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Transforming Medicaid Delivery on Staten Island: A Case Study
Session # 39, March 6, 2018
Joseph Conte, PhD, CPHQ, Executive Director, Staten Island Performing Provider System (SI- PPS)
Raj Lakhanpal, MD, FRCS, FACEP, Chief Executive Officer, SpectraMedix
Joseph Conte, PhD, CPHQ
Has no real or apparent conflicts of interest to report.
Presenter
Raj Lakhanpal, MD, FRCS, FACEP
Has no real or apparent conflicts of interest to report.
Presenter
Learning Objectives
• Identify the information technology and performance reporting capabilities needed
to support Delivery System Reform Inventive Payment (DSRIP) projects and goals
• Analyze the key challenges DSRIP Performing Provider Systems (PPS) face
implementing their projects
• Define DSRIP data sources, including Department of Health, provider partner,
public data sources and other outside sources
• Perform a deep dive into DSRIP initiatives to manage and reduce emergency
department visits and preventable readmissions
• Determine how successful strategies, processes and lessons learned from New
York DSRIP can be applied across Medicaid Reform Initiatives in all states
5© SpectraMedix, 2009-2017. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.
1) SI PPS and New York State DSRIP
2) Current Results
3) IT and performance reporting capabilities needed for DSRIP
4) Use cases
5) Importance of social determinants of health
6) Takeaways
Agenda
6© SpectraMedix, 2009-2017. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.
Case Study:Staten Island Performing Provider System
Delivery System Reform Incentive Program (DSRIP)
Year 3
Key Goals
• 90% of managed care payments be value-based
• Integrate physical and behavioral health
• Incentivize Medicaid providers to create integrated, high-performing system
• Reduce avoidable hospital use by 25%
Entities 25 Performing Provider Systems
Project
Domains
• System Transformation
• Clinical Improvement
• Population-wide Projects
Payments Measure based performance with transition from P4R to P4P
Staten Island Performing Provider System
We are a limited liability corporation
formed by Richmond University Medical
Center and Staten Island University
Hospital to implement Project
Management Function.
– PMO staff recruited solely for
program execution
Goal: Improve the quality and transform
the healthcare delivery system of Staten
Island
Breadth:
– 4 out of 10 Staten Island residents
affected by DSRIP
• Strategic analytics requires Advanced data integration warehousing
and visualization
• Multiple sources create complexity- DOH/MCO claims, clinical
datasets, external sources, EMRs, Care planning
• Successful solution demands integration of multiple data sources,
capability of projecting clinical and business risk & implementing
solutions in real time
Turning Data Into Business Intelligence
Impact of Peer / Substance Use Disorder (SUD) Initiatives on Performance
147.39
100.8384.56 73.14
0
20
40
60
80
100
120
140
160
Baseline MY1 Result MY2 Result MY3 Result toDate
Potentially Preventable ED Visits (BH Population)Preventable ED Visits per 100 Medicaid members
Salient NYS Medicaid Enterprise System, DSRIP Performance Module as of 5/31/17
Potentially Preventable ED Visits (BH Population)
24.96%
21.97%
51.94%
50.72%
0% 10% 20% 30% 40% 50% 60%
MY3 Result to Date
MY2 Result
MY2 vs. MY3 Improvement in SUD MeasuresSalient NYS Medicaid Enterprise System, DSRIP
Performance Module as of 5/31/17
Initiation of AOD* Treatment Engagement of AOD* Treatment
*Alcohol and other drug
12© SpectraMedix, 2009-2017. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.
Current Progress- Improving Outcomes
14.00 14.05
12.45
DY1 DY2 DY3Q1-Q2
2.A.III: Health Home at Risk Intervention30-day ER Rate (Per 100 Members)
6.44
3.53 4.24
DY1 DY2 DY3Q1-Q2
2.B.VII: Implementing the INTERACT Project (Inpatient Transfer Avoidance Program for SNF)30-day ER Rate (Per 100 Members)
14.37 14.11
12.76
DY1 DY2 DY3Q1-Q2
3.A.IV: Development of Withdrawal Management 30-day ER Rate (Per 100 Members) Improvement in 30-day ER Utilization Rate
• 2.A.III: Health Home at Risk12% reduction from Apr, 2015 – Sep, 2017
• 2.B.VII: Interact Project52% reduction from Apr, 2015 – Sep, 2017
• 3.A.IV: Withdrawal Management13% reduction from Apr, 2015 – Sep, 2017
SIPPS Strategy: Technology Supporting Performance and Program Developments
• SI PPS moved very quickly to populate an EDW with “live” partner data
• SpectraMedix (“SM”) harmonized data from diverse sources, created MPI
• PMO uses analytics to inform strategic direction, gauge P4P risk and develop action plans
• Hot spotting, geo-mapping and population health data visualization are critical tools
• SM measurement platform and portal are in use by key partners
• Salient tools and MAPP exports are integrated into EDW to enhance analysis
• Critically important to bring in outside data sources
14© SpectraMedix, 2009-2017. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.
Improving Population Health
Source Data
Labs Amb.WA-IIS PharmDSHS CustomEMR HIE Claims
Enterprise Data Warehouse
Measures Calculation and Reporting
Performance Improvement & Visualization
Predictive Modeling and Simulation
DSRIP Platform Building Blocks
15© SpectraMedix, 2009-2017. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.
Direct Data Feed from Partners
Lead Providers
Clinical Data
Other Partners
Clinical/Billing Data
Care Management Partners (GSI)
Actively Engaged
roster
Public Data
Uninsured population
Planning Dept. Data
ACS Data: Education & Housing
Status
NYC FITNESS-
GRAM
DOH Data SourcesMedicaid
Member Roster v3
IPA File
Claims Data
v1
CPA File
Medicaid Data Warehouse /
SIM
Other Feeds
Patient Activation Measures (PAM)
Overdose Death data
Local RHIO
Data Sources
Naloxone Data
(Hospitals, FDNY, NYPD)
MCO’s
EMS Calls Data
1 2
3 4
Data Sources
16© SpectraMedix, 2009-2017. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.
Custom
Enterprise Data Warehouse
Provides daily and near
real-time updates
Applies rules to normalize
data
Aggregates data from disparate sources
Payer CAHPS Pharm EMR Labs Ambulatory HIE Claims
SpectraMedix EMPI
Map to DOH sources
Data Management/ Aggregation
SpectraMedix ETL Overview
EMR/
RHIO
All Payer
Claims
Database
Provider
Directory
Extract
Agent
Extract Reject /
Failures
New Business Rules
Input to Analytics
Data Quality
Checks & Data
Standardization
Rejects
Transformation
RulesSpectraMedix
CDR
Rejects
Source feeds
ClientQuality
Analyst
Provider
Attribution
• Configurable Email Alerts
• Success/Failure Reports
• Other Standard Reports
• Interactive Dashboards
Source Data Quality Assessment
EMPI: Unifying Patient Records
• Increased matching accuracy for two systems data from 83% to >98%
• Deterministic matching
• Built-in safeguards to prevent false positive matching
• Combines matching accuracy with computing efficiency for in-line
execution
• Different patient identifiers used at different institutions or programs
• Multiple identifiers assigned to a single person at one institution
• Lack of standards for including patient identifiers in data feeds
SpectraMedix
Enterprise
Master Patient
Index Solution
Patient Data
Integration
Challenges
20© SpectraMedix, 2009-2017. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.
Data Aggregation to Actionable Insights and VBP
SpectraMedix DSRIP Platform
eMeasures360 Framework
eureQa360
Enterprise Data Warehouse/EMPI
Regulatory Electronic Data
Submission
Structured data sources format
• Adjudicated claims• Partner 837 I/P• Clinical QRDA / C-CDA
RHIOs
• Healthix• Hixny• Rochester RHIO
Non standard format
• Custom DSRIP Data Spec Files
• Interfaces
Disease Registries
DSRIP
Pop Health Analytics
CMS Programs
Commercial Payer
Programs
The Impact of Top 1000 High Risk Patients (HRP)
Staten Island PPS Risk profile algorithm identified the top 1000 High Risk
Patients (HRP) from 82,906 Staten Island PPS Medicaid Enrollees
>25%
2.a: IntegratedDelivery
(Health Home or HHR)
17%
2.b: Care Coordination(2.b.iv, 2.b.vii,
2.b.viii)
31%
3.a: Behavioral Health
(3.a.i, 3.a.iv)
>50%
Took PAM survey as of 04-07-2017
Percentage of Top 1000 High Risk Patients
(HRP) engaged in DSRIP projects
… and 40% of preventable readmissions
100% HRP had one or more Chronic
conditions
That population drives 23% of preventable
ED Visits (PPV) of Staten Island PPS Medicaid enrollees
Avg. PPV /HRP: 4.55Min PPV /HRP: 4 Max PPV /HRP: 140
Avg. PPR/HRP: 0.28Min PPR /HRP: 1 Max PPR /HRP: 5
1.2% of Staten Island PPS Medicaid Enrollees
are defined as High Risk Patients (HRP)
Diabetes12%
Schizophrenia7%
Other Mental Health
2%
Depression1%
Other47%
Asthma, Hypertension,
CVD31%
22© SpectraMedix, 2009-2017. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.
Measure Gaps by Partner - Summary
23© SpectraMedix, 2009-2017. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.
Analytics engine identifies gaps in care
Member Utilization
*Dashboards created using synthetic data
Gaps in Care Dashboards
Hospital Programs
• HIQR eCQM
• MU eCQM
• TJC eCQM
Ambulatory Programs
• Medicaid Reform
• MIPS
• CIN (Clinically Integrated Network)
• ACO
• Medicare Advantage
• Commercial P4P Programs
• PCMH
• CPC+
Enterprise Data Warehouse
Electronic Interfaces
Data Sources
Inpatient Custom Programs Outpatient Custom
Programs
Continuous Performance Improvement for all Payers
CustomPayer CAHPS Pharm EMR Labs Ambulatory HIE Claims
HEDIS
When Outcomes are the Barometer of Success Can we Afford to Neglect SDOH?
Using Health & SDOH Data to Implement DSRIP Programs
MAPP Dashboard
Performance Management Dashboard
Stra
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nin
g
Perf
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Im
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Pop
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Hea
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Population-based Registry 2.0Healthcare Hotspotting
Population Health
Management
Tool:Population-basedPatient Registry
Ver. 1.0
Use Case:Diabetes w/chronic
Comorbid Conditions
Population: Attributed Members with at least one of
the chronic comorbid
conditions:
Diabetes, BH, COPD and CHF
1 Key Statistics
3Patient Demographics
4Hospital Utilization Trend
2
Utilization by Population
Population Health View
0%
0%
Use Case: Diabetes Management
Improving Diabetes Management
PPS gathers and evaluates baseline
data for this population
Population Health Improvement Program
(PHIP) target Small Practices
City Harvest Program w PHIP to give a
“Healthy Food Prescription” &
nutrition/cooking classes
Fund Stanford Model – Chronic Disease
Self-Management Program and Diabetes
Self-Management Program
Expansion to other healthcare providers
and community groups
Overlaying data to target key hot spots and develop programs
Use Case: Asthma Analytics and Program Development
Improving Asthma Management
PPS gathers and evaluates
baseline data for this population
Incorporated Asthma as a VBP
component of our PHIP Program
Introduced Asthma Home Visits by
CBO Partner for at risk patients
Utilize School Health data to
hotspot lost days and monitor
progress
PPS shares analysis with clinical
partners to improve follow-up and
outcomes for asthma patients
Data Period: Oct, 14 – Oct, 16
Geomapping: Substance Abuse & Nation of Origin Overlay
Use Case: Substance Abuse Epidemic
Staten Island
Overdose Deaths in
NYC
Heroin
Opioids
SI PPS EMS Super Utilizer
Analyzer
Where are the calls originated?
What are the 911 Calls about?
Staten Island EMS Super Utilizers Analysis
Rank Chief Complaint # of Calls %Total
1 Alcohol Intox / ETOH 1261 10%
2 Psychiatric / Behavior 748 6%
3 Abdominal Pain 700 6%
4 Dyspnea-SOB 654 5%
5 Chest Pain 470 4%
6 Weakness 392 3%
7 Fall 303 2%
8 Seizure 229 2%
9 Asthma Symptoms 217 2%
10 Trauma Injury 174 1%
Subtotal 42%
Top 10 Chief Complaints Top 10 Locations
56
69
79
87
88
124
146
201
207
404
10 HOWARD CT
(T)Lakeside Manor Home - 797…
(T)NYCHA - STAPLETON
(T)Project Hospitality Outreach - 25…
(T)BAY STREET/VICTORY BLVD
(T)Family Support Staten Island-262…
(T)NYCHA - RICHMOND TERRACE
(T)NYCHA - SOUTH BEACH
(T)South Beach Psychiatric Center - 777…
(T)FERRY TERMINAL
#Calls
Data Period: 2014Q1-2016Q3Data Sources: RUMC and SIUH EMS tracking systems
SDOH and Public Health Data Defines Targeted Clinical and Social Programs
• Innovative program development on Staten Island includes multi-disciplinary pilots
• Identification of health disparities driven by continuous data mining community
needs assessment and public health data
• CBO and partner engagement critical for engaging underserved populations
affected by social determinants of health
• Use of claims and comprehensive data sources enhances PPS analytics
• Data drives DSRIP projects, Population Health Improvement Projects and informs
Cultural Competency and Health Literacy strategy
• DSRIP Year 2 data suggests outcome improvements
Use of Data to Inform Program Development Recruitment of Partners
Diversity and Inclusion (D&I) SI PPS Partner
Survey
Identify CCHL Site
Champions Gap Analysis
• Plans, policies, procedures
• D&I initiatives• Staff development
and training
Assessing outcome gaps includes identifying role of Language Access, Health Literacy, Cultural Competence, Healthcare Equality
• Monthly meetings• Develop programs,
share best practice• Report all
information to site leadership
• Organizational capacity
• Training: status, ability and needs
• Service improvement
90% partners identified Health Literacy as area for
improvement
65% partners seek LGBT and Disability sensitivity training
85% partners identified need for Medical Interpreter
Training
50% partners without language access
Contracted vendor for interpreting and translating needs; supplying sites with Video Remote Interpreting Equipment
Contracted 2 Medical Interpreter training vendors specializing in hospital and community interpreting
Contracted with CBO- Pride Center of Staten island to provide PPS-Wide LGBT Healthcare Equality training
Contracting with CBO PCCS to deliver sensitivity training for working with persons with developmental disabilities
Developing Health Literacy provider and community training
Findings: Action:
36© SpectraMedix, 2009-2017. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.
DY1 (4/2015-11/2015) vs. DY2 (4/2016-11/2016)
Potentially Preventable ER and Readmission Results
Key Takeaways
• DATA is the OXYGEN that enables delivery system reform
– Aggregation and governance of data is key
– Data from outside sources is essential
– Data needs to be turned into Business Intelligence
• Technology enables program developments and performance improvement
• Hot spotting, geo-mapping and population health data visualization are critical tools
• SDoH and public health data drives targeted clinical/social programs
• Ultimate goal is to transition to Value-Based Care
– Efforts should lead providers to implement other commercial and VBP programs
Questions
Raj Lakhanpal, MD, FACEP
Chief Executive Officer,
SpectraMedix
Tel: 609-336-7733 Ext. 301
Cell: 609-865-3244
Raj.Lakhanpal@SpectraMedix.com
Joseph Conte, PhD(c), CPHQ
Executive Director
Staten Island Performing Provider
System (SI PPS)
Tel: 917-830-1145
Jconte@statenislandpps.org
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