General

Assembly

June 7, 2017

WELCOME

Mario J. ParedesChief Executive Officer

IN SICKNESS AND IN HEALTH:Marrying Social Determinants

to the World of Health Care Delivery

Larry McReynoldsExecutive Director, Family Health Centers at NYU Langone

SVP, Community Health, NYU Langone Health System

Mary Ellen Connington, Chief Operating Officer

Chloe Cheng, Project Director Equity Programs

Sharif De Los Santos, Project Director, Clinical Projects

Les Halpert, Ph.D, Project Director, Behavioral Health Project

Cindy Klein, Project Director, Community Care Management Projects

PAY-FOR-PERFORMANCE

Introduction Mary EllenMY 2 CindyMY 3, 4, & 5 ChloeUnique Challenges with BH LesMoving the Needle Shariff

AGENDA

Doing well, getting tougher

Doing Well, Getting Tougher!

• DSRIP wants “Proof” that processes are in place and effective

• Detailed workflows

• Achieving OUTCOMES is the proof

• The climb is steeper

• More measures, more $ at risk

• Let’s take a deeper dive

MY 2

Doing well, getting tougher

How did we do in MY2?“ACP is a Leading Performer”

June 30, 2016Measurement Year

2July 1 2015

Measurement Year 2:

• 18 P-4-P measures

• ACP scored well compared to other PPSs

• Met Annual Improvement Targets for 50% of Metrics

• $13.5M at risk (P-4-P)

• ACP to collect $7.5M + High Performance

MY 3, 4, & 5

MY 2

Doing well, getting tougher

MY3 Closes in 3 Weeks!

6/30/2016Measurement

Year 27/1/2015 6/30/2017

Measurement Year 3

7/1/2016

• Moved from 18 P4P measures in MY2 to 87 P4P measures in MY3

• Mix of HEDIS/QARR and CAHPS measures

• $63M+ at risk in MY3 for P4P measures alone

• We can still improve, but DOS must be by June 30 to count for MY3

$13.6m

$56.6m

$65.8m

$32.9m

MY 2, 18

MY 3, 87

MY 4, 109 MY 5, 109

0

20

40

60

80

100

120

$-

$10,000,000.00

$20,000,000.00

$30,000,000.00

$40,000,000.00

$50,000,000.00

$60,000,000.00

$70,000,000.00

MY 2 MY 3 MY 4 MY 5

P4P Dollars at Risk Metrics

P4P Dollars vs. Count of Metrics

Behavioral Health

MY 3, 4, & 5

MY 2

Doing well, getting tougher

Behavioral Health and Population Health

• Behavioral Health co-occurs across health issues such as:

• Opioid epidemic

• Smoking

• Childhood diabetes

• Medication adherence

Behavioral Health Opportunities

• PCP integration:

• Screening and referral for behavioral health

• Breaking down silos between medical and behavioral health

• Support Value Based Payments

• Initiate care management programs

• ACP PPS level:

• Meet Performance Metrics – 14 are Behavioral Health

• Coordinate with MCOs

Moving the Needle

Behavioral Health

MY 3, 4, & 5

MY 2

Doing well, getting tougher

Moving the Needle!

ECW Dashboards

“If it is not in the claim,

it never happened!”

Soraya SussmanSenior Director of Quality Control

PATH TO QUALITY

Overview

• What is Quality to you?

• What is Quality?

• Benefits of Quality Improvement (QI)

• Core Principles and Process of Quality Improvement

• Quality Improvement and Drivers of Transformation

Quality = Value / Cost

Patient Experience & Population Health

• 2017 MAX Series Collaborative Partnership Presentation

What is Quality to you?

What is Quality?

Outcomes

Cost

Quality

Time

Benefits of Quality

Increase

• Quality

• Engagement

• Patient Experience

• Sustainability

• Consistency

• Performance

Decrease

• Risk

• Waste

• Adverse Events/Error

• Complaints

• Time

• Variation

Quality Improvement Core Principles

• Leadership - Embed quality improvement as a core business foundation.

• Continuous Improvement - Review and enhance internal systems.

• Build Organization Culture – Teamwork

Michael Porter, Professor Harvard School of Business

Core Process…Create a QI Environment

• Identify Provider and Patient Needs

• Collect and Analyze Data

• Team Approach

• Ongoing Quality Improvement

• Sustains Wins

• Incorporate Innovative Ideas

Michael Porter, Professor Harvard School of Business

Quality Improvement at a Glance

Leadership &

Stakeholder Buy-in

Personnel & Organization Development

Continuously improving

system and process

Reach Best Outcomes

Align Value and cost

The right path is QUALITY

The right goal is VALUE!

“Value Thinking”

To create value, it is not the individual services that matter but the collective set of services required to deal with the patient medical problem.

– Total Patient Health Needs

ACP Jamaica Hospital MAX Series QI Experience

Advocate Community Providers, Jamaica HospitalMAXimizers – High Utilizer

Care Pathway Overview

Monthly Dashboard 3/1 – 3/31Number of HU Discharges 72

Number of HU Patients 68

% Served Prior to Discharge 93%

% Served Post-Discharge 72%

* Denotes workshop action plan

Identify

• BPA ‘SuperMAX’ Flag in EMR identifies HU.*

• Facilitator, treatment team and RCA team are notified.

Assess

• SW conducts Comprehensive Social Work Assessment.*

• ED Physician reviews current and past medical records of all MAXpatients.

• ED Physician orders consult to Medicine Attending beforeadmission.

Link

• RCA team leverage DOU and comprehensive SW assessment to develop care plan.*

• Facilitator connects HU to HH partner where appropriate; to community partners; and to primary care.

Manage

• HU receives post-discharge call and follow up assistance with care plan from facilitator.

• Facilitator supports HU connection to and compliance with outpatient providers as needed.

Goal: “To improve the quality of life

for our patients and care providers

by education and providing

comprehensive care within an

integrated multidisciplinary

approach to empower our patients

in every way.”

Enjoy your lunch!

DATA AND ANALYTICS

Corey MaherChief Technology Officer

Recent Happenings

Since the last General Assembly…

Engagement Data Cleaning and Submission For DY2Q4

• Discovered serious data issues from DY2Q2 submission, wrist

slap from IA

• Massive cleanup effort from Ernie, Paul, Bill, Rong, Shariff, et. al

• IA results came back with no indication of quality issues

EngagementDatabase

Arcadia Project Kickoff

• File transfers setup for five pilot practices

• Server/infrastructure build for Arcadia

• Project management assists from Emma and Tonguc

EMR

Funds Flow Data Processing

• Chloe setup and manages a process for investigating issues

• Please email fundsflowquestions@acppps.org for issues

• Daily updates of funds flow data for finance available

In Flight

Things we’re working on now…

Airflow – Jobs Management

• Current jobs:

• State data

• Engagement data

• 5 ECW pilot practices

• Upcoming jobs:

• 6 health plan feeds with 4-5 files each

• Potentially ~200 more ECW feeds

• Exports to plans

• Pharmacy feeds, lab feeds

• Airflow:

• Apache project from Airbnb

• Manages automated execution of many jobs

Airflow – Jobs Management

Physician Scorecards

• Support core DSRIP and VBP metrics

• Prototypes currently in Excel

• Building into Tableau

Arcadia and eCW Update

• Arcadia – Proof-of-concept project

• eCW –

• Population health dashboard change requests

• Practice onboarding into the portal

• Nightly data dumps

PREVIEW OF HEALOW

Rakhee LangereClinical Works

Engage Your Patients Better with the healow suite of products

Presenters:Rakhee Langer

Healthcare in the digital age

Delivering accurate, accessible, and actionable health information

Empowering the consumer

Shift to value based care – Engagement, Satisfaction and Access

Technology to provide a personalized patient centric experience

• Access to health records

• Remote interactions via telehealth

Paper EMR PE

ProblemsThat Need Solutions

• How to cater to the Millennials and Seniors

• Resource Availability & Readiness

• Understanding the value of Engagement Products

• Marketing Roadblocks

• Increased Competition

• Sustainability in keeping patients engaged

Patient Relationship Management

The goal is to transform your practice to one that suits the evolving needs of your patients in the digital world, in turn increasing patient engagement and better health outcomes

Program Objectives

Serve our customer and provide top class service. At the same time assist in making the provider-patient bond stronger by our product offeringsRelation

Provide your patients better knowledge of all the tools you have to offerEducate

Provide your patients access to their own health via the Patient Portal and the healow AppAccess

Offer changes to your practice to serve in the digital world to market better to your current patients and help bring in new patientsChange

Train and assist your staff to contribute to this change for the futureHelp

Online Presence and patient engagement

Health Access

- Patient Portal

- Website marketing

- Healow app

Educate and Market

• Digital Marketing

• Education for the staff & Providers

• Patient interaction & assistance

Engaged patients lead to incremental price benefits

Online appointment booking

- Scheduling for appointments- Community health workers

able to book appointments

healow Health Dial

healow APP

healow APP

healow APP

Focus on Patients for follow-up or preventive care

Appointment Reminders

Preset Messages

Disease Management RemindersPreventive Reminder

Administrative Reminders

Smart Patient Finder

Multi Modality OutreachMessenger

✓ Many ways to connect with your Patients

Automatically engage your patientsanywhere, anytime

Voice Text Email Portal App

Messenger

6200+ Practices

200 Million Annual Messages

25+ Automated Campaigns

Custom Campaigns

Questions

Thank you!

We hope you found this helpful

If you have questions or concerns with regards to this, please reach out to the healow team.

prmservices@eclinicalworks.com

2017 OMIG WORKPLAN

Thomas GimlerChief Compliance Officer

Summary

• OMIG – Office of Medicaid Inspector General -- oversees investigations, audits, review of Medicaid providers. OMIG has authority to pursue civil and administrative enforcement actions related to fraud, waste and abuse.

• Medicaid is New York state’s largest payer of health care and long-term care. 6+ million New Yorkers receive Medicaid-eligible services through a network of 80,000+ health care providers and 90+ managed care plans.

• Total federal, state, and local Medicaid spending for SFY 2018 is expected to be $65 billion.

• Health care fraud, waste, and abuse can involve physicians, pharmacists, nurses and aides, medical equipment companies, MCOs, transportation providers.

2017-2018 OMIG Strategic Work Plan

Three overarching goals:

• Enhancing Compliance

• Fighting Fraud, Waste, and Abuse

• Promoting Innovative Analytics

Goal #1: Collaborate with Providers to Enhance Compliance

Compliance Program Reviews

• Most reviews initiated due to a Medicaid provider’s failure to meet annual program certification obligation.

• Corporate Integrity Agreements are an alternative to termination or exclusion from Medicaid when a provider has committed an act of Medicaid fraud, waste and abuse. Medicaid subsequently monitors providers under CIAs and takes necessary action in the event of a breach of the terms of the CIA.

Goal #1 Objectives

• Enhance provider outreach and education through engagement and participation efforts.

• Generate policy based on provider collaboration efforts.

Goal #2: Coordinate with Stakeholders to Identify and Address Fraud, Waste

and Abuse in Medicaid Program

• Prescription Drug and Opioid Abuse: Patients suspected of overuse or abuse are restricted to a single designated provider.

• Home Health and Community Based services: As Medicaid moves from hospitalization and long-term care under value-based payment system, oversight of these services is critical to the Medicaid population.

Goal #2 Objectives

• Referral and supporting prosecution of cases related to fraud in program integrity partnership with the Attorney General’s Medicaid Fraud Control Unit.

• Managed Care Plan Review, Network Provider Review and Pharmacy Project teams focus on efficient and effective audit processes to enhance integrity of managed care environment.

Goal #3: Develop Innovative Analytic Capabilities to Detect Fraudulent

or Wasteful Activities

• Data Review Project Team seeks to ensure availability and usability of data from Medicaid Data Warehouse, Salient Data Mining solution, All-Payer Database, Data Mart, and Encounter Intake system. Collaborates with DOH to improve completeness and accuracy of MCO-submitted encounter data.

• Analytics used to review encounter analysis, system match recoveries, third-party liability matches and recovery services.

Goal #3 Objectives

• Enhances multidisciplinary activities, including improved data access, storage and mining capabilities.

• Utilizes multidisciplinary activities to improve upon audit and investigation efforts to recovery and help preserve Medicaid funds.

SECURE ID, SECURE PRINTING

Thomas MaruschakDirector of Infrastructure Services

Secure ID

Secure ID enables staff to enter ACP offices

Security: Badges must be worn in the office at all times by every employee and staff member

Secure Print with Secure ID

Secure ID will enable printing on any Multi-Functional Printer

Security: Documents are printed only when you log in at the device with your

ID card. This reduces waste and document insecurity.

Easy Use: One quick swipe is enough to unlock the device

BENEFITS AND PROFESSIONAL DEVELOPMENT

Liz WebbVice President of Human Resources

Training and Development CalendarGeneral Assembly

• Quarterly, mandatory all-employee meetings

• 10 am to 2 pm

Professional Development Series

• Mandatory all-employee meetings

• 90-minute workshops

• How to Be A Top Performer (July 13)

• How to Communicate Effectively (September)

• How to Present with Clarity and Conviction (November)

• How to Master Time Management (2018)

Lunch & Learns

• All-employees are invited

• Behavioral Health (June 28)

• DASH (July 19)

Employee Intranet & Calendar

NEW EMPLOYEEINTRODUCTIONS

EMPLOYEE RECOGNITIONAWARDS

Thank You!