Implementation Planning Survey & PPS Wide Next Steps · · 2015-02-19Implementation Planning...

Implementation Planning Survey & PPS Wide Next Steps

Wednesday, February 18, 2015TBD- TBD

FLPPS FINGER LAKES PERFORMING PROVIDER SYSTEM

Agenda

• NY DOH Implementation Planning Timeline

• FLPPS Survey• Survey Uses & Next Steps• DSRIP Funds Flow• Performance-Based Contracting • Questions

NY DOH Implementation Planning Timeline

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Implementation Planning Structure

•Governance & Compliance •Financial Sustainability & IT Systems•Cultural Competency and Health Literacy•Physician Engagement & Clinical Integration •Performance Reporting & Population Health •Workforce

Organizational

•Budget •Funds Flow

Organizational

•Overall approach to implementation •Dependencies on work streams •Key stakeholders •IT Requirements •Community Engagement •Performance Monitoring

Overall DSRIP Projects

•Provider Scale & Speed •Patient Engagement Scale & Speed

Individual DSRIP Projects


Implementation Planning Timeline

Activity 9‐Jan 9‐Feb 17‐Feb 1‐Mar 15‐Mar 1‐Apr

NY DOH released Implementation Planning Structure Overview

NY DOH released near final Implementation Plan template

Anticipated release of final NY DOH Implementation Plan template

Draft Implementation Plan due to KPMG for review

Anticipated release of PPS Valuation

Final Implementation Plan due to NY DOH

FLPPS Survey


Survey Purpose• FLPPS is surveying all partner providers who have

attested to participate in DSRIP projects• This survey is the first of two surveys, and will inform the

partner-level project milestones required for the Implementation Plan submission to NYS DOH on April 1, 2015

• This type of reporting is part of the partner performance and will be measured for payment

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What FLPPs needs from the survey We need 100% participation from all partners

Survey results will become the milestones and metrics that facilitate the PSS’s ability to draw down funds from the State

Survey will also begin to set projections on partnership funds flow

For providers, these numbers will eventually be tied to performance‐based

contracting.

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Failure to complete the survey will Impact partner contracting


Survey Structure

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Brief demographic information

Which projects you’re

participating in BY

PROJECT

Understanding partners individual

timelines for successful

implementation of project

requirements

Seeking input on process to ramp

up patient engagement

Understanding your perceived risks to project implementation


Survey Instructions • All organizations who wish to participate in FLPPS projects for DSRIP

funding must complete the questions for EACH project selected• Very important: first complete the survey in the PDF format and → then

transfer your responses into the survey monkey. – The final surveys will need to be completed in one sitting.

• The achievement dates submitted in these surveys will be used to calculate region-wide participation goals as well as provider-specific participation goals. – It is important that your survey answers are realistic and accurate

to the best of your ability.• When reviewing project requirements, also known as Domain 1

requirements, please use your discretion in knowing which requirements apply to your unique provider type.

The survey is due on February 23, 2015.

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FLPPS DSRIP Projects

Integrated Delivery System (2.a.i) ED Triage for At‐Risk Populations (2.b.iii)

Behavioral Health Integration with PCMH (3.a.i)

30‐Day Readmission Care Management (2.b.iv)

Community Crisis Stabilization (3.a.ii)

Improving Behavioral Health and Substance Abuse Treatment (4.a.iii)

Transitional Housing (2.b.vi)

Behavioral Health in Nursing Homes (3.a.v)

Overall Health and Wellness (4.b.ii)

Implementation of Patient Activation Activities to Engage Uninsured and Low Utilizing Medicaid in Community Based

Care (2.d.i)

Maternal Child Health (3.f.i)

How the Survey data will be used


Survey Uses • Confirming project participation by partner • Informing the implementation plan due April 1, 2015

• Inform the FLPPS implementation plan for the five demonstration years • Begin the process for Performance-based contracting by identifying

contracting entities, their projects and plans for implementation.

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Project Implementation Speed table

No. of providers per category meeting 100% of project requirements per quarter

DY1, Q2 DY1, Q3 DY1, Q4 DY2, Q1 DY2, Q2 DY2, Q3 DY2, Q4 DY3, Q1 DY3, Q2 DY3, Q3 DY3, Q4 DY4, Q1 DY4, Q2 DY4, Q3 DY4, Q4

Emergency Departments which contain co‐located primary care services which meet all project requirements

= TotalCommitted (as reported in project plan application)


Survey FAQs• How do I know if I should be participating in a project?

– “Do you provide services that would benefit a patient in the operation of this project?”

– “Are you able to meet all of the domain 1 requirements by the date committed by the PPS?”

– “Do you have any operational best practices you would be willing to share with the PPS?”

• Where can I find more details regarding Domain 1 Requirements?– There is a link to the NY DOH Domain 1 requirements by project on the first

page of the survey and available on the FLPPS website under Resources • What do I do if Domain 1 requirements do not apply to my organization?

– Consider if your organization can help support the PPS in achieving the requirement (specifically for 2.a.i)

– Answer N/A for the individual requirement and explain why you don’t think the requirement does not apply to you

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Survey FAQs• Are actively engaged patient numbers cumulative?

– Actively Engaged patients are cumulative within a year, but not across years. (Q3/4 includes Q1/2 numbers)

• How do I know if I am eligible to become a PCMH? – NCQA (National Committee for Quality Assurance) has a workflow to help you

understand if your practice is eligible for PCMH certification. Visit www.ncqa.org/pcmh for more information.

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Next steps

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Provider Implementation Survey Phase 1 Update participating provider

demographic information based on newly released State guidelines

Confirm project participation Provide preliminary conservative speed

for meeting Domain 1 project requirements

2/9/2015 6/30/2015

2/13/2015 2/23/2015 3/15/2015 3/31/2015

Provider Implementation Survey Phase 2 Current status and updated speed of meeting Domain 1

requirements for eligible projects Plan for meeting the Domain 1 requirements for eligible

projects Patient engagement speed current status and goals Plan for meeting patient engagement speed goals Inform performance based contract master template

4/1/2015 6/30/2015

Feb 27, 2015Milestone Description

Feb 18, 2015FLPPS Next Steps: Implementation Planning Webinar

Mar 1, 2015Draft Implementation plan due to KPMG

Apr 1, 2015Final Implementation Plan due to DOH

Apr 1, 2015Final Implementation Plan due to DOH

2/27/15Deadline: Preliminary DSRIP Performance‐based Contract

Template released Collect feedback and

recommendations regarding draft contract terms and conditions

Outline partner roles and responsibilities for meeting corresponding project requirements

3/20/15PPS and Provider‐specific potential funds flow

award amount released Formula‐driven maximum value for each

partner based on participating projects and implementation plan

Annual breakdown of provider‐specific fund flow methodology contingent upon Project requirements as outlined in FLPPS Performance‐based Contracts

FLPPS Next steps: Implementation planning

Webinar Opportunity to ask questions

regarding the Provider Implementation Survey Phase 1

Provide technical assistance in survey completion

Share next steps in implementation planning and how it ties to provider contracting

FLPPS Performance‐based Contracts Execute contracts on a rolling basis

depending on provider readiness, internal review requirements, etc.

Mar 4, 2015FLPPS Next Steps: Implementation Planning Webinar

Mar 20, 2015

3/4/15FLPPS Performance‐based Contracting: Current status and next steps Webinar

FLPPS vision in contracting with performing providers and core principles

Terms and conditions of performance based contracting

Performance based contracting structure Provider‐specific funds flow tied to

meeting performance metrics

DSRIP Funds Flow


• Not distributed evenly from year to year

Earning DSRIP Payments

Funding Breakdown DY 1 DY 2 DY 3 DY 4 DY 5 Total

DSRIP Annual Funding % 15.84% 16.88% 27.29% 24.16% 15.84% 100%

Pmt 1 Pmt 2 Pmt 3 Total

DY1 Payments 40% 20% 40% 100%

15%

5%23%

57%80%

DSRIP Funding Distribution -- DY 1

Domain 2-3 Pay for Reporting

Domain 2-3 Pay forPerformanceDomain 4 Pay for Reporting

Scale and Speed achievement

Domain 1 Pay for Reporting


• Two types of payments:• PPS Infrastructure Development: Pay for Reporting (P4R)• Clinical Improvement and Health Outcomes: Pay for Performance (P4P)

• Funding Domains:

Earning DSRIP Payments

13%

43%

5% 11%

28%39%

DSRIP Funding DistributionDY1 ‐ DY5

Domain 2‐3 Pay for Reporting

Domain 2‐3 Pay for Performance


Scale and Speed achievement



Pay 4 Reporting → Pay 4 Performance

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Pay for ReportingDomain 1 Process Measures

Other Process Measures

Pay for Performance Performance Measures


Project Valuation for an Example PPS

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*This example PPS can earn $171,665,000 in DSRIP Funding across the five-year demonstration period.

Projects Index Score

PPS Attribution Total

DSRIP Project Plan Application Score

# of DSRIP Months

Maximum Project Value

2.a.i 56 250,000 0.95 60 $26,600,000

2.a.iii 46 250,000 0.88 60 $20,240,000

2.b.iii 43 250,000 0.92 60 $19,780,000

2.b.iv 43 250,000 0.81 60 $17,415,000

3.a.i 39 250,000 0.94 60 $18,330,000

3.a.ii 37 250,000 0.82 60 $15,170,000

3.b.i 30 250,000 0.98 60 $14,700,000

3.c.i 30 250,000 0.81 60 $12,150,000

4.a.iii 20 250,000 0.83 60 $ 8,300,000

4.b.ii 17 250,000 0.80 60 $ 6,800,000

2.d.i 56 125,000 0.87 60 $12,180,000

Total DSRIP Project Valuation $171,665,000

EXAMPLE


FLPPS Funding Buckets

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Budget Category %Administrative Costs for FLPPS● Staffing the Project Management Office (PMO), PMO operations, running FLPPS and management of

centralized services for DSRIP project implementation, and cost of DSRIP project implementation, includingthe development and management of centralized services.

15%

Revenue Loss and Sustainability Fund● Support FLPPS providers who are essential to FLPPS success but may be at risk for financial losses and have

exhausted all other financial resource options● Make up for financial losses from unforeseen levels of utilization as we transition to value‐based payments

10%

Contingency Fund● Needs such as non‐covered services, high costs for niche populations, need for specific population health

expertise, termination of state funding streams, and other unforeseen levels of utilization

10%

Partner Share of Funds• 85% based on attributed lives x complexity of chosen projects x performance on project metrics

(consistent with distribution methodology to FLPPS but modified to reflect intra‐FLPPS relativeperformance and projects chosen)

• 10% based on response to surveys, information requests, and engagement in planning andgovernance

• 5% for non‐DSRIP eligible providers

65%

Bonus Funds● If FLPPS receives bonus funds from the state based on performance, those will be distributed to the

underlying providers contributing to that performanceTotal 100%


PPS Budget Categories (example)• Total Valuation: $171,665,000

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Budget CategoryDY1 DY2 DY3 DY4 DY5

% 15.84% 16.88% 27.29% 24.16% 15.84%Administration and Project Implementation

15% 3,711,672 4,346,558 7,027,107 6,221,140 4,078,760

Revenue loss and Sustainability 10% 2,474,448 2,897,705 4,684,738 4,147,426 2,719,174

Contingency 10% 2,474,448 2,897,705 4,684,738 4,147,426 2,719,174

Partner share of funds 65% 16,083,912 18,835,084 30,450,796 26,958,272 17,674,628

Total Maximum Possible 100% $24,744,480 $28,977,052 $46,847,379 $41,474,264 $27,191,736

Funds Flow Example


Example Funds Flow• Provider name: Flip Flop Primary Care Practice (FFPCP)• Projects: 2.a.i, 3.a.i, 4.b.ii

• Attributed Lives: 40,000• Commitments:

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Q4 DY2 Q4 DY3

Patients Engaged 25% of eligible 75% of eligible

Q4 DY2 Q4 DY3

Speed of Implementation 40% requirements met 80% requirements met

Project Index Score2.a.i 563.a.i 394.b.ii 17


Partner Share of FundsNon

‐ Attributed Medicaid Members Project Complexity

Performance on Metrics and Milestones by providers

Response to Surveys, info requests and planning engagement

Providers with non‐attributed lives and non‐safety net providers

Definition

Number of attributed Medicaid members impacted by the project(s) selected

For providers with limited ability to receive attribution, consider counting # of lives impacted by project

As defined by the State

Payments for achieving outcomes on metrics and milestones for those projects selected by provider

Responses to information requests were submitted on time for use in developing the December 22nd application and February 28th implementation plan

Any provider that serves the population but doesn’t have lives attributed to them

Logic

Number of attributed Medicaid members is a key factor for the PMPM calculation

More complex projects add higher value

Performance on Metrics and Milestones is the most important determinant providers can directly impact with relation to amount of funds drawn down

FLPPS payments will be substantially driven by the information submitted by providers ‐this will impact the overall PMPM dollars available to the PPS

There will be services that add value from providers who don't get attributed lives

% Multiplier Multiplier Multiplier 10% 5%

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Earning DSRIP payments through…

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Organizational measures

Domain 1 Process Measures (P4R)

Domain 2 Projects

Domain 1 Process Measures

(Speed/Scale)(P4R)

Domain 2 System transformation milestones (P4R

and P4P)

Domain 3 projects

Domain 1 Process Measures

(Speed/Scale)

Domain 3 Improvement

Milestones (P4R and P4P)

Domain 4 Projects

Domain 4 Outcome

milestones (P4R)

FLPPS Contracting


Transition to Value-based paymentsNum

ber o

f services

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Value‐destroying care(i.e. Avoidable admissions)

Value‐add services (i.e.

preventive care)

DY 15 – CY19

$$

FLPPS contracts$$

MCO contracts

DY 20 –


Performance-Based Contracting

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1

2

3 4

5

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FLPPS FINGER LAKES PERFORMING PROVIDER SYSTEM31

Funds Flow Through Contracts

Outcome achievement score

(multiplier)Provider Engagement Score

10%

Process Achievement Score

(multiplier)

Performing Provider Contracts

Attributed Lives (multiplier)

Selected Projects (multiplier)

Partner Share of Funds

Performance and outcome reporting


Performance-Based Contracting• As the milestones and metrics are tied to funding, it is crucial that FLPPS

set realistic goals that reflect the capacity of the PPS providers. • The results of the second survey will help FLPPS set expectations in the

contracting process• The FLPPS Finance committee is working to assemble a preliminary

contract framework until the final awards are announced by the State. • Final contracts will be drafted following the award announcement and will

include details of project delivery, and how funds will be accumulated and distributed to partners.

• The contracts will not be required for signature until funding is clearly defined.

• To be most efficient in forwarding funds to partner providers, we ask the initial contract framework be reviewed by authorizing bodies to ensure an expedited return once the award notification has been received from the State.

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FLPPS FINGER LAKES PERFORMING PROVIDER SYSTEM33

FLPPS Provider ContractingKey Principles

• Joint responsibility• Performing Provider contracts vs. affiliate/vendor

contracts• Funding interdependencies between DOH, FLPPS and

performing providers• Alignment with DSRIP Project Requirements and

committed Speed and Scale goals• Alignment with sustainability plan (i.e. managed care

contracting)• Clearly defined FLPPS vs. provider responsibilities by

type by project• Shared savings arrangement with MCOs

– Care management capacity• Infrastructure for proper reporting• Formal audit process

Questions


Contact Us!E-Mail:

[email protected] Website:www.flpps.org

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Implementation Planning Survey & PPS Wide Next Steps · · 2015-02-19Implementation Planning...

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