DSRIP Meeting Agenda

PAGE 1

Date and Time 12/19/16, 8am-9am Meeting Title NYP PPS Executive Committee

Location GoTo only Facilitator Betty Cheng, David Alge

Go to Meeting https://global.gotomeeting.com/join/530564805 Conference Line United States +1 (872) 240-3412

Access Code: 530-564-805

Invitees

David Alge Betty Cheng (CBWCHC) Steven Kaplan (Clinical Operations) Dan Lowy (Argus) Brian Kurz (Finance) Sharen Duke (ASCNYC) Gil Kuperman (Data/IT Governance) Jay Gormley (MJHS) Anne Sperling (PAC) Ellen Harnett (Isabella) Isaac Kastenbaum (PMO)

Meeting Objectives Time

1. Review Action Items from Last Meeting 2. Open NYP seat on the Executive Committee 3. NYP PPS Mid-Point Assessment Report and response 4. Upcoming PAOP presentation on February 2, 2017 5. Review of Plan for Engaging Attributed Members in Qualifying Entities 6. Shift to focus on performance metrics 7. Identify Action Items for Next Meeting

2 mins 5 mins

15 mins 10 mins 15 mins 15 mins 2 mins

Action Items

Description Owner Start Date Due Date Status

Submit Bed Management Plan as part of DY2, Q3 reporting

Lauren Alexander 11/21/2016 1/31/2017 Not started

DSRIP Meeting Agenda

PAGE 1

Date and Time 12/19/16, 8am-9am Meeting Title NYP PPS Executive Committee

Location GoTo only Facilitator Betty Cheng, David Alge

Go to Meeting https://global.gotomeeting.com/join/530564805 Conference Line United States +1 (872) 240-3412

Access Code: 530-564-805

Attendees

David Alge Betty Cheng (CBWCHC) Steven Kaplan (Clinical Operations) Dan Lowy (Argus) Brian Kurz (Finance) Sharen Duke (ASCNYC) Gil Kuperman (Data/IT Governance) Jay Gormley (MJHS) Anne Sperling (PAC) Ellen Harnett (Isabella) Isaac Kastenbaum (PMO) Lauren Alexander (NYP)

Meeting Objectives Time

1. Review Action Items from Last Meeting 2. Open NYP seat on the Executive Committee 3. NYP PPS Mid-Point Assessment Report and response 4. Upcoming PAOP presentation on February 2, 2017 5. Review of Plan for Engaging Attributed Members in Qualifying Entities 6. Shift to focus on performance metrics 7. Identify Action Items for Next Meeting

2 mins 5 mins

15 mins 10 mins 15 mins 15 mins 2 mins

Action Items

Description Owner Start Date Due Date Status

Explore how collaborator organizations can submit feedback on behalf of the PPS as part of the mid-point assessment process

D. Alge/

I. Kastenbaum 12/19/2016 1/30/2016 In progress

Submit IT Milestone #4 – Engaging Attributed Members in QEs – as part of DY2, Q3 reporting

L. Alexander 12/19/2016 1/31/2016 Not started

Distribute performance metrics to Committee

L. Alexander/ I. Kastenbaum

12/19/2016 1/30/2016 In progress

Approvals: The Plan for Engaging Attributed Members in QEs was presented by Gil Kuperman to the Executive Committee for approval. Steven Kaplan motioned to approve. Sharen Duke seconded. All were in favor.

NYS DSRIP Timeline

End of 2016

DY2 Q3 (12/31/16)

DY2 Q2 Remediation

MY3 Q2 Performance

“DSRIP Midpoint”

1

We are here.

2

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.

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

We are here

NYS DSRIP Timeline: Shift from P4R to P4P

NYP PPS: Transition to P4P Focus

3

NYP PPS: Transition to P4P Focus (2)

4

Integrated

Delivery

System

Ambulatory

ICU

ED Care

Triage

30-Day Care

Transitions

BH – Primary

Care

Integration

BH Crisis

Stabilization

HIV Center of

Excellence

Palliative

Care in

PCMHs

Tobacco

CessationReduce HIV

Morbidity

PPS Governance

Committees

Project-Centric Governance Performance-Driven Governance

Avoidable Utilization

(IP & ED)

Access to Primary Care

Behavioral Health Quality

Primary Care Quality

PPS Governance

Committees

Patient Experience

NYP PPS: Transition to P4P Focus (3)

Anticipated Transition

PPS Governance Committees

focus on metrics / QI

opportunities

Distribution of performance

reports

Move beyond project-specific

reporting requirements (DY2 Q4)

Reorganize away from project

silos

Anticipated Challenges

Performance data

– 1+ year lag (directional)

– Not directly attributed to single

provider/organization

– Few data sources are identifiable /

actionable

QI achieved through population-

specific efforts vs. NYS reporting

/ messaging focused on projects

5

Immediate Focus: Assessing Quality

Improvement Opportunities

Domain 1 IT Systems and Processes

1

Milestone 4 Develop a specific plan for engaging attributed members in Qualifying Entities

Background

NYP PPS Network Overview and Community Needs Assessment Highlights The New York and Presbyterian Hospital Performing Provider System is anchored by NewYork- Presbyterian Hospital’s five Manhattan-based locations (Weill Cornell Medical Center, Lower Manhattan Hospital, Columbia University Medical Center, Morgan Stanley Children’s Hospital of New York and The Allen Hospital) as well as its Ambulatory Care Network (with practices across Manhattan and the Bronx).

Based on the preliminary Community Needs Assessment attribution maps, the PPS serves Medicaid beneficiaries throughout Manhattan, the Southwest Bronx, Western Brooklyn and Western Queens. See more details below for the patient populations associated with each of the following three hubs around which the PPS is centered:

o Columbia University Medical Center and Washington Heights-Inwood, o Weill Cornell Medical Center and East Harlem, Queens, Brooklyn, and o Lower Manhattan Hospital and Lower Manhattan.

Columbia University Medical Center Campus and Washington Heights-Inwood A total of 870,000 people live in the catchment area of the Columbia University Medical Center (CUMC) hub. This region includes the communities of Washington Heights, Inwood, Harlem and portions of the Southwest Bronx. Sixty-one percent of the CUMC region is of Hispanic descent and 31% are of African-American descent. Forty percent of the total population in the CUMC region is foreign born. Spanish is the predominant language spoken in these communities (55%); however, 35% of the population surveyed reported English as their primary language.

Weill Cornell Medical Center Campus and East Harlem, Queens, Brooklyn A total of 524,000 people live in the Weill Cornell Medical Center catchment area. This region includes the communities of the Upper East Side of Manhattan, East Harlem and Northwest Queens. Twenty- five percent of the WCMC region is of Hispanic descent, with an additional 11% African-American and 11% Asian/Pacific Islander. English is the predominant language spoken in these communities; however, 22% of the population surveyed reported Spanish as their primary language.

Lower Manhattan Hospital and Lower Manhattan Based on the most recent U.S. Census Bureau data available, a total of 336,000 people live in the Lower Manhattan catchment area. Twenty-five percent of the Lower Manhattan region is of Asian descent. In addition, 30% of the total population in the Lower Manhattan catchment area is foreign born.

The PPS Collaborator network consists of 85 organizations, which include Federally Qualified Health Centers, community-based physicians, nursing homes, home care providers, behavioral health providers, pharmacies as well as social services and community-based organizations (e.g. supportive housing, transportation, meal programs). The network, as a whole, has a tremendous amount of resources committed to improving the health and wellbeing of the safety net population.

Domain 1 IT Systems and Processes

2

The IT/Data Governance Committee developed an approach for engaging attributed members in Qualifying Entities based on the broad cultural and linguistic needs of the attributed population identified in the NYP PSS Community Needs Assessment.

Qualified Entity The NYP PPS established a partnership with Healthix, a New York City-based Qualified Entity (QE) and the largest public health information exchange in the nation, to deliver real-time patient data at the point-of- care to NYP PPS collaborator organizations.

Plan for Engaging Attributed Members in Qualifying Entities

1. The NYP PPS IT/Data Governance Committee will review the current Healthix (Qualified Entity) patient consent process, including pitfalls experienced by clinical and operational staff in the current model.

2. The NYP PPS Cultural Competency, Clinical Operations and IT/Data Governance Committees will work together to ensure that cultural competency and health literacy principles are incorporated into the new RHIO consent process, particularly in linguistically isolated patient communities covered by the PPS.

3. The NYP PPS Cultural Competency, Clinical Operations and IT/Data Governance Committees will

develop a staged plan for outreach to PPS collaborators to communicate Healthix (Qualified Entity) consent processes, assist with implementation (as needed) and track/report member engagement.

4. The NYP PPS Director of Interoperability Informatics will be responsible for engaging Healthix (Qualified Entity) to work with PPS collaborators to finalize planning, including obtaining feedback from collaborators on operational feasibility and cultural appropriateness. NYP has hired a Manager for Team-based Care to coordinate implementation activities.

5. The NYP PPS Cultural Competency, Clinical Operations and IT/Data Governance Committees will

present this Plan for Engaging Attributed Members in Qualifying Entities to the Executive Committee for ratification in December 2016.

The following are other examples of how the NYP PPS will engage collaborators and attributed members in Qualifying Entities:

Engage Patients in their Preferred/Primary Languages o Ensure providers, care managers, care coordinators or other care team members

that are implementing Qualified Entity consents at their organizations speak the patient’s primary language.

o If providers/care team members do not speak a patient’s primary language, the organization will utilize interpreter services, both in-person or via phone.

o The NYP PPS can assist with the identification of these services.

Domain 1 IT Systems and Processes

3

Availability of Forms in Patient’s Primary/Preferred Language o The NYP PPS will use the Healthix consent forms, currently translated into 19

different languages. A complete listing of languages and their respective forms can be found

here: http://healthix.org/who-we-serve/healthix-participant- organizations/compliance/consent-forms/.

Provider/Care Team Training o Providers and care team members will be trained to communicate/explain the

benefits of sharing data with the qualified entity (Healthix). o The NewYork-Presbyterian PPS will extend the Quality Interactions Resource

Center (QI-RC) to providers/care team members involved in the consenting process. The QI-RC is a reference tool designed to help providers improve their cultural competency awareness and communication skills.

Resource information is available and organized according to the following categories:

Foundations in cultural competency Difficult cross-cultural situations Common clinical issues Major world religions Ethnic origin references Language and interpretation

The PPS will use its IT/Data Governance Committee to share best practices about how to address the language and cultural barriers to achieving engagement in Qualified Entities.

Results from Preliminary Engagement of Healthcare Providers and CBOs The NYP PPS worked with two collaborators, Charles B. Wang Community Health Center and VillageCare in order to identify strategies for engaging attributed members in Qualifying Entities. Both Charles B. Wang Community Health Center (CBW CHC) and VillageCare represent a large number of culturally and linguistically isolated patient communities. VillageCare mostly serves patients who speak Spanish, Cantonese, Mandarin and Urdu while 90% of clients at CBW CHC primarily speak Chinese and Korean.

At a meeting of the IT/Data Governance Committee in mid-2016, these two organizations shared their approaches for obtaining patient consent in a linguistically and culturally appropriate manner. The presentations and the ensuing discussions helped the other organizations identify approaches that could be implemented in their care settings.

Contact Information Gil J. Kuperman, MD, PhD Director, Interoperability Informatics NewYork-Presbyterian Hospital Adjunct Professor of Biomedical Informatics, Columbia University 212.585.6847 gkuperman@nyp.org