PROJECT ADVISORY COMMITTEE (PAC) Thursday, March 31, 2016 - - PowerPoint PPT Presentation

PROJECT ADVISORY COMMITTEE (PAC)

Thursday, March 31, 2016 9:00am-12:00pm Islandia Marriott Long Island Hosted by the Office of Population Health at Stony Brook Medicine 1

AGENDA 2

9:00 am – 9:10 am

Welcome Remarks Joseph Lamantia,

Chief of Operations for Population Health Stony Brook Medicine 9:10 am – 9:45 am

SCC DSRIP Program Progress Reports Alyssa Scully,

Director Project Management Office,

Ashley Meskill, RN,

Clinical Project Manager,

Amy Solar Greco,

Project Manager

Susan Jayson, LCSW,

BH & PC IC Implementation Specialist 9:45 am – 10:00 am

BREAK

10:00 am – 10:40 am

Integrating Behavioral Health Across the Continuum of Care Kristie Golden, PhD

Associate Director of Operations, Neurosciences Neurology, Neurosurgery & Psychiatry Hospital Administration, Stony Brook Medicine 10:40 am – 11:50 am

Primary Care - Behavioral Health Integrated Care Practices Panel Discussion Moderator, Kristie Golden, PhD

Associate Director of Operations, Neurosciences Neurology, Neurosurgery & Psychiatry Hospital Administration, Stony Brook Medicine 11:50 am – 12:00 pm

Closing Remarks Question & Answers Joseph Lamantia,

Chief of Operations for Population Health Stony Brook Medicine

WELCOME REMARKS

Presented by Joseph Lamantia Chief of Operations for Population Health Stony Brook Medicine

3

4

Five Stages of the DSRIP

(Apologies to Kubler-Ross)

Denial – Anger – Bargaining – Depression – Acceptance –

DY1 IS IN THE BOOKS! You’re kidding right? You want us to do what? How many meetings do I have to go to? Are the days for fee-for-service really numbered?

Where do I sign!

5 KEY THEMES – “BUILDING A FOUNDATION”

March 2015 IT Interoperability and Care Management June 2015 CBO’s and PCMH October 2015 Cultural Competency & Health Literacy and Value Based Purchasing December 2015 Partner Onboarding Program (Provider Contracting) 2015 PAC mtg Key Themes “These key themes have and will continue to shape and provide form, function and purpose to the SCC”

STAY INFORMED

• Project Advisory Committee

Membership

• Membership directory just over 1,100
• Communication Strategies:

eNewsletters

• Synergy and DSRIP In Action
• Website at www.suffolkcare.org

guide for partners/providers, community and project stakeholders

Text SUFFOLKCARES to 22828 to join our eNewsletters!

Quarterly PAC Meeting Participation

BEHAVIORAL HEALTH AND PRIMARY CARE INTEGRATION The “Burning Platform”

Approximately 23% of our PPS Medicaid members are defined as behavioral health recipients (member* with 1+ claims with a primary or secondary behavioral health diagnosis)

Source: CY 2013-2014 Medicaid claims data is the data source

Behavioral health recipients cost, on average, 4.65 times more per recipient and represent 58%of total Medicaid spending Behavioral health recipients drive 48% of all ED visits; Behavioral health recipients represent 58% of admissions to hospital and on average have a 1.65X longer length of stay in hospital than non-behavioral health recipients 32% of all Primary Care visits are attributed to behavioral health recipients

8 BEHAVIORAL HEALTH AND PRIMARY CARE INTEGRATION PROGRAM

• BH → PC

Behavioral Health co-located in Primary Care Practices

Model 1

• PC → BH

Primary Care co- located in Behavioral Health Practices

Model 2

• IMPACT

Evidence-based Care Coordination Model for Depression Care

Model 3

This program is aimed at developing collaborative integrated care models between PCPs and behavioral health organizations.

MEETING OBJECTIVES

• The office of population health will highlight current status reports on the

NYS DSRIP Program efforts, including project-specific updates and achievements to date.

DSRIP Program Progress Reports

• Dr. Kristie Golden, Associate Director of Operations, Neurosciences,

Neurology, Neurosurgery & Psychiatry, Hospital Administration at Stony Brook Medicine and Project Lead of the SCC DSRIP Project 3ai, will be describing current trends in Primary Care – Behavioral Health Integrated Care practices, best practices in screenings, and integrated care implementation strategies.

Integrating Behavioral Health Across the Continuum of Care

• A panel of health care leaders representing primary care and mental health

will share thoughts and perspective on the Primary Care – Behavioral Health Integrated Care Model and discuss what can be leveraged for DSRIP PPS.

Behavioral Health & Primary Care Integrated Care Panel Discussion

9

DSRIP PROGRAM PROGRESS REPORTS

Presented by

Alyssa Scully, Director Project Management Office, Ashley Meskill, RN, Clinical Project Manager, Amy Solar Greco, Project Manager Susan Jayson, LCSW, Implementation Specialist, Behavioral Health & Primary Care Integrated Care Program

10

PATIENT ENGAGEMENT SCORECARD DY1 Q1 - DY1 Q3 (APRIL 1 - DEC 31, 2015)

2bvi: TOC Hospital 2bix: OBS Hospital 2bvii: INTERACT Nursing Home 2di: PAM CBO 3ai: PCBH PCP & BH 3bi: Cardio PCP 3ci: Diabetes PCP 3dii: Asthma PCP

Target 9,531 Actual 22,397 Achievement Rate 235% Target 2,216 Actual 2,400 Achievement Rate 108% Target 717 Actual 1,294 Achievement Rate 180% Target 7,950 Actual 8,471 Achievement Rate 106% Target 4,505 Actual 11,473 Achievement Rate 255% Target 2,180 Actual 3,609 Achievement Rate 165% Target 4,533 Actual 5,246 Achievement Rate 115% Target 2,180 Actual 3,081 Achievement Rate 141%

SCC Project Management Office Report Template Key: Checkmark means meeting or exceeding target, X=Not on Target

12

BUILDING AN INTEGRATED DELIVERY SYSTEM (2AI)

Approach

• Engage groups of

SMEs to direct each of the 11 IDS Project Requirements

• Create an integrated

delivery system through clinically integrating network providers aimed at achieving improved population health. Accomplishments

• Expanded IDS/PHM

Workgroup

• Clinical Integration

Needs Assessment Complete

• IT Clinical Data Sharing

& Interoperable Systems Roadmap Complete

• Initial RHIO Gap

Analysis Complete Next Steps

• Complete Clinical

Integration Strategy

• Complete Population

Health Management Roadmap

• Continue working with

safety-net partners on RHIO enrollments

• Continue technical-on-

boarding with partners in building the IDS

Visit our program page: https://suffolkcare.org/aboutDSRIP/projects/2ai1

13

BUILDING AN INTEGRATED DELIVERY SYSTEM (2AI)

2ai Project Committee PHM/IDS Project Workgroup

TOC Workgroup PM: Ashley Meskil IT Task Force PM: Ned Micelli PCMH Certification Workgroup PM: Althea Williams Care Management & Care Coordination Workgroup PM: Kelli Vasquez Performance Reporting & Management Workgroup PM: Kevin Bozza Value Based Payment Team PM: Neil Shah Community Engagement Workgroup PM: Althea Williams Community Health Activation Program PM: Amy Solar-Greco

IDS Project Key Themes

• Integrated Delivery System
• Population Health Management
• Transitions of Care
• Clinical Integration/Clinical

Interoperable Systems

• RHIO/SHIN-NY Connectivity
• Meaningful Use
• PCMH Certification
• PCP access & capacity
• Care Coordination & Collaborative care

practices

• Care Management
• Value Based Payment
• Community Navigation/Engagement

14

ACCESS TO CHRONIC DISEASE PREVENTIVE CARE INITIATIVES (4BII)

Approach

• Support promotional

activities to increase prevention and awareness efforts for lung cancer, breast cancer and colorectal cancer screening education, obesity prevention and tobacco cessation in clinical and community settings. Accomplishments

• Create a first draft

community resource directory

• HITE Online

Community Resource Directory website partnership formalized

• Patient Education

materials reviewed & approved by CC & HL workgroup Next Steps

• Initiate work on online

Community Resource Directory on the SCC website

• Formalize materials

for chronic-disease prevention/education programs

Visit our program page: https://suffolkcare.org/aboutDSRIP/projects/4bii

15

SUBSTANCE ABUSE PREVENTION AND IDENTIFICATION INITIATIVES (4AII): SBIRT

Approach

• Identify & train SBIRT

Hospital-based Facility Champions to implement SBIRT Implementation Plan

• Operationalize PPS-wide

SBIRT Training Program for Hospital staff

• Workgroup & Committee

engaged to collaborate

• n best practices, lessons

learned and risk mitigation strategies through “Learning Collaboratives” Accomplishments

• SCC Monthly SBIRT

Training Program underway

• Stony Brook Medicine &

Brookhaven Hospital go- live complete

• CHS held kick-off for

Health System

• Continue learning from

Northwell Health Southside’s experiences in SBIRT roll-out Next Steps

• Continue to host Monthly

SBIRT Trainings at all partner hospitals to train staff

• Next Learning

Collaborative scheduled to share collaborative practices implemented by Stony Brook Medicine & Brookhaven Hospital

• Begin collecting data to

support program development efforts

Visit our program page: https://suffolkcare.org/aboutDSRIP/projects/4aii

16

TRANSITION OF CARE PROGRAM FOR INPATIENT & OBSERVATION UNITS (TOC) (2BIV & 2BIX)

Approach

• Engagement of nationally

recognized SME to support TOC Model development

• Identify & train TOC

Hospital-based Facility Champions to initiate TOC Implementation Plan

• Workgroup & Committee

engaged to collaborate

• n best practices, lessons

learned and risk mitigation strategies through “Learning Collaboratives” Accomplishments

• TOC Model designed by

the Project Committee has been approved by the Clinical Governance Committee & Board of Directors

• Partnered with two

Preventive Medicine Residents from the Stony Brook Medicine School of Preventive Medicine to support Hospital’s during Implementation Next Steps

• TOC Implementation Plan

for each Hospital will be initiated

• Training Curriculum will

be designed using the contents of the TOC Model Approved

• First Learning

Collaborative will be scheduled to begin collaboration amongst project stakeholders

Visit our program page: https://suffolkcare.org/aboutDSRIP/projects/2biv

17

INTERVENTIONS TO REDUCE ACUTE CARE TRANSFER PROGRAM (INTERACT) (2BVII)

Approach

• SNF Facility Champion &

Co-Champions obtain INTERACT Training Certification

• INTERACT Workgroup

representative of all SNF DNS engaged in designing content and deploying a SCC INTERACT Implementation Toolkit

• SNF Facility Champions will

be using Performance Logic to report progress against the SNF INTERACT Implementation Plan Accomplishments

• SNF Facility Champions &

co-champions trained & certified

• SNF INTERACT

Implementation Toolkit Complete and adopted by Project Committee

• SNFs oriented to Technical

On-boarding processes to support IDS

• SCC Project Manager

presented our INTERACT Implementation approach at a GNYHA Post-Acute Care Workgroup Meeting Next Steps

• SNF Facility Champions will

initiate INTERACT Implementation Toolkit. First steps include building SNF-based Implementation Teams & Hosting Kick-Off Meetings

• SCC PMO begins to support

development of INTERACT program patient, family and caregiver communication pamphlets Visit our program page: https://suffolkcare.org/aboutDSRIP/projects/2bvii

18

CLINICAL IMPROVEMENT PROGRAMS (3BI) & (3CI)

Approach

• Adopt evidence-based

guidelines to support training and implementation of clinical improvement practices in medical settings.

• Operationalize a Stanford

Peer Training Program in partnership with our existing community based programs.

• On-board Provider

Relations Managers to monitor Practice Site Implementation Plans and training requirements. Accomplishments

• Evidence-based guideline

summaries are complete.

• PCP and Non-PCP practice

site implementation plan complete.

• Clinical improvement

program materials are in development for the Diabetes and Cardiology in concert with program SMEs. Next Steps

• Initiate practice site

Implementation Plan with

• ur contracted/engaged

practice Sites

• Continue to develop

Training Curriculum and program materials to support implementation.

• Hot-spotting strategies to

support implementation in development. Visit our program page: https://suffolkcare.org/aboutDSRIP/projects/3bi & https://suffolkcare.org/aboutDSRIP/projects/3ci

19

PROMOTING ASTHMA SELF-MANAGEMENT PROGRAM (PASP) (3DII)

Approach

• Through community

partnerships initiate an Asthma-Home Environmental Trigger Assessment Program deployed by CHWs in our communities for high risk patients.

• Promotion of Program to

PPS medical practice sites and promote use of Asthma Action Plans at medical practices. Accomplishments

• Home Environmental

Trigger Assessment Program procedures and workflows created. Next Steps

• Formalize partnerships to
• perationalize Home

Environmental Trigger Assessment Program.

• Engage workgroups to

create communication materials and pamphlets for program for our network of providers.

Visit our program page: https://suffolkcare.org/aboutDSRIP/projects/3dii

20

COMMUNITY HEALTH ACTIVATION PROGRAM (CHAP) (2DI)

Approach

• Support a CBO-led in-reach

and outreach program to identify, engage, educate and integrate the uninsured and low/non-utilizing Medicaid populations into Community Based Care.

• Identify hot-spot locations

across the County to identify individuals.

• Build community navigation

resources and partnerships to connect individuals to primary care, BH, access to health care/enrollment, health home or social service agencies resources. Accomplishments

• Met 100% DY1 patient

engagement survey-targets 1 month early.

• Identified beneficiaries to

attend Project Workgroup discussions to support strategies to further enhance program operations. Next Steps

• Continue working with

partner CBO’s and identifying new CBO partnerships for program.

• Formalize the Coaching for

Activation program for surveyed individuals.

• Baseline and evaluate year 1

survey data to support strategies in year 2.

Visit our program page: https://suffolkcare.org/aboutDSRIP/projects/2di

21

PRIMARY & BEHAVIORAL HEALTH INTEGRATED CARE PROGRAM (3AI)

Approach

• Partner with Nationally

recognized SME to support development of evidence-based program materials and training curriculum for Integrated Care.

• Design and deploy a Program

Toolkit to support implementation of Integrated Care at practice sites.

• Engage practices sites in a

phased approach which includes: current state assessment, model selection, implementation and monitoring.

• Practice sites will be invited to

participate in “Learning Collaboratives” led by our SMEs.

Accomplishments

• Program Toolkit drafted

for Integrated Care (IC) practice sites.

• Phase 1 practices sites

have selected the model they will implement. Next Steps

• Initiate implementation
• f IC at Phase 1 practice

sites.

• Partnering with

Community Based Organizations for embedded staff resources.

• Phase 2 practice sites will

initiate in July 2016.

Visit our program page: https://suffolkcare.org/aboutDSRIP/projects/3ai

BREAK

22

INTEGRATING BEHAVIORAL HEALTH ACROSS THE CONTINUUM OF CARE

Presented by: Kristie Golden, PhD Associate Director of Operations, Neurosciences Neurology, Neurosurgery & Psychiatry Hospital Administration Stony Brook Medicine

23

INTRODUCTION

• Primary Care-Behavioral Health Integration, also

referred to as physical-mental health integration, is an evidence-based approach that supports collaboration between physical health and behavioral health providers to improve the identification and triage of those in need

• f mental health and/or substance abuse services.
• Promotes the collaboration between primary care

providers, behavioral health specialists and other disciplines

• Various models of how to integrate services being

implemented nationwide

GLOBALLY - WHY INTEGRATE?

• Individuals/families that are closely connected with a PCP have a

trusting relationship with that doctor

• Individuals/families are more likely to follow up with appointments

either in their PCP’s familiar location or coordinated by their PCP rather than traveling to a new doctor or initiating an appointment on their own

• Better communication among all parties, screenings for early

intervention and treatment, better individual health and family

• utcomes, lower healthcare costs, improved work and school

performance

• Opportunity to identify behavioral health conditions and address

them when the patient is in the office.

WHY IDENTIFY BEHAVIORAL HEALTH DISORDERS?

• Research evidence supports that screening for potential medical problems

(cancer, diabetes, hypertension, tuberculosis, vitamin deficiencies, renal function) provides preventative services prior to the onset of acute symptoms and delays or precludes the development of chronic conditions

• Depression is linked to numerous medical conditions such as diabetes and

cardiac disease

• Risky levels of substance use and any level of smoking are also directly

linked to numerous medical conditions and chronic disease

• Co-occurring tobacco use is a significant contributor to the increase in

mortality among individuals with psychiatric disorders

• Screening for depression and substance use has been proven to help

identify those individuals at risk who have not previously sought services

Source: Barbara E. Warren, Psy. D. LMHC, CASAC, CPP: Stony Brook Presentation 8/20-8/21

SCREENING BENEFITS

• Primary focus on depression and substance use
• Does not require a behavioral health specialist to complete the

screening

• Provides approach and language to address issues using motivational

interviewing

• Approach is non-confrontational and puts the responsibility for change
• n the patient
• Provides an active systematic way to screen and provide a brief

intervention or a referral for more services

Source: Barbara E. Warren, Psy. D. LMHC, CASAC, CPP: Stony Brook Presentation 8/20-8/21

HOW DOES THIS RELATE TO DSRIP?

• Population health efforts seek opportunities for education and

intervention at the point of care (i.e. emergency department, hospital unit or PCP/GYN office)

• Studies indicate that screening, education and brief intervention for

substance use reduced future use of substances.

• Studies indicate that screening and intervention for depression has a

positive impact on the management of chronic medical conditions.

• When depression, alcohol and other drug screening becomes more

routine, you typically find:

• Greater patient & family satisfaction
• Better patient management & follow-up

Source: Barbara E. Warren, Psy. D. LMHC, CASAC, CPP: Stony Brook Presentation 8/20-8/21

OTHER BENEFITS

• Reduces ED visits
• Reduces readmission rates
• Improves public health over time
• Addresses/Treats the “whole” person
• Improves family outcomes
• Improves patient/family satisfaction
• Reimbursable services in hospitals and doctors offices
• Promotes a proactive/wellness approach

WHAT HAS HELD UP WIDESPREAD ROLL-OUT IN THE PAST?

• Fear and a lack of understanding between PCPs and BH Providers
• ften paralyzes forward movement when considering collaboration
• Work culture differences
• Differences in knowledge-base and/or approach to care
• PCP’s struggle with the many psychosocial needs of their patients

and the needs of their families and appreciate the BH support

• Older adult-specific issues
• Youth-specific issues
• Family situation-specific issues
• Addiction concerns
• Screening/Assessment opens the door to a myriad of psychosocial

issues which cannot be ignored (collaboration is imperative here)

• Case management needs: adequate housing or in home support,

safety, nutrition, social isolation, health insurance, medications, managing chronic conditions, etc.

YEARS PAST

• Problem Identified
• Go to Doctor
• Get Treatment
• All is Well

2016

• Problem Identified
• Go to Doctor (in Your Insurance Network)
• Get Treatment (Maybe from a Specialist through a Referral from

your PCP)

• Find Out Ideal Treatment is Limited or Not Authorized
• Doctor Makes Case for Treatment
• Make Calls to Specialists
• Find out There are no Appointments for 6 Weeks
• Go to Appointment
• Get Prescription
• Find Out Prescription is not Covered Under Your Plan
• Call Doctor Back……

DSRIP Concepts Promote Solutions

HOW TO SET-UP WITHIN A PCP PRACTICE

What discipline(s) is needed? Is more than one person necessary?

 Social Workers/Mental Health Counselors  Psychologists/Neuropsychologists  Health Coaches/Peer Specialist  Alcohol & Substance Abuse Counselors  Psychiatrists/Nurses  Care/Case Managers

Who is affordable/sustainable?

• Define the collaborative agreement between the PCP/BH

Employed? Shared space? Lease agreement? etc.)

• Work through issues and set a target start date**
• Identify PCP needs:
• What does their PCP patient caseload look like?
• How many people does the PCP see daily?
• Does the PCP have BH experience? Prescribing experience?
• Are they comfortable identifying those in need through screening?
• What is the insurance mix of his/her patient load?
• How will the office staff be involved in the planning?

**(2 people collaborating requires time to work through a lot of detail) DEVELOP COLLABORATIVE RELATIONSHIPS SET-UP CONTINUED…

Review Potential Arrangements & Work Flow

• Identify local BH resources for back-up and other urgent care or

specialty care needs (i.e. inpatient units, long-term treatment)

• Discuss screening tools, i.e. PHQ9, PSC, AUDIT, DAST other

screenings, and how this will define when a hand-off is made to the BH Specialist

• Develop practice specific protocols
• Screening completed during annual office visit?
• Paper or EMR? - Who will do it/review it?
• Who will refer patient for services?
• Where will services take place?
• Who does scheduling?
• How will the services be billed?
• What coding needs to be considered and understood?

The “Warm” Hand-off

COMMUNICATION BETWEEN DIVERSE DISCIPLINES Communication Process

• Establish plan to share records, preferably electronically
• Who uses what documentation “language”? Abbreviations?

Strength-based or “weakness-based” notes?

• Plan communication protocols for ongoing dialogue
• How and when will cases get reviewed?
• How will treatment plan be updated and whose input will be

included?

• How will progress be monitored/measured?
• How will crisis/emergencies be handled?
• Plan for use of other communication technology, i.e. smart phones,

email

• Consideration of HIPAA compliance

COMMUNICATION CONTINUED… Monitor Outcomes

• DSRIP Metrics - Design how you will measure health outcomes,

i.e. reduced symptoms, better patient engagement, fewer ER visits

• Design how to measure “life” outcomes, i.e. living

independently, socializing, improved school outcomes, relationship development, etc.

• Design how, where and by whom data will be collected and

analyzed and reported to PPS

• Utilize EMR to communicate and measure progress
• Conduct satisfaction surveys- both patient and referral source

LESSONS LEARNED

• Collaboration does work
• Patients gain access to services more quickly
• Symptoms improve
• PCPs offer more comprehensive treatment to their

patients

• PCPs have a more consistent patient flow
• People get healthier
• Creates possibility of “high reliability” organization

HAPPIER PATIENTS = HAPPIER PROVIDERS

Integration improves patient satisfaction. Warm hand-off should reduce patient wait time.

FUTURE FRAMEWORK

• Establishing PCP and BH collaboration at the start of a practice
• Seeing integrated model as routine in areas where it is not yet standard
• Teach integration in medical schools and other clinical degree programs
• Learn and measure value of routine screening and prevention
• Change reimbursement methods to support wellness approach
• Population-level change
• PCPs developing trusting relationship with BH peers
• Co-located/Integrated Specialist
• Telepsychiatry and Telephone “Curb-side Consultations”
• Project TEACH in NY
• Reimbursement Models for Sustainability
• Short-run…Utilizing appropriate billing codes
• Long-run…….Value-based reimbursement
• Reduced or eliminated fee-for-service models

Contact Information

Kristie Golden, PhD, CRC, LMHC Associate Director of Operations Stony Brook Medicine (631) 444 - 2032

Moderator

Kristie Golden, PhD, Associate Director of Operations, Neurosciences, Neurology, Neurosurgery & Psychiatry, Hospital Administration, Stony Brook Medicine

Panelists

Luigi Buono, D.O. Board Certified-American Board Family Practice Prime Care Medical of Long Island d/b/a North Fork Family Medicine Martha A Carlin, Psy.D. Director, Long Island Field Office New York State Office of Mental Health Jeff Steigman, Psy.D. Chief Administrative Officer Family Service League Rajvee Vora MD, MS Director, Ambulatory Behavioral Health for DSRIP Implementation Northwell Health

43

PRIMARY CARE - BEHAVIORAL HEALTH INTEGRATED CARE PRACTICES PANEL DISCUSSION

QUESTION & ANSWER

www.suffolkcare.org 44

Appendix

45

PAY FOR PERFORMANCE FUNDING SCHEDULE

• Over the life of the waiver, funding shifts from process milestones

(Domain 1) and reporting (P4R) to performance (P4P): 46

Domain

Payment

Annual Funding Percentages DY 1 DY 2 DY 3 DY 4 DY 5 Domain 1 Project Process Milestones P4R 80% 60% 40% 20% 0% Domain 2 System Transformation & Financial Stability Milestones P4P 0% 0% 20% 35% 50% P4R 10% 10% 5% 5% 5% Domain 3: Clinical Improvement Milestones P4P 0% 15% 25% 30% 35% P4R 5% 10% 5% 5% 5% Domain 4: Population Health Outcomes P4R 5% 5% 5% 5% 5%

Source: NYS DOH Presentation Presented June 18th 2015 – DSRIP Incentive Payment Domain 2-4 Achievement Values

DOH DSRIP DEMONSTRATION YEAR TIMELINE & PAYMENT SCHEDULE

Demonstration Year & Quarter* Reporting Period Quarterly Report Due Payment Due

DY 1, Q1 4/1/15 – 6/30/15 July 31, 2015 January 2016 DY 1, Q2 7/1/15 - 9/30/15 October 31, 2015 DY 1, Q3 10/1/15 – 12/31/15 January 31, 2015 July 2016 DY 1, Q4 1/1/16 – 3/31/16 April 30, 2016 DY 2, Q1 4/1/16 – 6/30/16 July 31, 2016 January 2017 DY 2, Q2 7/1/16 – 9/30/16 October 31, 2016 DY 2, Q3 10/1/16 – 12/31/16 January 31, 2017 July 2017 DY 2, Q4 1/1/17- 3/31/17 April 30, 2017

47

Source: Department of Health presentation on April 21, 2015 entitled “DSRIP Domain 1 Achievement Values “

Table continues through DY 5*

Domain 1 AVs are tied to semi-annual payment based on completing all Domain 1 requirements

Demonstration Year* DSRIP Year Date Range Payments Measurement Period Used for Domain 2-3 AVs DY 1 4/1/2015- 3/31/2016 Payment 1: Q2 (9/30/2015) N/A Payment 2: Q4 (3/31/2016) Measurement Year 1 7/1/2014 – 6/30/2015 DY 2 4/1/2016 – 3/31/2017 Payment 1: Q2 (9/30/2016) Measurement Year 1 7/1/2014 – 6/30/2015 Payment 2: Q4 (3/31/2017) Measurement Year 2 7/1/2015 - 6/30/2016 DY 3 4/1/2017 – 3/31/2018 Payment 1: Q2 (9/30/2017) Measurement Year 2 7/1/2015 - 6/30/2016 Payment 2: Q4 (3/31/2018) Measurement Year 3 7/1/2016 - 6/30/2017

48

Domain 2-4 AVs are tied to semi-annual payment based primarily on measures calculated annually

Source: NYS DOH Presentation Presented June 18th 2015 – DSRIP Incentive Payment Domain 2-4 Achievement Values

Table continues through DY 5*

DOH DSRIP DEMONSTRATION YEAR TIMELINE & PAYMENT SCHEDULE

QUANTIFYING ACHIEVEMENT OF DSRIP GOAL OF 25% REDUCTION IN AVOIDABLE HOSPITAL READMISSIONS OVER 5 YEARS

49 DSRIP OVERALL GOALS

GOAL OF 90% PAY FOR PERFORMANCE BY DY 5

Reduction Bucket Potentially Avoidable 25% Reduction Denominator Denominator Definition Prevention Quality Indicators (PQIs) 3,651 913 35,540 Suffolk County Medicaid admissions age greater than 18 Pediatric Quality Indicators (PDIs) 432 108 3,837 Suffolk County Medicaid admissions age less than 18; excluding newborns Reduction Bucket Potentially Avoidable 25% Reduction Denominator Denominator Definition Avoidable ED (PPV) 86,435 21,609 112,902 Emergency department volume by Suffolk County Medicaid members Avoidable Readmissions (PPR) 1,612 403 26,714 At risk admissions defined by 3M at Suffolk County hospitals

Source PQIs and PDIs are computed from the 2013 limited SPARCS data All other measures are based on CY 2012 data

SUFFOLK PPS AWARD 50 Period of Agreement: April 1, 2015 To: December 31, 2020 Suffolk PPS Award of funds is contingent on our ability to meet DOH deliverables and performance measure targets.

Net Project Valuation Net High Performance Fund Additional High Performance Fund Public Equity Guarantee Public Equity Performance Total Valuation

$ 181,115,320 $ 4,200,998 $10,045,427 $58,971,622 $44,228,717 $298,562,084

NYS Total Valuation Grand Total $ 7,385,825,815

PROJECT IMPLEMENTATION SPEED 51

DY Timeline DY 0 (2014) DY 1 (2015) DY 2 (2016) DY 3 (2017) DY 4 (2018) DY 5 (2019) Projects Q1/Q2 Q3/Q4 Q1/Q2 Q3/Q4 Q1/Q2 Q3/Q4 Q1/Q2 Q3/Q4 Q1/Q2 Q3/Q4 Q1/Q2 Q3/Q4

2A1 - IDS

X

2B4 - TOC

X

2B9 - OBS

X

3A1 - BH-PC

X

3B1 - CV

X

3C1 - DIABETES

X

3D2 - ASTHMA

X

2D1 - UNINSURED

X

2B7 - INTERACT

X

Suffolk PPS Speed Requirements by Project

Domain 4 Projects do not have Project Speed & Scale Commitments

We are here

SPEED & SCALE OVERVIEW 52

Project Project Description Providers to be Engaged (Revised 9/30/15) # of Actively Engaged % of Attributed Population Actively Engaged Definition By Year: 2.a.i IDS 3,702 N/A N/A

N/A

N/A 2.b.iv Transitions

• f Care

3,278 25,326 17%

Care Transition plan developed

2 2.b.vii INTERACT 38 SNFs 1,914 1.3%

Avoided hospital transfer due to INTERACT

2 2.b.ix Observation Units 1,079 8,866 6%

Utilizing Observation services

3 2.d.i PAM/ Uninsured 350 trained in PAM 45,426 N/A

Individuals who completed PAM survey

4 3.a.i PC & BH Integration 3,432 45,059 30%

1) PHQ/SBIRT screening at PCMH site 2) Primary care services at BH site 3) PHQ/SBIRT screening at IMPACT site

4 3.b.i Cardio 3,538 14,556 10%

Documented Self-Management goals in Medical records

4 3.c.i Diabetes 3,538 12,094 8%

Received a hemoglobin a1c test in previous DSRIP year

3 3.d.ii Asthma 3,382 6,751 4.5%

Registered in home assessment log, patient registry, or other IT platform.

2