PROJECT ADVISORY COMMITTEE (PAC) Tuesday, October 6, 2015 - - PowerPoint PPT Presentation

PROJECT ADVISORY COMMITTEE (PAC)

Tuesday, October 6, 2015 9:00am-12:00pm Islandia Marriott Long Island Hosted by the Office of Population Health at Stony Brook Medicine 1

AGENDA 2

9:00 a.m. – 9:20 a.m.

Welcome Remarks

Joseph Lamantia, Chief of Operations for Population Health Stony Brook Medicine 9:20 a.m. – 10:00 a.m.

DSRIP General & Project Updates

Alyssa Scully, Director, Project Management Office & Kevin Bozza, Director, Network Development & Performance Office of Population Health Stony Brook Medicine 10:00 a.m. – 10:15 a.m.

BREAK

10:15 a.m. – 10:30 a.m.

Cultural Competency & Health Literacy

Althea Williams, Senior Manager, Provider & Community Engagement Office of Population Health Stony Brook Medicine 10:30 a.m. – 10:45 a.m.

Value Based Purchasing in NYS: New York’s VBP Roadmap

Joseph Lamantia, Chief of Operations for Population Health Stony Brook Medicine 10:45 a.m. – 11:50 a.m.

Moving from Volume to Value

Moderator, John Sardelis, Professor/Associate Chair at St Joseph’s College and Board Member for Affinity Health 11:50 a.m. – 12:00 p.m.

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

MEETING OBJECTIVES

DSRIP General & Project Updates

 The office of population health will highlight current status report on the NYS DSRIP Program efforts, including project specific updates, our contracting strategy and upcoming survey efforts.

Cultural Competency & Health Literacy Highlights

 Our Cultural Competency & Health Literacy Project Lead, Althea Williams, will be describing our progress to date made within our DSRIP milestones related to defining cultural competency for the PPS.

Moving from Volume to Value Panel Discussion

 A panel of health care leaders representing different sectors of our industry will share thoughts and perspective on the States Value Based Payment Roadmap and discuss what can be leveraged for DSRIP PPSs.

4

DSRIP GENERAL & PROJECT UPDATES

Presented by

Alyssa Scully, MHA, PMP

Director, Project Management Office

Kevin Bozza, MPA, FACHE, CPHQ, RHIT

Director, Network Development & Performance Office of Population Health Stony Brook Medicine

5

DSRIP PROGRAM KEY MILESTONES 6

• 9/8: Received feedback from Independent Accessor on First Quarterly Report

Submission & Project Implementation Plans

• 9/15: Additional Regulatory Waiver Requests Submitted
• 9/17-18: First PPS Statewide Learning Symposium Held
• 9/24: Revised PPS First Quarterly Report & Project Implementation Plans due

September

• 10/7: Expect Final approval of PPS First Quarterly Report & Project

Implementation Plans

• 10/18-10/31: PPS Performance Networks in MAPP open for additions & edits
• 10/31: PPS Second Quarterly Report (7/1/2015-9/30/2015) Due from PPSs

October

• PPS Notice and Opt our letters mailed to Medicaid Members from the NYS

DOH

• IA Completes review of PPS Second Quarterly Report submission
• 11/8-9: DSRIP Project Approval & Oversight Panel Bi-Annual Meeting

Scheduled

November

PMO HIGHLIGHTS 7

• DSRIP Project Management Plans (PMP) initiated in

Performance Logic PMO Software Tool

• Supplemental to the DSRIP DOH work plans, the PMO has

written “unit level” plans to help inform and monitor engagement of individual network partners in specific projects

• Developing strategies and tools to support initiating

Implementation plans across network partners

• Second DSRIP Quarterly Report Due 10/31
• Preparing milestone narrative updates
• Patient engagement metric reporting
• Finalizing all deliverables due

LET’S COLLABORATE

• Join a Project Committee or Workgroup
• Easily join our mailing list by texting SUFFOLKCARES to 22828
• Visit our website at www.suffolkcare.org
• Email us at DSRIP@stonybrookmedicine.edu
• Contact a Project Management Office team member directly
• State-wide: Collaborate on the MRT Innovation eXchange (MIX). Join the

discussion around Medicaid Redesign, share your ideas and collaborate with experts in the field of health care at the MRT Innovation eXchange, known as the MIX. https://www.ny-mix.org/login

8

PROJECT HIGHLIGHTS: OBSERVATION PROGRAM (2BIX) & CARE TRANSITION INTERVENTION MODEL (2BIV)

9

• Establish appropriately sized and staffed

OBS units in close proximity to ED services, unless the services required are better provided in another unit. When the latter

• ccurs, care coordination must be provided.
• Use of EHR to track patients engaged in the

project

• Implement standard 30-day care

coordination methodology for safe discharge with short stay protocol

Hospital OBS

• Develop Standardized protocols for a

Transition Intervention Model:

• Model to include early notification of

planned discharges

• Ability of the transition case manager to

visit the patient prior to discharge

• Model to include care record transition

protocols with timely updates to primary care provider

• Include 30-day transition of care period,

established post-hospitalization, for high risk, chronic health conditions

• Partnerships with Home Care and Social

Service Agencies & Medicaid Managed Care

• Use of EHR to track patients engaged in the

project

TOC

10

80% 80% 20% 20%

Does your hospital have standardized protocols in place to manage transitions of care practices? Yes No

PROJECT HIGHLIGHTS: OBSERVATION PROGRAM (2BIX) & CARE TRANSITION INTERVENTION MODEL (2BIV)

PROJECT HIGHLIGHTS: BEHAVIORAL HEALTH & PRIMARY CARE INTEGRATED CARE MODEL

• As we move towards project implementation, a group of

pilot partners will be engaged to complete a comprehensive practice assessment for Integrated Care (IC) Readiness.

• The tool that will be deployed was adapted from the Robert Wood Johnson

Foundation Primary Care Assessment and The MacColl Center for Health Care Innovation.

• Strategy highlights:
• Building a Integrated Care Tool kit containing best-practice guidelines such

as medication management and care engagement processes related to integration practices.

• The PPS commits to offering support through a provider centered learning

collaborative and technical assistance during implementation of IC.

• Integration with PCMH transformation efforts
• We’re currently recruiting for an Integrated Care Program

Coordinator to support IC implementation, apply online!

11

PROJECT HIGHLIGHTS: DOMAIN 3 CLINICAL IMPROVEMENT PROJECTS CARDIOLOGY, ASTHMA, DIABETES Project workgroups engaged in reviewing Patient Education materials collected from PPS partners to support disease management improvement strategies

Engaged in designing the logistics for the Stanford Medicine Chronic Disease Self-Management Program, specifically, how trainers, participants and hot spot locations will be identified for this peer training initiative. Preparing Care management role and collaboration to build county-wide partnerships with Health Home, Care Management Organizations and Community-based Organizations Engagement of Primary Care Providers regarding implementation of the Clinical Improvement Program such as the Million Hearts Campaign

12

• “INTERACT” – Interventions to Reduce Acute Care Transfers Program

for Skilled Nursing Facilities (SNF)

• 42 Skilled Nursing Facilities are currently engaged to pursue INTERACT

implementation

• Implementation model centers around the Directors of Nursing or

designed INTERACT Facility Champion becoming Certified INTERACT

• Champions. Following formal training they will be leading implementation
• f the INTERACT 4.0 Toolkit within their respective SNF.
• INTERACT T.E.A.M. Strategies, LLC are engaged to train just about 100

key project participants from November 3-6th, 2015 at Stony Brook Medicine

• We’re currently recruiting for an INTERACT Implementation Specialist

to support implementation of the model at participating SNFs, apply online! PROJECT HIGHLIGHTS: IMPLEMENTING “INTERACT” AT SNFS 13

14 PROJECT HIGHLIGHTS: DOMAIN 4 POPULATION WIDE INITIATIVES

Lung Cancer Screening Program Breast Cancer Screening Program Colorectal Cancer Screening Education Program Obesity Prevention Awareness Tobacco Cessation Awareness

SBIRT (Screening, Brief Intervention & Referral to Treatment) Program SBIRT Training Source: https://www.oasas.ny.gov/workforce/training/SBIRTCert.cfm

15

1000 2000 3000 4000 5000 6000

163 394 891 1446 2123 2738 3555 4497 5538 PAM SURVEY COUNT

Target DY 1 Q2: 4,542 Project 2di Workgroup (left to right)

Front row: Michael Miller, Intern, HRHCare; Roberta Leiner, Chief, Patient Engagement, HRHCare; Amy Solar-Greco, Project Manager, SCC; Tara Larkin-Fredricks, Director of Special Projects, MHAW; Anne Stewart, Director of Programs, EOC; Gwen O'Shea, President/CEO, HWCLI Back row: : Halim Kaygisiz, Director of Health Outreach Services, EOC; Andrew Lehto, Director,Community Outreach & Engagement of Special Populations, HRHCare; Michael Stoltz, CEO, MHAW Not Pictured: Adrian Fassett, President/CEO, EOC; Paula Fries, COO, MHAW; Pedro Martinez, Outreach Worker, EOC; Sarah McGowan, MHAW; Trevor Cross, Community Liaison, HRHCare; Nalini Purvis, VP Community Initiatives, HRHCare

PROJECT HIGHLIGHTS: COMMUNITY HEALTH ACTIVATION PROGRAM (CHAP)

16

PROJECT HIGHLIGHTS: COMMUNITY HEALTH ACTIVATION PROGRAM (CHAP)

WORKFORCE – POTENTIAL DSRIP IMPACTS

• Greater coordination of care and integration of

systems

• Shifting of care and services from emergency room

settings to ambulatory and clinic settings

• Increased staffing among key positions, including

care managers, case managers, social workers, behavioral health practitioners, primary care practitioners, and patient navigators

• New skills for the workforce in working with decision

aids, telehealth and other self-care technologies; and real-time information about patient experience

17

Modified from DOH February 2015 Workforce Presentation

WORKFORCE – DOH MILESTONES

Workforce Due Date Milestone 1 Define target workforce state (in line with DSRIP program’s goals) DY1 Q4 Milestone 2 Create a workforce transition roadmap for achieving your defined target workforce state DY2 Q1 Milestone 3 Perform detailed gap analysis between current state assessment of workforce and projected future state DY1 Q4 Milestone 4 Produce a compensation and benefit analysis, covering impacts on both retained and redployed staff, as well as new hires, particularly focusing on full and partial placements DY2 Q1 Milestone 5 Develop training strategy DY1 Q4 Governance Milestone 8 Finalize Workforce Communication and Engagement Plan DY2 Q1

18

 Established Workforce Governance Committee  Established Workforce Advisory Group  Developed Implementation Plan  Completed Extensive RFP Process To Select Workforce Consultant – KPMG

WORKFORCE – PLANNING UPDATES 19

20

• KPMG Engagement

Kick-off Meeting Early October

• Deploy Consolidated

Survey Across PPS Mid to Late October

WORKFORCE – PLANNING UPDATES

PRACTITIONER ENGAGEMENT

• Established Practitioner

Engagement Workgroup

• Developed Partner

Onboarding Process and Education Collateral

• Finalized PPS Partner

Participation Agreement

21

The Participation Agreement is comprised of the following parts:

Body of the Agreement (pages 1 through 10). The body of the Participation Agreement sets

forth the key terms and conditions that define the role of the coalition partners in SCC, including their participation in the DSRIP projects, DSRIP funds flow, and managed care contracting.

Exhibit A – List of DSRIP Projects List of DSRIP projects. Exhibit B – Project Participation Eligibility Requirements identifies which types of coalition

partners are required to participate in which DSRIP projects.

Exhibit C – Business Associate Addendum is intended to enable the coalition partners to share

protected health information with SCC in a manner that complies with HIPAA.

Exhibit D – New York State Department of Health Standard Clauses for Managed Care Provider/ IPA Contracts. Since SCC is an independent practice association (IPA), SCC is required

by the Department of Health to include certain standard clauses prepared by the DOH regarding an IPA’s contracting with managed care organizations. These standard clauses are reproduced verbatim in Exhibit D. We are prohibited by the DOH from revising these standard clauses.

Exhibit E – General Terms and Conditions Addendum sets forth certain legal terms and

conditions that are applicable to SCC and the coalition partners.

22 PPS PARTNER PARTICIPATION AGREEMENT

BREAK

Please stop by the SCC Clinical Summary poster boards to learn more about the DSRIP Domain 3 Clinical Improvement Programs!

23

CULTURAL COMPETENCY & HEALTH LITERACY

Presented by Althea Williams Senior Manager, Provider & Community Engagement Office of Population Health Stony Brook Medicine

24

CULTURAL COMPETENCY/HEALTH LI LITERACY MILE LESTONES AN AND WORK RKGROUP HIGHLIGHTS START DATE EN END D DATE

Mile ilestone 1: 1: Fin Finali lize cu cult ltural com

• mpetency / he

healt lth lit iteracy strategy.

4/1 /1/2 /2015

12 12/31 31/2015 15 a.

• a. Form
• rmalize

Work

• rkgroup

Initial Cultural Competency and Health Literacy Advisory Workgroup meeting was held on March 24, 2015. Completed b.

• b. De

Defi finitions s CC & HL L Developed PPS-wide definitions for cultural competency and health literacy and designed a definition flyer Completed Next xt step eps: s: Sharing the definition with the CNA, Outreach and Cultural Competency/Health Literacy Committee for approval. 4/1/2015 12/31/2015 Share definitions at October 2015 PAC meeting and post the definition on the PPS website 10/1/2015 12/31/2015 The education component of the partnership agreement/contracting process will include the definition. 10/1/2015 12/31/2015 Establishing the standard for culturally competency and health literacy 10/1/2015 12/31/2015 c.

• c. CC & HL

L Sur Survey Workgroup updated the cultural competency and health literacy survey that had been conducted last year. 6/1/2015 12/31/2015 PPS has approved the survey for distribution to community partners 9/1/2015 12/31/2015 Activity has been identified as a practicum project for a MPH student Completed Next xt step eps: s: Identifying a survey engine Completed Post survey on PPS website and share survey access at October 2015 PAC meeting 10/6/2015 12/31/2015 d.

• d. CC & HL

L St Strategy Develop a first draft cultural competency and health literacy strategy plan 9/1/2015 12/31/2015

CC/HL DOH MILESTONE

• 25

CC/HL DOH MILESTONE

CUL CULTURAL COMPETENCY/HEALTH LITE LITERACY MILE LESTONES AN AND WORK RKGROUP HIGHLIGHTS START DATE EN END D DATE

Mile ilestone 2: De Develo lop a a trainin ing strategy foc

• cuse

sed on

• n ad

addressin ing the driv drivers

• f
• f hea

health di disparitie ies s (be (beyond the avail ilabil ility of

• f language-appropria

iate materia ial) l). 8/ 8/1/2015 6/ 6/30/2016

a.

• a. Ide

dentify ify tr train inin ing g nee needs PPS will conduct surveys. 8/1/2015 12/31/2015 b.

• b. Ide

dentify fy tr train inin ing g pr practic ices

• f
• f clinic

icia ians A Practitioner Assessment Questionnaire (PAQ) was mailed out and PPs has received some preliminary feedback. A more comprehensive survey is expected to be executed to the practices which will provide additional insight to training practices . 11/1/2015 3/31/2016 Ne Next xt steps: Aggregate PAQ feedback 11/1/2015 3/31/2016

• c. Ide

dentify fy tr train inin ing g pr practic ices

• f
• f CBO

CBOs & & no non n clin inic icia ian seg egments PPS will conduct surveys. 11/1/2015 3/31/2016

• 26

COLLABORATIVE DELIVERABLES

• Organizational

Work streams:

• IT
• Population Health

Management

• Workforce
• Across 11 DSRIP

Projects

27

CULTURAL COMPETENCE

A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals, enabling the delivery of services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse populations.

28 PPS-WIDE DEFINITION

HEALTH LITERACY

• Health literacy is the degree to which individuals have the

capacity to obtain, process and understand basic health information and services needed to make informed health decisions.

• Individuals must possess the skills to understand

information and services and use them to make informed decisions about their healthcare needs and priorities.

• Health Literacy is the product of individuals’ capabilities

and the health literacy related demands and complexities

• f the healthcare system.

29 PPS-WIDE DEFINITION

30

NEXT STEPS:

• Education on

definitions

• Survey
• October Workgroup

meeting

OPPORTUNITY

Workgroup Expansion

31

Althea Williams

Senior Manager, Community & Provider Engagement

Phone #: 631-638-1392 Fax #: 631-638-1009

Email: althea.williams@stonybrookmedicine.edu

CONTACT INFORMATION 32

33

VALUE BASED PURCHASING IN NYS: NEW YORK’S VBP ROADMAP

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

34

At 16.4% of GDP in 2012, US health spending is one and a half as much as any other country, and nearly twice the OECD average

• 1. In the Netherlands, it is not possible to clearly distinguish the public and private share related to investments.

Source: OECD Health Data 2015

35

US spends two-and-a-half times the OECD average

• 1. In the Netherlands, it is not possible to clearly distinguish the public and private share related to investments.

Source: OECD Health Data 2015

36

37 There is no incentive for coordination or integration across the continuum of care. The MCO often ‘makes up’ for the lack of integration & coordination.

38

• From fragmented and overly focused on inpatient care towards integrated

and community, outpatient focused

• From a re-active, individual provider-focused system to a pro-active,

collaborative, and patient-focused system

The DSRIP Challenge – Transforming the Delivery System “A thorough transformation of the delivery system can only become and remain successful when the payment system is transformed as well”

• Many of our system’s problems (fragmentation, high (re)admission rates,

poor primary care infrastructure, lack of behavioral and physical health integration) are rooted in how we pay for services 39

• Paying providers Fee For Service incentivizes volume over value, pays for inputs

rather than outcome

• Our current payment system does not adequately incentivize prevention,

coordination or integration 40

The DSRIP Challenge – Transforming the Payment System

Old World

• FFS
• Individual provider is anchor for

financing and quality measurement

• Volume over Value

New World

• VPB arrangements
• Integrated/coordinated care

services are anchor for financing and quality measurement

• Value over Volume

Transition period: DSRIP allows providers to restructure themselves so as to succeed in new financial & regulatory environment 41

There will be more than one path towards Value Based Payments. Rather, there will be a variety of options that MCOs and PPSs/providers can jointly choose from

The Path towards Payment Reform – “New York State Roadmap…”

PPSs/providers and MCOs will be encouraged to discuss opportunities for shared savings arrangements from within the following set of integrated service options:

• For the total care for the total attributed population of the PPS
• Per integrated service for specific condition (bundle): maternity care;

diabetes care

• For integrated PCMH/APC
• For the total care for a subpopulation: HIV/AIDS care; care for HARP

population 42

In addition to choosing what integrated services to focus on, the MCOs and PPSs/providers can choose different levels of Value Based Payments:

The Path towards Payment Reform – “New York State Roadmap…”

Guiding Principles (requirements):

• ≥80-90% of total MCO-provider payments to be captured in Level 1 VBPs at end of DY5
• 35% of total costs of fully capitated plans captured in VBPs should be in Level 2 VBPs or

higher

Level 0 VBP Level 1 VPB Level 2 VPB Level 3 VBP

FFS with bonus and or withhold based on quality scores FFS with upside only shared savings available when

• utcome scores are

sufficient FFS with risk sharing (upside available when outcome scores are sufficient) Prospective capitation PMPM or Bundle (with outcome based component)

43

Options Level 0 VBP Level 1 VBP Level 2 VBP Level 3 VBP

All care for total population

FFS with bonus and/or withhold based on quality scores FFS with upside-only shared savings when outcome scores are sufficient FFS with risk sharing (upside available when outcome scores are sufficient; downside is reduced when outcomes scores are high) Global capitation (with

• utcome-based component)

Integrated Primary Care

FFS (plus PMPM subsidy) with bonus and/or withhold based

• n quality scores

FFS (plus PMPM subsidy) with upside-only shared savings based on total cost of care (savings available when

• utcome scores are sufficient)

FFS (plus PMPM subsidy) with risk sharing based on total cost

• f care (upside available when
• utcome scores are sufficient;

downside is reduced when

• utcomes scores are high)

PMPM Capitated Payment for Primary Care Services (with outcome-based component)

Acute and Chronic Bundles

FFS with bonus and/or withhold based on quality scores FFS with upside-only shared savings based on bundle of care (savings available when

• utcome scores are sufficient)

FFS with risk sharing based on bundle of care (upside available when outcome scores are sufficient; downside is reduced when outcomes scores are high) Prospective Bundled Payment (with outcome- based component)

Total care for subpopulation

FFS with bonus and/or withhold based on quality scores FFS with upside-only shared savings based on subpopulation capitation (savings available when outcome scores are sufficient) FFS with risk sharing based on subpopulation capitation (upside available when outcome scores are sufficient; downside is reduced when outcomes scores are high) PMPM Capitated Payment for total care for subpopulation (with

• utcome-based component)

Sustainable Delivery Reform Requires Matching Payment Reform

44

A Path toward Value Based Payment New York State Roadmap For Medicaid Payment Reform June 2015 45

MOVING FROM VOLUME TO VALUE

Moderator: John Sardelis, Professor/Associate Chair at St Joseph’s College and Board Member for Affinity Health

46

Moderator

John Sardelis, Professor/Associate Chair at St Joseph’s College and Board Member for Affinity Health

Panelists

Susan Beane, MD, Vice President & Medical Director, Healthfirst Joseph Schulman, Executive Director, North Shore-LIJ Care Solutions Maria Basile, MD, MBA, Immediate Past President of the Suffolk County Medical Society and Member of the Medical Society of the State of New York on Value Based Purchasing Robert Chaloner, President and CEO of Southampton Hospital 47

MOVING FROM VOLUME TO VALUE PANELISTS

QUESTION & ANSWER

www.suffolkCare.org 48

Appendix

49

PAY FOR PERFORMANCE FUNDING SCHEDULE

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

(Domain 1) and reporting (P4R) to performance (P4P): 50

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

51

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

The SCC PMO is currently preparing for the first DSRIP Quarterly Report Due July 31, 2015

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

52

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

53 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 54 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 55

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 56

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