AHI PPS All-Partner Meeting PRESENTED BY: AHI PPS Team October 8, - PowerPoint PPT Presentation

Collaboration • Catalyst • Community AHI PPS All-Partner Meeting PRESENTED BY: AHI PPS Team October 8, 2015

AHI: Who We Are AHI is an independent, non- profit organization that partners with regional health care providers and community-based organizations to improve care, lower costs and realize a healthier future.

How We Accomplish Our Goals 1. Promote population health best practices and implementation strategies. 2. Manage programs for health advancement; and 3. Ensure individuals have access to care.

AHI Timeline 5

Where We Work… 700,000 9 Total Population Counties 11,000 Clinton Essex Square Miles Franklin 9 Fulton Hamilton Saratoga Payors St. Lawrence Warren Medicare (FSS), Washington Medicaid, BSNENY, CDPHP, Empire BCBS, Empire UHC, Excellus, Fidelis, MVP

Shared Vision: Regional Population Health 7

Integrated Delivery System • Integrated Delivery System (IDS): Network of organizations that provides a coordinated continuum of services, and is willing to be clinically and fiscally accountable for outcomes and health status. The goals of the IDS include improving efficiency, quality and access to care. 8

Evolution of the PPS Governance • DOH mandated establishment of a Project Advisory Committee during the planning period; and establishment of formal governance during the implementation phase. • AHI obtained legal consult • AHI PPS Steering Committee reviewed proposed structure and charter in August, revisions were made, final model and charters were endorsed by Steering 9/29/2015. AHI BOD to finalize at November meeting.

Roles and Responsibilities of AHI

AHI Governance Adirondack Health Institute Board of Directors Ad Hoc Committees Standing Committees DSRIP Steering Audit & Executive Governance Finance Population Compliance Committee Committee Committee Health Committee Improvement Program Health Home Adirondack Rural Health Network

AHI BOD Representation by County Saratoga St. Lawrence Washington Franklin Warren Clinton Essex Hamilton Fulton

AHI BOD Representation by Sector Workforce Education Providers Insurers/ Public Health/ Business Behavioral Other Other Officials Community Health Payers Consumer Hospital Post-Acute

PPS Governance Structure Holds contract with State; final approval rights over all Adirondack Adirondack Health Institute actions/decisions of the ACO LLC Steering Committee and the other Committees Provides certain support services to the PPS Reviews all pursuant to a contract Steering Committee actions/decisions of the with AHI other Committees Community Clinical & IT & Data- Network Governance Finance Workforce Beneficiary Sharing & Quality Committee Committee Committee Engagement Committee Committee Committee Collaborative Contracting Model AHI will enter into a DSRIP Participation Agreement with each participant in the AHI PPS that will govern the operation of the PPS. Among other things, the DSRIP Participation Agreement will: • Set forth the responsibilities of AHI and the participants with respect to the establishment and operation of the PPS • Establish the governance model set forth above

Governing Members: Knowledge/Skills • Strategic Planning • Finance • Data Analytics • Clinical Integration • Provider Relations / Engagement • HIT • Clinical Quality • Operations

Governance: Operation of Committees Committee Charter Outline Charge: Description of scope Composition: List of members or types of • Governed by a charter individuals/ organizations that should be represented Meeting Frequency: Projected meeting • Adhere to a consensus-based process for frequency and duration decision-making that facilitates Participant Responsibilities & Expectations: Description of and community stakeholder engagement specific duties and time commitment (i.e., development of project plan, care model • Decision-making process of each Committee and protocols) will be transparent to all Participants Deliverables: List and description of key deliverables Timeline: Expected timeline for achieving above deliverables and activities

Governance Committees 20 30 one

Governance Committees five 15 AHI 20 10 one

Governance Committees five 15 AHI 10 20 one

Governance Committees 20 10 AHI five 15 one

Governance Next Steps • October: AHI PPS Steering Committee is surveyed for representation by sector, geography, and knowledge/skill set; determine if membership changes are needed to fulfill Charter. Nominate Chair. • October: Subcommittees are convened, review charter and composition, make recommendations for expanding or revising committee membership. • The AHI PPS Steering Committee’s recommendations are taken forward to the newly reconfigured AHI Board of Directors (1 st meeting, November 2015).

Performing Provider System Governance Management • • Represents the vision of the owners of Carries out the functions of the the organization organization • • Sets priorities & policies Sets procedures & implements processes • • Oversees management Provides Governance with information • • Evaluates performance of the Evaluates performance of the parts of organization as a whole the organization against targets

New York State Health Innovation Plan

PHIP Goals By actively: Promote the Triple Aim….. • Convening neutral forums • Sharing, disseminating Improved Population Health and helping implement Improved patient experience of care best practices and including quality and satisfaction population health Reduced Health Care Costs • Working to reduce health care disparities by using data to drive decisions 24

Regional Initiatives ~ Population Participating Insurers ADK ACO AHI PPS Medical Home Medicare (MMSP) NY Medicaid Medicare (FFS) Medicaid BSNENY CDPHP Adirondack Empire BCBS ACO Empire UHC PPS Excellus 25,000 Fidelis MVP 144,000 Geography (Medicaid: 94,000 ADK ACO AHI PPS Medical Home Uninsured: 50,000) Clinton Clinton Clinton Medical Home Essex Essex Essex Franklin Franklin Franklin 100,000 Hamilton Fulton (part) Hamilton Warren Hamilton (Warren) Washington St. Lawrence (part) (Washington) Saratoga (part) Warren Washington  Metrics  Healthcare Sections  Reporting Process and Schedule 25

New York State Health Innovation Plan

Population Health Management Competencies ~ Capabilities 1. Information & Communications Infrastructure 2. Clinical Management 3. Financial & Risk Management 4. Network Development & Physician Alignment

Timeline 28

Performing Provider Systems Across NYS • Consolidation ~ 50+ letters of intent, 25 PPSs today. • Variety of Governance Models ~ Collaborative Contracting predominant • Regional AHI PPS Partners: • North Country Initiative (Samaritan, FDRHPO) • Alliance for Better Health Care (Ellis/ St.Peter’s ) • Albany Med

Capital Restructuring Financing Program • CRFP Re-opened in August: opportunity for applicants previously disqualified to re-submit; new applications also allowed. • AHI PPS did NOT receive any new applications. • No changes in CRFP rankings. • On September 1, 2015, proposals that were previously disqualified, were resubmitted to NYS DOH to be considered for funding.

The DSRIP Path to Value Based Payment  The Value Based Payment “Roadmap” was approved by CMS on July 22, 2015  CMS/DOH have agreed that the “Roadmap” will be updated/revised on an annual basis as more information and decisions are made  Subcommittees formed to assist with the implementation of VBP • Technical design • Integrated care services • VBP and social determinants of health • Regulatory impact • Community based organization • Advocacy and engagement • Performance management

Opt-Out Process • Opt-Out process is being handled at the State level • Purpose: opportunity for beneficiaries to opt-out of data sharing • Timeline: DSRIP Notice & Opt-Out Letters will be mailed to beneficiaries in November • Letters & Forms: see copies in your packets

Networks To Reopen • Performance Networks to open mid-October for 2 week period. • Opportunity to ADD providers to the network (does not affect attribution for valuation) • “Unaffiliated Provider List” distributed last week • No major additions expected

Speed & Scale • Commitments were made in January 2015 • Speed: pace at which providers meet the project requirements • Scale: number of actively engaged patients over time • Speed & Scale ~ part of Plan scoring, and subsequent valuation methodology • DOH recently announced changes to speed & scale targets

Project Approval & Oversight Panel • November 9 th & 10 th : Meeting of the PAOP / each PPS presents • Panel reviews work of the independent assessor (IA); advises the Commissioner of Health whether to accept, reject or modify the recommendations made by the IA. • The Panel will serve as advisors and reviewers of Performing Provider Systems status and project performance during the 5- year DSRIP duration.