1 2201 Hempstead Turnpike, East Meadow, NY 11554 516.572.5518 www.nassauqueenspps.org

Project Advisory Committee (PAC) Meeting

March 15, 2016

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I. Welcome David Nemiroff

II. NQP Updates

a. NQP Activities and Announcements

b. DY1Q3 Report Finalization/ DY1Q4 Submission

c. Funds Distribution Process

David Nemiroff

III. INTERACT Panel Discussion

Skilled Nursing Facilities, that are partnering with NQP, will discuss their

successes and challenges with using INTERACT

Dr. Laurie Ward

IV. Cultural Competency and Health Literacy Training Liz McCulloch &

Fallon Williams

V. Questions and Answers

David Nemiroff

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• The Independent Assessor had no remediation feedback on NQP’s DY1Q3 report – Report will be finalized March 16th

• DY1Q4 report will be submitted on April 30th, 2016 – NQP will have completed 8 Milestones comprised of

151 tasks

• Major DY1Q4 activities focused on initial network development (e.g. contracting, engagement, and training) and finalizing financial processes

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• Funds Flow refined December 21,2015

*values shown are five-year projections assuming 100%

achievement

Provider Types Total ($)

Waiver Revenue 447,293,833$

Practitioner – Primary Care Provider (PCP) 39,643,053$

Practitioner – Non-Primary Care Provider (PCP) 5,981,027$

Hospital 41,423,300$

Clinic 17,818,179$

Case Management / Health Home 1,989,382$

Mental Health 14,192,528$

Substance Abuse 2,792,525$

Nursing Home 13,958,268$

Pharmacy -$

Hospice -$

Community Based Organizations 18,505,900$

All Other 413,127$

PPS PMO 23,057,998$

Total Funds for Provider Incentives 156,717,290$

Undistributed Revenue (Reserves) 56,717,757$

Undistributed Revenue (PMO) 11,182,349$

Undistributed Revenue Hubs 45,535,408$

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• Project Activation Measure contracts are underway – Following an RFP process in the fall, NQP is

contracting with 3 CBOs to begin engaging with clients

• Planned Parenthood of Nassau County

• EAC Network

• Long Island FQHC

– NQP may continue to contract with additional organizations

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• NQP had the opportunity to present at the Project Approval and Oversight Panel meeting in January

• Discussed successes and challenges faced by the PPS as it shifted from planning into implementation

• The presentation can be found on the DOH website – https://www.health.ny.gov/health_care/medicaid/red

esign/dsrip/project_approval_oversight_panel.htm

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• NQP has shifted its clinical project meeting structure and timeline

• NQP hub groups will meet every other week • Committees, including community groups, will

now meet on a quarterly basis and will focus on: – Project implementation status (hub-based) – Clinical Strategy and partner impact – Best practice utilization or review – Provider network engagement – Questions / Concerns addressed – Educational opportunities based on need

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• INTERACT: Intervention to Reduce Acute Care Transfers

• Is a “quality improvement program designed to improve the early identification, assessment, documentation, and communication about changes in the status of residents in skilled nursing facilities”

• DSRIP Project 2bvii focuses on the implementation of INTERACT across NQP SNFs – There are more than 60+ SNFs in the NQP network

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• Gerard Kaiser, Executive Director, Northwell Health Stern Family Center for Rehabilitation

• Dr. Conn Foley, Chief of Medicine, Parker Jewish Institute

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• Define health literacy and cultural competency.

• Discuss the scope and challenges of health literacy and cultural competency and why it is important.

• Understand how culture, health literacy and language access influence patient-centered care.

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• U.S. is becoming more racially and

ethnically diverse.

– Racial and ethnic minorities are

projected to account for a

majority of the U.S. population

by 20431.

• As surrounding communities have

become more diverse, incorporating

cultural competency and health

literacy into practice is essential to

providing patient-centered care and

reducing healthcare disparities.

References: Health Research & Educational Trust. (2013, August). Reducing health care disparities: Collection and use

of race, ethnicity and language data. Chicago: Health Research & Educational Trust.

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Health literacy happens with

patients, (anyone on the

receiving end of health

communication), and

providers (anyone on the

giving end of health

communication), truly

understand one another.

It is the degree to which

individuals have the capacity

to obtain, process,

communicate and understand

basic health information and

services needed to make

appropriate health decisions

about their healthcare needs

and priorities.

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90 million people in the U.S. may be at risk because of the difficulty in understanding and acting upon health information.1

Literacy skills are a stronger predictor of an individual’s health status than age, income, employment status, education level, or racial/ethnic group.1

1 in 5 American adults reads at the 5th grade level or below; Most healthcare materials are written above the 10th grade level.1

Persons with limited health literacy skills are more likely to have chronic conditions and are less able to manage them effectively.2

1. National Patient Safety Foundation. “Health Literacy: Statistics-at-a-glance”. 2011,

2. U.S. Department of Health and Human Services (HHS). Quick Guide to Health Literacy. Fact Sheet. Health Literacy and Health Outcomes.

Available at: http://health.gov/communication/literacy/quickguide/factsbasic.htm . Accessed February 24, 2016.

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• National Assessment of Adult Literacy (2003)

Source: National Assessment of Adult Literacy (NAAL): National Center for Educational Statistics, U.S. Department of Education, 2003.

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Source: Health Literacy: A Prescription to End Confusion. Institute of Medicine, 2004

Low Health

Literacy

Less knowledge of

illness and treatment

Less use of preventative

services

Misuse of ER

Higher hospitalization

rates

Higher utilization

Higher health care costs

Poor health outcomes

Stigma and shame

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Source: Health Literacy: A Prescription to End Confusion. Institute of Medicine, 2004

• Adults with low literacy:

– Averaged 6% more hospital visits1*

– Stayed in the hospital nearly 2 days longer than adults with higher literacy skills1*

– Had fewer doctor visits, but used significantly more hospital resources2

– Had annual health care costs 4 times higher than those with higher health literacy3

1Kirsch IS, Jugebut A, Jenkins L, Kolstad A. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey. Washington, DC:

Department of Education 1993. 2Baker DW, Parker RM, Williams MV, Clark WS. Health Literacy and the Risk of Hospital Admission. Journal of General Internal Medicine. 1998; (13):

791-798. 3Weiss, BD. 20 Common Problems in Primary Care. McGraw Hill. December 1999.

•Among adults who stayed overnight in a hospital

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• All verbal communication with the patient,

client, family, significant other. Oral

• All print collateral (brochures, instructions, informed consent)

• Touches all departments - marketing, web, PR, finance, etc.

Written

• Provide easy access & navigation to all

• Destination signage, navigation, shame-free environment System

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Plain Language: Plain language is communication your audience can

understand the first time they read or hear it.

• Goes beyond everyday words & short sentences

• Organizing information so that the most important points come first

• Using words readers already know

• Defining medical terms

Teach Back: Teach-back is a method where health care professionals ask

patients to repeat information in their own words.

• Rather than asking: “Do you understand?”

• Ask: “I want to be sure I was clear with my explanation. Can you tell me in

your own words how you would explain what I just told you?”

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• Research shows health-related materials far exceed average reading ability of US adults.

• Demands for reading, writing, & numeracy skills have increased due to health care systems’ complexities, advancements, new technologies.

• Demands exceed health literacy skills of most United States (US) adults.

Health Literacy: A Prescription to End Confusion. Institute of Medicine, 2004.

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• Structure the delivery of care as if

everyone may have limited health

literacy

- You cannot tell by looking

- Higher literacy skills ≠

understanding

- Anxiety can reduce ability to

manage health information

- Create a shame free environment

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• LEP can also include those with hearing, language, or other

disabilities who may also require interpretive services or

assistive technology.

A limited ability to

read, write, speak or

understand English.

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• Business:

• Affordable Care Act

• Changes in demographic composition

• Medical:

• Racial and ethnic groups experience disparities and different disease trajectories

• Legal:

• Civil Rights Act

• Americans with Disabilities Act

• CMS, Joint Commission, NYSDOH

Magnitude of the Issue

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Patient Safety, Quality and Cost

Drivers

• Longer hospital stays.

• Greater risk of surgical delays and risk of readmissions.

• Less access to primary care.

Patient Safety, Quality and Cost

Drivers (continued)

• Less likely to understand their diagnoses, medications, and follow-up instructions.

Risk Management

• Multiple liability exposures:

• Poor/inadequate informed consent.

• Improper use of medications.

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• LEP Poster

• Patient Bill of Rights

– Main points of entry

– Patient care units

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• The language in which a patient prefers to communicate regarding health care.

– Assess at first point of patient contact.

• Offer free medical interpretation services.

– Explain the importance of using professional medical interpretation services.

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The ability to provide an expanded cross-cultural approach

to care of individuals with diverse values, beliefs and

behaviors, including tailoring delivery to meet patients’

social, cultural communication and linguistic needs.

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• Cultural Competency can help healthcare

providers address healthcare disparities to

improve quality by:

Developing cultural

awareness

Expanding cultural

knowledge

Enhancing cultural skills

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Cultural Competency

Stereotyping

Unconscious Bias

Health Literacy

Language Barriers

Non-Verbal Communication

Patient Mistrust

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• Allows us to respond to the needs of a diverse patient and family population

Helps our patients:

• Fosters a workplace where everyone feels included and valued

Helps our employees:

• Employees are committed to contributing their diverse and innovative ideas

Keeps teams engaged:

• Promotes commitment to service/achieving better health outcomes

Enhances the Patient/Consumer

Experience:

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CCHL Strategy

PCMH Approach

Hot Spotting

Clinical Providers

Non-Clinical

Staff

Community

Leadership /

Administration

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Nassau Queens Performing Provider System (PPS):

http://www.nassauqueenspps.org/

Training slides

http://www.nassauqueenspps.org/resources

State Department of Health DSRIP website:

www.health.ny.gov/health_care/medicaid/redesign/dsrip/

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• Surviving Spirt Newsletter March 2016- Hope, Healing & Help for Trauma, Abuse & Mental Health

• March 18th - Medication Assisted Treatment: Enhancing Recovery in Opiate Addiction – 9:00am - 3:00pm

– The Morrelly Homeland Security Center 510 Grumman Road West, Bethpage NY 11714

– Registration form and agenda are on our website: http://www.nassauqueenspps.org/resources

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