Mount Sinai PPS Town Hall

November 20th, 2014

State Updates

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Revised State Timeline

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Revised DSRIP Plan Application & Prototype Application

▶ DSRIP Plan Application

– Organizational Application

• Strong emphasis on Community Based Organizations including representation, contracting and

PPS support

– Project Plan Application

• Focus on identifying anticipated challenges as well as how these challenges will be addressed

by the PPS

• CNA data will be used to justify project selection as well as provider participation in each

project

▶ Prototype Application

– Mount Sinai Projects that overlap with Prototype Projects

• 2.a.i., 2.b.iv, 3.a.i., 3.b.i., 4.b.ii.

– Rural PPS

– Continued emphasis on projects related to CNA

– Emphasis on importance of scope and speed sections

Committee Updates

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Clinical Committee

▶ Updated State guidance

– Focus on connecting partners on each project with specifics from the CNA

– In addition to identifying unique challenges for each project, must also discuss the

solution for each presented challenge

▶ Project development

– Focus on education for providers and patients

– Building out current successful models

• Care management and care coordination

• Various clinical practices related to behavioral health

– Integration across the full continuum of care

▶ Identified challenges

– IT systems for shared connectivity between all providers and between providers outside

of the PPS

– Patient information and protection

– Infrastructure to support all PPS partners

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Workforce Committee

▶ Workforce Surveys

– Completed analysis of Workforce Survey #1, results provided information on the baseline

workforce of partners

– Currently analyzing results from the future anticipated workforce needs

▶ Organizational application development

– Section 5 – Workforce Strategy

– Completed draft by Friday, November 21st

– Content focuses on anticipated workforce needs as determined by both Mount Sinai and

the PPS partners

▶ Engagement with clinical project development

– Workforce Committee will review all project plan applications this week

– Feedback will be provided to subgroups to be incorporated during the first week of

December

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Finance Committee Flow of Funds

▶ Further review DOH guidance released on November 17th, specifically updated criteria and definitions for required buckets

▶ Potential changes– Consolidation of Performance Metrics with Project Costs– Consolidation of Administrative Costs within Project Costs (per state

guidance)

▶ Finalize supporting narrative in line with DOH guidance and prototype application and overall governance structure

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Finance Committee - Capital Funding Needs

▶ Full guidance and application process expected Friday, November 20th

▶ Preliminary guidance from KPMG indicates:

– The planning or design of the acquisition, construction, demolition, replacement, major repair or renovation of a fixed asset or assets, including the preparation and review of plans and specifications including engineering and other services.

– Construction costs;

– Renovation costs;

– Asset acquisitions; and

– Equipment costs, including capital costs for health information technology.

Q&A

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▶ IT Committee has organized:– 2 subgroups to focus on each section of the Organizational Application

– Subgroups have initial drafts of Organizational Application Section 6

– Completed IT retreat (Nov 14th), which engaged members of clinical committee

• Defined preliminary IT maturity tiers and broad principles for advancing PPS members to greater IT maturity overtime for all provider types –

• No provider should be left behind in tier 5

IT Committee Progress

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▶ What data will be available? – PHI vs. Non-PHI, will PPSs become Qualified Entities?

▶ Consent management – NY has an opt-in patient consent process. This could be a problematic

regulatory barrier that needs to be addressed

▶ EMPI (Enterprise/PPS Master Patient Index) – – At multiple levels, PPS, inter-PPS and State need to have a common

methodology for patient identification/ reconciliation

▶ Role of RHIOs and a statewide solution for connectivity and data-sharing– KPMG has conducted a statewide assessment, however there is

concern that assessment is primarily informed by RHIO self-reporting, not end-user feedback

IT Committee – Major Risks

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IT Committee Implementation Planning Strategy

Receive and aggregate IT survey results. Next step: Stratify results by provider type

Create common definitions for technology maturity across five tiers to determine lift

by project and provider type

Define minimum IT capabilities by provider type per project, per year

Define functional solutions needed per project and provider type based on role and

timing

Define proposed solutions/technologies based PPS needs and current capabilities

Q&A

Leadership Update

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PPS Governance Model

Collaborative ContractingRequires individual contracts between the lead entity and each partner

Pros Cons

• Created relatively quickly• No new entity required• Partners retain autonomy• Easy to obtain initial buy-in of partners

• Potentially large number of contracts• Hard to make decisions quickly• Potential for conflicts when limits of contracts are

reached• Rigidity of structure• Hard to do value based contracts with MCOs

Delegated AuthorityA new legal structure is formed and partners delegate certain authority to the new organization

Pros Cons

• Can be more efficient by centralizing decision making

• Can limit delegation of powers to the new entity to those aspects directly needed for DSRIP

• Has potential to lose buy-in of partners• Can be challenging to agree on what is delegated• Will require an effort to maintain transparency

Fully IncorporatedPartners forego their current organization structure and merge so the PPS provides full management and governance

Pros Cons

• Most efficient for decision making• May ultimately be best model to tie in non-facility

partners

• Partners lose autonomy• May be difficult to achieve functional completeness if

partners don’t want to join

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Delegated Authority Model

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Vision for Sustainable Governance

▶ Consideration for a sustainable model throughout and following DSRIP

– Legal structure

– Contracting with partners

– Partner evaluation

▶ Finance Considerations

– Management of cost/revenue shifting

– Financial support to partners

– Financial reporting

▶ Clinical Considerations

– Engagement of providers

– Oversight of clinical metrics

▶ IT Considerations

– Data sharing agreements

– Development of performance reports

Q&A

PPS Updates

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Attribution Released November 14th

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Attribution Timeline

▶ Upcoming Key Dates

– Nov. 21st 4th Round Initial Attribution Results released

– Nov. 24th Final Partner List due to the State

– Dec. 10th Final Attribution Results released

Mount Sinai PPSPartner Participation Packet

Partner Participation Packet

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• This packet of forms and survey was designed to

collect key information from PPS partners to ensure a

collaborative and comprehensive application

• Partners were asked to identify the projects they

wished to participate in and describe their role

• Packet also includes the Attestation Form, which is

required by the state.

• Please submit your information by Friday if you

haven’t already!

Packet Components

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• Partner Attestation Form

• Provider Information Form for Attribution

• Partner General Information Survey

• DSRIP Project Participation Surveys

• Domain 4 Population Health Project Survey

• Anticipated Workforce Needs Survey

General Information

Service Area of Partners

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• Manhattan…………………113 partners

• Brooklyn…………………...98 partners

• Bronx………………………97 partners

• Queens……………….…….88 partners

• Staten Island……………….41 partners

• Westchester County………..38 partners

Top Services Provided by Our Partners

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1. Community Based Organizations/ Social Services

2. Other

• Examples include, but are not limited to:

• Supportive Housing

• Job Training

• Personalized Recovery Oriented Services (PROS)

3. Nursing Home/Skilled Nursing Facility

4. Health Home or Downstream Care Management Agency

Provider Project Participation

Projects 2.a.i & 2.b.iv

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Project 2.a.i – Create integrated delivery systems that are focused on evidence based medicine/Population health management

Parent Organizations 67Unique facilities, sites, and programs participating 1264

Project 2.b.iv - Care transitions intervention model to reduce 30 day readmissions for chronic health condition

Parent Organization 48Unique facilities, sites, and programs participating 1156

“We service a large population of patients that are at risk for frequent hospitalizations, and through our involvement in this project we anticipate enhancing our services in ways that would directly decrease many of those risks.”

Projects 2.b.viii & 2.c.i.

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Project 2.b.viii - Hospital-Home care collaboration solutions

Parent Organizations 27Unique facilities, sites, and programs participating 799

Project 2.c.i – Development of community-based health navigation services

Parent Organizations Participating 43 Unique facilities, sites, and programs participating 511

“We are excited about this opportunity to expand on the role of our care teams and navigators to improve health literacy, patient self-efficacy, and patient self management.”

Projects 3.a.i. & 3.a.iii.

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Project 3.a.i - Integration of primary care services and behavioral health

Parent Organizations Participating 53Unique facilities, sites, and programs participating 700

“Our goal is to improve the ability to share information about medications, health status, preventive care, and referral for specialty care in a way that is seamless and achieves better outcomes.”

Project 3.a.iii - Implementation of evidence based medication adherence program (MAP) in community based sites for behavioral health medication compliance

Parent Organizations Participating 49Unique facilities, sites, and programs participating 537

Projects 3.b.i. & 3.c.i.

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Project 3.b.i - Evidence based strategies for disease management in high risk/affected populations (adult only) - Cardiovascular Health

Parent Organizations Participating 33Unique facilities, sites, and programs participating 534

“Disease Management Teams will be created to work with patients at risk for cardiovascular disease. Team members, including the registered dietitian and community based health coaches, will work to improve care delivery systems at the primary care level. Free diabetes education will be provided to the community, nutrition and case management services will be provided to our primary care patients.”

Project 3.c.i - Evidence based strategies for disease management in high risk/affected populations (adult only) - Diabetes Care

Parent Organizations Participating 42Unique facilities, sites, and programs participating 1058

Projects 4.b.ii. & 4.c.ii.

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Domain 4 projects are pay for reporting and are PPS-wide projects

Project 4.b.ii – Increase access to high quality chronic disease preventive care and management in both clinical and community settings

Project 4.c.ii - Increase early access to, and retention in, HIV care

“Our agency provides education, coordination, and referrals to community based agencies and health care providers in order to increase early access to, and retention in HIV care and prevention. Our Youth Services division provides educational workshops to youth surrounding HIV prevention and STDs. Educational seminars are also provided at our senior centers on HIV education and staff refer seniors for HIV screenings. We will formalize existing partnerships with schools, clinics, and other community based organizations to deliver health education.”

Anticipated Workforce Needs

Overall Workforce Needs

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• Total number of employees partners anticipate participating in the projects

20,416

• Total number of employees partners anticipate need retraining

12,045

• Total number of employees partners anticipate need redeploying

630

• Total number of new hires that partners anticipate1,435

Specific Workforce Needs

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Retraining needs:

• Certified Nursing Assistant

• Licensed Nurse

• Registered Nurse

• Social Worker

• Primary Care Physician

Redeployment needs:

• Registered Nurse

• Medical Providers (MD, NP, PA)

• Clerical Support

• Social Workers

Hiring needs:

• Case Management

• Psychiatrist

• Psychologist

• Social Worker

Partners identified what

types of their employees

need to be retrained,

redeployed, and who they

would need to hire.

Next Steps

Provider Participation per Project

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Partners will be evaluated by numerous committees within the PAC:

1. Clinical subgroups

2. Finance Committee

3. IT Committee

4. Leadership Committee

Evaluation of partners will assess characteristics such as the following:• Is this the appropriate mix of providers for this project’s needs?• Is that partner able to support meeting that project’s metrics and

milestones?• Is the partner’s financial status such that they are able to support

project goals?

Thank you

Email the Mount Sinai PPS Team at dsrip@harbageconsulting.com

Visit the Mount Sinai PPS website at www.mountsinaipps.org

Official CMS and State DSRIP documentation & guidance is posted on the New York State Department of Health website

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