AHI PPS Year 1 Progress Report

Collaboration • Catalyst • Community

May 2016

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DSRIP

“[DSRIP is] not about launching 10 or 11 projects, not about ticking boxes to hit particular requirements, not about moving the needle on performance measures. It’s about a fundamental restructuring towards a system that really rewards value. It’s beginning to sink in with folks that that’s really the endgame here, and what they should be working towards.”

State government officialReport of the Commonwealth Fund, April 2016, “Implementing New York’s DSRIP Program; Implications for Medicaid Payment and Delivery System Reform”.

By incentivizing care collaboration and paying for performance, DSRIP is the catalyst for NYS Healthcare to transition to Value Based Payment (VBP)

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DSRIP – the catalyst for VBP

Current State

• Providers are paid on a FFS basis; volume incentive

• Avoidable visits are rewarded • Prevention, coordination,

integration: lack strong incentives

Future State

• MCOs reward value over volume; 80-90% of payments are value-based

• Care patterns add value not excess volume

• Transformations in the delivery system are sustainable

DSRIP

2015 2020

Adapted from: Value Based Payment Roadmap. Mar 2016. NYS DOH DSRIP Website.

CMS NYS PPS

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DSRIP Funding

Risk: if the VBP Roadmap goals are not met, overall DSRIP dollars from CMS to NYS will be significantly reduced

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Population Health Management

PHM Competencies

Information and Communication Infrastructure

Clinical & Quality Management

Financial and Risk Management

Network Development & Physician Alignment

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What’s in our Plan?

– Governance– Financial Sustainability and

Budget– Cultural Competency and

Health Literacy– IT Systems and Processes– Performance Reporting– Population Health

Management– Clinical Integration– Physician Engagement– Workforce Strategy

AHI PPS Organizational Components

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AHI PPS EARNS 100% of all possible ACHIEVEMENT VALUES

1. Governance

2. Finance

3. PHM / IT Systems & Processes

4. Workforce

5. Cultural Competency / Health Literacy

• Community Based Organizations

ORGANIZATIONAL COMPONENTS DY1 STATUS

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A best practice is that before any rule is created or any decision is made, a prior decision must be addressed: who gets to make the decision, and when, and using what information & processes?

GOVERNANCE: Decisions, decisions, decisions…..

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DSRIP Principles

M1: Finalize governance structure and sub- committee structure 09/30/15

M2: Establish clinical governance structure 12/31/15

M3: Finalize bylaws and/or policies and/or Committee Guidelines 09/30/15

M4: Establish governance structure reporting and monitoring processes 12/31/15

M5: Finalize community engagement plan 09/30/15

M6: Finalize partnership agreements or contracts with CBOs In progress

M7: Finalize agency coordination plan In progress

M9: Inclusion of CBOs in PPS Implementation Plan 09/30/15

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GOVERNANCE MILESTONES

NOTE: M8 Reported under Workforce

AHI Reconfigured

Board of Directors

Adirondack Health Institute

Executive Committee

Finance Committee

Audit & Compliance Committee

Governance Committee

AHI PPS Steering

Ad HocCommittees

Population Health Improvement

Program

Health Home

Adirondack Rural Health Network

Standing Committees

• New By-laws• New Board Composition• New Committee Structure

Next Slide

AHI Board of Directors

AHI PPS Steering Committee

Finance Committee

Clinical Governance and

Quality Committee

IT & Data Sharing Committee

Community Beneficiary & Engagement Committee

Network Committee

Workforce Committee

Compensation & Benefits

Workgroup

Employee Engagement Workgroup

Recruitment & Retention

Workgroup

Training and Resources

Workgroup

Data Security & Confidentiality

Workgroup

PHM & Performance Reporting &

Analytics Workgroup

Interoperability & Data Exchange

Workgroup

Budget and Funds Flow Workgroup

Financial Sustainability Workgroup

Valued Based Payment

Workgroup

Adirondacks ACO

Provides certain support services to the PPS

pursuant to a contract with AHI

Compliance Workgroup

Reviews all actions/decisions of the other Committees

Approves all recommendations of the

Steering Committee

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DSRIP Year 1 Development: GOVERNANCE

• Compliance

• Network Committee

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DSRIP Year 1 Development: FINANCE

• All Milestones Met: Financial Structures & Reporting Processes; assessment of network financial health.

• Workgroups Established

• Year 1 Disbursement of Engagement Funds completed

• CFO recruited

• Funds Flow: to be completed DY2Q1 (June 2016)

• DY2 partner disbursements in development

• AHI PPS Finance & Steering Committees have endorsed another round of “partner funds”, $5 million in total, to be disbursed during DY2Q1.

– Funds Flow Workgroup to develop methodology for the disbursement.

• AHI PPS Finance & Steering Committees have endorsed Innovation Fund RFP Concept: anticipate awarding $5 million total over the DSRIP period to support innovative projects.

An overview of the Innovation Fund RFP proposal and timeline is presented on next slides; all items are proposed, pending finalization and review by Committees.

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UPDATE: Funds Flow & Innovation Fund

Proposal

• Innovation

– Service design, delivery, payment models

– Healthcare & “related services”; social, community-based, prevention, wellness

• Triple AIM

• Sustainability

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INNOVATION FUND: Purpose

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INNOVATION FUND: Proposed Timeline

Funding Period Begins

January 2017

August 2016 ~ RFP Release

APPLICATION COMPONENTS (character limit – no spaces; 3000 characters is equivalent to one single spaced page of text). The total page limit is 8 pages (does not include cover page, workplan, budget, letters of support)

– Cover Page - Project Title, Applicant Organization & Contact Information– Executive Summary (3000) – Purpose - Goals & Objectives (3000)– Statement of Need (3000)– Organizational Capacity (3000)– Project Narrative (6000)– Plan for Evaluation (3000)– Sustainability Plan (3000)– Workplan (template to be provided)– Budget (template to be provided)– Letters of Support (required)

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INNOVATION FUND: Application

• LOIs & Applications

• Members - at least 1 member from each of the AHI PPS Governing Committees, at least 1 member of the AHI Board of Directors, at least 2 individuals who do not represent an AHI PPS partner organization.

• Incorporate LGU and/or mechanism to identify items projects LGU purview

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INNOVATION FUND: Review Panel

– purpose and goals are clearly articulated– the proposal strengthens, extends, or otherwise supports the success of, one of

the 11 AHI PPS projects– strength of the narrative; it explains how the goals and objectives will be met–major budget items have been identified– project represents an innovative approach to the design, delivery, and/or

payment models for health care and related services.

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INNOVATION FUND: Letter of Intent

• AHI to provide template

• Solicited twice annually

• Proposed Review Criteria

• Population Health Management

• Data Sharing

• Performance Measurement

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Population Health Management / HIT Focus

Create an information architecture which helps transform health care delivery from a process which generates data, to a process which utilizes information to achieve improved clinical performance outcomes and reduced cost.

AHI PPS is developing processes to:

• Ensure timely, easy, and secure access to information;• Provide information that enables outcomes improvement;• Increase collaboration and information sharing.

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PPS IT Goals

It is the goal of AHI PPS Information Technology (IT) to help further DSRIP Program goals by:

• Providing support to transform care delivery for the PPS’s Medicaid population by increasing quality and efficiency and improving the patient experience;

• Offering an interoperable system that uses clinical, utilization and administrative data to measure performance and identify actionable opportunities for improvement;

• Providing services that both support the delivery of quality health care and improve the decision-making process.

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DSRIP IT Goals

• Governed by the Information Technology & Data Sharing (IT&DS) Committee, which reports to the DSRIP Steering Committee.

• Responsibilities: Develop and implement an IT strategy for the AHI PPS:– PPS information and data management goals, standards, practices and processes;– Data governance;– Aligning the PPS’s information technology;– Monitoring and evaluating information technology expenditures;– Processes and protocols.

• IT&DS’s Three Workgroups:– Population Health Management, Performance Management, Analytics;– Interoperability/Data Exchange;– Data Security/Confidentiality.

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DSRIP IT Governance

• John Dudla Hudson Headwaters Health Network• Bob Cawley AHI - Adirondack Health Institute• George DeAngelis Adirondack Health• Wouter J Rietsema MD University of Vermont Health Network - CVPH• Valerie Ainsworth, LCSW-R Mental Health Association in Essex County• Ken Dales Mountain Lake Services• Jan M. Dahlen Behavioral Health Services North, Inc.• Martin (Marty) Brown Nathan Littauer Hospital• John Kelleher Glens Falls Hospital• Pete Gilhooly Glens Falls Hospital• Dennis Hadley St. Joseph’s ATRC in Saranac Lake, NY• Beth Foley Center for Disability Services• Andrew Bascom HCR Home Care• Andy Cruikshank Fort Hudson Home Care• Jorge Grillo St. Lawrence Health System

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HIT WG

24 meetings (10/23/14 – 10/15/15

PMH preview event – 6/25/15

Five meetings to date from 12/16/15 to 4/21/16

• Kim Atkins Planned Parenthood Mohawk Hudson, Inc.• Martin (Marty) Brown Nathan Littauer Hospital• Bob Cawley AHI – Adirondack Health Institute• Andrew Cruikshank Fort Hudson Home Care• Ken Dales NYSARC North Country Management Services• John Dudla Hudson Headwaters Health Network• Jessica Fraser Hudson Headwaters Health Network• Jorge Grillo St. Lawrence Health System• Dennis Hadley St. Joseph's ATRC in Saranac Lake, NY• John Kelleher Glens Falls Hospital• Aaron Kramer Adirondack Health• Mark Lukens Behavioral Health Services North, Inc. • David Murray Center for Disability Services• Wouter Rietsema, MD University of Vermont Health Network - CVPH

Ad Hoc Meetings, PPS CIO Meetings, Auditing participants

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IT & DS Committee

Needs Assessment

• Assess Infrastructure Needs, Plan, Design

• Acquire, Implement Hardware/Software Solutions

• Operate DSRIP Infrastructure, Upgrade as Needed

Interfaces, Data Collection

• Identify Interfaces

• Develop Data Collection Interfaces

• Collect Source Data Via Interfaces

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Infrastructure

Population Health Management

• Data Analytics, Registry

• Care Management and Coordination

EHRs

• Identify EHR, Other Data Needs

• Implement Partner Upgrades to Existing EHRs

• Implement EHR/EHR Lite for Paper-Based Providers

• Document and Report Full EHR Data

Tracking Actively Engaged Patients (Due DY2Q4—3/31/17)

• Implement Electronic Tracking of Patients—Quarterly

• Track Actively Engaged Patients Electronically

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Infrastructure

Alerts, Secure Messaging• Assess Alerts, Secure Messaging Readiness

• Initial Implementation of Alerts, Secure Messaging

• Remaining Implementation of Alerts, Secure Messaging

• Alerts, Secure Messaging Across the PPS

Performance Reporting and Management• DSRIP Project Metrics

• Reporting to DOH

• Reporting to PPS Partners

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Infrastructure

Patient-Centered Medical Home:• Assess PCMH Readiness

• Implement EHR Upgrades Needed for PCMH Recognition, Apply for Recognition

• Providers Operate as Patient-Centered Medical Homes

Stage 2 Meaningful Use (Due DY3Q4—3/31/18)

• Assess MU Readiness

• Implement EHR Upgrades Needed for MU

• Providers Attest to MU Stage 2

• Providers Continue to Be Eligible for MU Incentives

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PCMH and MU

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IT Strategic Roadmap

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Population Health Roadmap

Support providers, staff and the PPS to become a data-driven, evidence-based system in order to measure quality, identify high risk patients, and provide care management for patients to improve outcomes, the PHM supports providers, staff and the PPS to become a data-driven, evidence-based system.

• Analyze PPS PHM Needs, Develop RFP, Contract w/ Vendors;

• Design, Build, Test, Implement PHM Solution(s) across PPS;

• Analyze, Report, Adjust Care to Patient Needs.

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Population Health

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PHM Requirements Executive Summary

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Current State Summary and Target Future State Maturity

Each type of member in the AHI PPS will need to progress through 4 levels of maturity in population health adoption. As a Network, adoption of population health at lower tiers will need to be accomplished in order to implement a comprehensive PHM program.

©2015 KPMG LLP

• Assess metrics and data needed, define reporting needs, establish data governance, plan interim & long-term performance management solutions;

• Obtain data to/from HIE/RHIO/payers;

• Develop reports and dashboards;

• Report on PPS and partner performance, identify improvements needed, develop/execute action plans.

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Performance Management

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DSRIP Performance Management Structure

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Current State Summary – PPS Technological Capability

Data Security & Confidentiality: Ensure that our system is secure at all levels and patients can trust that their privacy is preserved, while being able to share the information they authorize. (Due DY2Q1—6/30/16)

RHIO/HIE Connectivity, Clinical Interoperability: Connecting care settings and supporting organizations to one another via the Health Information Exchange (HIE) or Regional Health Information Organization (RHIO), to create a regional, patient-centered record for all patients. (Due DY3Q4—3/31/18)

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Data Security & Confidentiality/Interconnectivity

Telehealth/Telemedicine

Utilizing telemedicine to address gaps in care for a largely rural region, telemedicine can support access to specialty care as well as integrating primary care and behavioral health.

Home Monitoring

Patient home monitoring can extend care management resources to better care for patients with multiple chronic conditions.

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Telehealth/Telemedicine/Home Monitoring

• Analyze HIT survey results;

• Establish infrastructure;

• Population Health Management solution search and selection

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Next Steps

DSRIP Year 1 Development : WORKFORCE

M1: Define Workforce Target State 6/30/16

M2: Create a Workforce Transition Roadmap 9/30/16

M3: Gap Analysis 9/30/16

M4: Complete Compensation & Benefits Analysis 6/30/16

M5: Training Strategy 9/30/16

• All Workgroups Established & Functioning• Process for accessing Training funds established.• Mandated DY1 Workforce Spend MET • Milestones due June 2016 ~ on track

M1: Finalize a Cultural Competency / Health Literacy (CCHL) Strategy. 9/30/15

M2: Develop a training strategy addressing the drivers of health disparities. 6/30/16

Milestones: CULTURAL COMPETENCY ~ HEALTH LITERACY

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CBOs in the AHI PPS: A Snapshot

• 68 CBOs have signed Terms of Participation

• Represented in each of the 11 PPS projects, on Steering Committee, and governance sub-committees

• Cover 9 county service area

• Sectors include housing/homeless services, community action, public health, behavioral health and substance abuse, family services, EMS, home care

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Road to Value Based Payment (VBP)

“Many CBOs have years of experiencing improving SDH (Social Determinants of Health). This expert understanding of community needs, coupled with support and clinical expertise of a provider network, could make a significant impact on population health and generate savings for the entities involved.”

NYS DOH Path toward Value Based Payment: Annual Update, June 2016: Year 2 , p. 42

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Collaborating for the future

What’s next?

•Provider organizations and CBOs should begin to build collaborative relationships within DSRIP’s framework.

• Identify potential partnership opportunities by assessing:

- Local social determinants to health- Needs identified by community- Gaps identified by data and hotspotting, partners, projects and workstreams- alignment with PPS project goals

Collaborate on Shared Goals

• Population Health

• Triple Aim

• PPS Quality Measures

• Prevention Agenda Indicators

• PPS Project Requirements

• Actively Engaged

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Building a Collaboration

Define Your Value• How can your organization help

achieve the goal(s)? • What services or functions can you

perform that will enable success?• Why are you the organization best

able to fill this role?• How much does it cost you to

provide the service or function? • How is the service currently

reimbursed or funded? • What would be a better way?

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PPS Funds Flow – Supporting CBOs

Three Avenues:

• AHI PPS Innovation Fund• CBO, or group of CBOs, responds to the RFP

• Vendor Agreement with AHI PPS• CBO contracts directly with AHI

• Subcontractor to an AHI PPS Participating Organization• CBO contracts with a PPS Partner to provide a service