equal access to living spaces

without compromising their health.Smoke-free housing policies are not:…about prohibiting smokers from living on the premises,

but requiring them to smoke outside, to protect the air for everyone.

Air Goes Everywhere

DSRIP and Tobacco-Control Contracts

• DSRIP works along side the three tobacco-control contracts at RPCI

• Augments work the three contracts are doing in WNY; fills in gaps of care

• Promotes NYS’s message of having providers treat tobacco use

• Provides direct cessation counseling to lower SES and mental health/substance abuse populations

DSRIP : Connecting Lower SES Populations to Cessation Resources

Our Partners:

• Hospitals• Primary Care Offices• Specialists• FQHCs• Mental Health Clinics• Substance Abuse Clinics• Soup Kitchens/Homeless Shelters

DSRIP : Connecting Lower SES Populations to Cessation Resources

Process in Clinical Setting:

• Visit potential sites to introduce services• Bring material to share with staff and doctors• Educate on PHS Clinical Practice Guideline • Introduce referral programs for the NYS Quitline

• If site expresses interest, meet with office “champion” • Nurse Manager• Office Manager• Doctor

DSRIP : Connecting Lower SES Populations to Cessation Resources

Process Continued…• Provide trainings

• Help craft policy for tobacco treatment inoffice, matching Clinical Practice Guideline

• Implement policy for a referral plan:Refer-to-Quit or Opt-to-Quit™

• Set up data exchanges

• Follow up with offices

DSRIP Services Offered

Cessation Classes: Train the Trainer Four (4) one-hour sessions over four weeks*

*Already completed for BMHA, Tonawanda Tower and scheduled in Niagara Falls in September.

Contact: Emily Foschio, BA, TTS, Tobacco Control SpecialistEmily.Foschio@roswellpark.org or call 716-845-4803

NYS Smokers’Quitline Services

• Cessation coaching • Nicotine patches (phone and

online registrations)• Interactive and informational

website resources• Text messaging services• Social media• Triage to known health plan

programs• Provider patient referral services• Best practice resources • Liaison for NYS DOH BTC

Contractors

Referral Process

Meet Annie

Characteristics: 58 year old female Smoked since she was 18,

usually 2-3 packs per day Married with two children,

four grandchildren Insured High school graduate Recently diagnosed with COPD and advised by

her doctor to stop smoking Prior quit attempts going cold turkey

Annie Calls the Quitline!

Assessment

Motivation

Readiness to quit

Confidence level

Triggers

Quit Date: within 30 days

Quit Plan: Stop-smoking medications Coaching and support

Keys to Success

Remember…

Together…We Will Make a Difference!

Thank You!

Contact Information:Patricia Bax, RN, MS, CC

NYS Smokers’ Quitline, Roswell Park Cessation Services716-845-4365 patricia.bax@roswellpark.org

Questions?