Albany Medical Center Hospital PPS Collaboration & Networking - - PowerPoint PPT Presentation

Albany Medical Center Hospital PPS Collaboration & Networking September 19, 2016

This WebEx Meeting is being recorded

Meeting Attendance

Please email confirmation of your participation in today’s meeting to DSRIP@mail.amc.edu Name and Organization is required within 24 hours

Today’s Presentations: 1. Alliance for Positive Health 2. Catholic Charities 3. Center for Disability Services 4. Community Caregivers 5. Community Health Center 6. Healthy Capital District Initiative 7. In Our Own Voices 8. NY StateWide Senior Action Council 9. The Healthcare Consortium 10. Trinity Alliance

Project ID Metric ID Metric Type Contract Metric PPS Responsibility Partner Responsibility Supporting Documentation 2.a.iii 2.a.iii_P6 Performance Identify key CBOs/external stakeholders to develop collaborations and partnerships to meet goals

• f project 2.a.iii

Facilitate relationships and provide networking

• pportunities to bring

providers and CBOs together.

Provide list of identified CBOs/external stakeholders for future partnerships and

• collaborations. Hold at least one

meeting to discuss future partnership goals and strategies for success of the project.

List of identified CBOs/other external stakeholders to develop collaborations with; meeting agenda, attendees list, and minutes from initial meeting held to discuss partnership goals and strategies 2.b.iii 2.b.iii_P3 Performance Identify key CBOs/external stakeholders to develop collaborations and partnerships to meet goals

• f project 2.b.iii

Facilitate relationships and provide networking

• pportunities to bring

providers and CBOs together.

Provide list of identified CBOs/external stakeholders for future partnerships and

• collaborations. Hold at least one

meeting to discuss future partnership goals and strategies for success of the project.

List of identified CBOs/other external stakeholders to develop collaborations with; meeting agenda, attendees list, and minutes from initial meeting held to discuss partnership goals and strategies 3.b.i 3.b.i_P1 Performance Identify key CBOs/external stakeholders to develop collaborations and partnerships to meet goals

• f project 3.b.i

Facilitate relationships and provide networking

• pportunities to bring

providers and CBOs together.

Provide list of identified CBOs/external stakeholders for future partnerships and

• collaborations. Hold at least one

meeting to discuss future partnership goals and strategies for success of the project.

List of identified CBOs/other external stakeholders to develop collaborations with; meeting agenda, attendees list, and minutes from initial meeting held to discuss partnership goals and strategies 3.d.iii 3.d.iii_P1 Performance Identify key CBOs/external stakeholders to develop collaborations and partnerships to meet goals

• f project 3.d.iii

Facilitate relationships and provide networking

• pportunities to bring

providers and CBOs together.

Provide list of identified CBOs/external stakeholders for future partnerships and

• collaborations. Hold at least one

meeting to discuss future partnership goals and strategies for success of the project.

List of identified CBOs/other external stakeholders to develop collaborations with; meeting agenda, attendees list, and minutes from initial meeting held to discuss partnership goals and strategies

Organization Name

• Key services
• Please list key services and any details you would like to share focusing
• n those relevant to the following four projects (Health Home At-Risk

Intervention, ED Care Triage, Cardiovascular, and Asthma) – Service 1 – Service 2 – Service 3, etc.

• Contact Information

– Please list name, position, email and/or phone number for other partners to connect with after the webinar – Website, if applicable.

Location(s): Counties served:

Please feel free to use an approved slide background from your organization.

Alliance for Positive Health

The Alliance for Positive Health is a Health Home provider for adults with chronic illnesses, including cardiovascular disease, asthma, HIV, substance use disorders, mental illness, etc. Care managers work with clients in their homes, accompany them to medical appointments, and coordinate ER and hospital discharges. The Alliance provides linkage and navigation services, coordination of medical services, assistance with maintaining benefits, education regarding managing chronic illnesses, referrals to social services, harm and risk reduction counseling, and limited financial assistance for emergencies. In addition to the Health Home program, the Alliance offers a wide array of services for individuals with HIV, at risk for HIV, individuals with mental illness, substance use disorders, the LGBTQ community, and individuals with chronic illnesses.

• Contact Information

– Laurie Lanphear, Director of Health Homes and DSRIP, llanphear@alliancefph.org, 518-434-4686, ext. 2228 – www.allianceforpositivehealth.org

Location(s): Albany, Schenectady, Plattsburgh, Hudson Falls, Hudson Counties served: Albany, Clinton, Columbia, Essex, Franklin,

Fulton, Greene, Hamilton, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington

Key services

• Behavioral Health/Counseling
• Case Management/Service Coordination/Health Homes
• Children and Youth Services

– Adolescent pregnancy and parenting – Supervised Visitation – Parent Education – Kinship Care – Youth Mentoring

• Developmental Disabilities Services
• Emergency Assistance around Basic Needs
• Food Services
• Housing Services
• WIC Services

Contact Information

– Further program and contact information for all 12 Catholic Charities’ Agencies can be located at www.ccrcda.org – Theresa Lux, Executive Director – Columbia/Greene: tlux@cathcharcg.org; 518-828-8660

Location(s): Albany, Catskill, Glens Falls, Hudson, Saratoga Springs Counties served: Albany, Columbia, Greene, Saratoga, Warren

Of the Diocese of Albany

Catholic Charities

Center for Disability Services

• Key services
• Please list key services and any details you would like to share focusing on those

relevant to the following four projects (Health Home At-Risk Intervention, ED Care Triage, Cardiovascular, and Asthma) – Article 28 D&TC providing PC, Dental, Neuro, Behavioral Health Services, other Med Specialties and Outpatient Therapies; services are designed to accommodate the needs of individuals with physical/cognitive/behavioral challenges however most practices, excluding behavioral health, are open to the general public. Heart Disease is one of the leading causes of death in individuals with IDD. – Lead Partner with CNYHHN’s Children’s Health Home – Pediatric SNF – St. Margaret’s Center for Children – Accessible Transportation Services including VIA Specialized Transportation (similar to CDTA STAR)

• Contact Information

– Lori Kearsing – kearsing@cfdsny.org – 518-944-2106 – www.cfdsny.org

Location(s): Albany , Clifton Park & Queensbury Counties served: Greater Capital Region including AMC PPS

Footprint

Community Caregivers, Inc.

Key services

• Recruits and trains volunteers to provide clients of all ages with non-medical

services at no charge, including transportation, shopping, light chores, visits and re-assurance phone calls. 150 volunteers serving over 300 families and caregivers – Provides support group for Alzheimers caregivers – Conducts education programs on important health and human services – Registered nurse is Client Intake Coordinator making home assessment and visits; Transportation Coordinator arranges for actual delivery of services; Program Coordinator recruits and trains volunteers and conducts community outreach and education programs.

Contact Information

– Linda Miller, Program Coordinator, linda@communitycaregivers.org – www.communitycaregivers.org

2120 Western Avenue, Albany, NY 12203 (518) 456-2898 Serving: City of Albany, Towns of Guilderland, Bethlehem, Knox, Berne, New Scotland

Community Health Center

• Key services

– Certified Home Healthcare Agency providing skilled nursing, physical ,

• ccupational, speech and respiratory therapies, medical social work,

palliative care, asthma certified clinicians, wound care, diabetes education (fully servicing all areas) – Care transition coaching – Telehealth

• Contact Information

– Cynthia Lockrow LMSW Director of Homecare Marketing – clockrow@chchomecare.org – Website: www.chchomecare.org

Location(s):Johnstown, Herkimer, Galway Counties served: Montgomery, Fulton, Schoharie, Herkimer, Hamliton, Saratoga and Warren

Healthy Capital District Initiative

Services

– Free Health Insurance Enrollment Services for people of all ages and post-enrollment support for those having cost, access to care or other issues.

Allison Wagoner, Enrollment Services Director - 518-462-7040

– Population Health Improvement Program (PHIP) –Align resources to transform health care delivery, improve population health, and eliminate health disparities. (Provide technical assistance: 1. community health needs reports, 2. self-management programs, 3. care coordination support, 4. consumer research to improve adoption and satisfaction.)

Shirley Belotte, PHIP Manager - 518-486-8413

– Asthma Coalition of the Capital Region (ACCR) which coordinates sustainable initiatives reducing the burden of asthma in Albany, Rensselaer, Schenectady, Fulton and Montgomery

• counties. Primary focus is providing:
• Resources and tools to support guidelines-based asthma care and self-management;
• Opportunities to collaborate and share information; and
• Continuing ed. and training opportunities for medical and public health professionals.

Katrese Minor, ACCR Coordinator - 518-486-8411

www.hcdiny.org

Location: Administrative Office, 175 Central Avenue, Albany Counties served: Albany, Rensselaer, Schenectady, Saratoga, Greene, and Columbia

In Our Own Voices, Inc.

• Key services

– Capital Region LGBT Anti-Violence Project – TransCare – Youth Development Network – Ask-A-Lawyer Legal Clinic – Health Care Kits & HIV/Hep C Testing – Say it Loud! Black and Latino Gay Pride – Unity Through Diversity- National LGBT POC Health Summit – Our Space/Our Face – YMSM/MSM Program – Project Sano

• Contact Information

Tandra La Grone, Executive Director- tlagrone@inourownvoices.org Katherine Romero, Social Worker- kromero@inourownvoices.org http://inourownvoices.org/

Location(s): 245 Lark Street, Albany, NY 12210 Counties served: : Albany, Columbia, Greene, Montgomery, Rensselaer,

Saratoga and Schenectady Counties

Mission: To work for and ensure the physical, mental, spiritual, political, cultural and economic survival and growth of the Lesbian, Gay, Bisexual, and Transgender People of Color communities.

• Key Services

– Patient Navigation, Patient Activation – Counseling and assistance with Medicare and Medicaid insurance coverage, prescription coverage – Patients rights helpline: counselors provide assistance with hospital, nursing home or home care quality of care, discharge, or coverage problems.

• Contact Information

– Marcus Harazin, Coordinators Patient Advocates Program, statewidepatientsrights@gmail.com – www.nysenior.org, address: 275 State St. Albany, NY 12210

Location(s): Albany, New York Counties served: Albany, Saratoga (all counties can access helpline)

The Healthcare Consortium

• Key services

– Door-to-door non-emergency medical transportation to Medicaid enrollees and

• thers, and non-medical transportation for HCBS-eligible HARP enrollees (eff. 10/1)

– Health insurance enrollment services through our In-Person Assistor/Navigator Program – Low and no –cost prescription medications through our Prescription Access and Referral Program – Free Breast, Cervical and Colorectal Cancer Screenings for the uninsured and underinsured through our Integrated Cancer Services Program – Information about long term services and supports for the aged or disabled persons

• f any age through NYConnects
• Contact Information

– Claire Parde, Executive Director: cparde@columbiahealthnet.org; 518-822-8820 – www.columbiahealthnet.org

Location(s): Hudson, NY Counties served: Columbia and Greene

Trinity Alliance of the Capital Region, Inc.

• Key services
• Refugee Community Health Partnership, two Food Pantries, Monthly Mass Food

Distributions, 35 classes including Health and Wellness, Capital South Campus Center (educational and workforce development site), Re-Entry Services including Jail Transition and ROOTS. – Prevention, Cure Violence in Albany and Troy, Homer Perkins Residential Rehabilitation for Substance Abuse Treatment, Settlement House Outreach, After School and Summer Camp programs in Arbor Hill and the South-end, nightly open house for youth. – Early Intervention and Parent and Child Early Enrichment, Race to 10,000 Words, Family and Neighborhood Resource Centers in Arbor Hill and the South End which offer walk-in case management, classes and special events, community action projects and advocacy. The advantages of Trinity Alliance of the Capital Region, Inc. (established in 1912) include location, numbers of people served (about 25,000), facilitation, and most importantly, we are

• trusted. We have six sites in Albany and Troy and serve people from any county, always free of

charge.

• Contact Information

– Benna Eldridge, Director of the Family and Neighborhood Resource Centers, 15 Trinity Place, Albany, NY 12202, 518-449-5155, ext. 127, b.eldridge@ta-cr.org. – www.trinityalliancealbany.org

Arbor Hill, West Hill, the South End and Troy Counties served: any and all

Questions???

DSRIP Project Management Office DSRIP@mail.amc.edu For additional information, please visit our website: www.albanymedpps.org

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Thank you!