AHI North Country PPS Capital Restructuring Financing Program (CRFP) Webinar December 4, 2014 www.facebook.com/adirondackhealthinstitute www.adirondackhealthinstitute.org CRFP Request for Application  On November 18th NYSDOH released the Capital Restructuring Financing Program Request for Applications.  The full application and all relevant appendices can be downloaded at:  http://www.health.ny.gov/funding/rfa/1410100351/index.htm Today’s Agenda  Overview of Application (15 minutes)  Key dates  Submission process and eligibility  Key sections  Role of AHI North Country PPS (25 minutes)  Supporting development of submissions  HIT investments  Prioritization criteria  Q&A (20 minutes) Today’s Agenda  Overview of Application (15 minutes)  Key dates  Submission process and eligibility  Key sections  Role of AHI North Country PPS (25 minutes)  Supporting development of submissions  HIT investments  Prioritization criteria  Q&A (20 minutes) Overview of Application  The 2014-15 State budget authorized the establishment of the CRFP to make awards totaling up to $1.2 billion to support capital projects to help strengthen and promote access to essential health services, including projects to:    improve infrastructure promote integrated health systems support the development of additional primary care capacity  It is expected that contracts resulting from this RFA will have the following time period:  April 1, 2015 to March 31, 2020 Estimated Dollars for North Country $1.2B Total / 5 years = $240M Annually North Country (9-cty) Total Pop. as % of New York = ~4% North Country (9-cty) Medicaid & Uninsured Pop. as % of New York = ~2.5% Potential Range for Annual Capital Dollars allotted to North Country Region: ~$6M to ~$9M Overview of Application  The state has developed two Processes for CRFP application submission: Today’s focus Process A Process B DSRIP Participant organizations prepare and submit applications to their PPS Lead Non-DSRIP organizations prepare and submit applications directly to DOH PPS Lead ranks projects in order of priority and submits all proposals together Each eligible application is evaluated and scored separately Each eligible application is evaluated and scored separately Tentative Key Dates (subject to change)  December 10: Two-page project summary template distributed to all PPS partners  December 30: Two page project summaries due from partners to AHI  January 6: Steering Committee meets to review and score project summaries  January 10: Feedback sent to applicants  February 3: Full proposals due to AHI  February 12: Steering Committee meets to review full proposals and rank for submission  February 20: AHI submits ranked proposals to DOH Eligible Organizations Minimum eligibility criteria:          General hospitals Residential health care facilities Diagnostics and treatment centers Clinics licensed pursuant to the PHL or the Mental Hygiene Law (“MHL”) Assisted living providers Primary care providers Home care providers certified or licensed under PHL Article 36 Provider organizations which hold operating certificates issued by the DOH, OMH, OPWDD and OASAS OMH clinic programs, Intensive Psychiatric Rehabilitation, Treatment Programs, Continuing Day Treatment Programs, Day Treatment Programs, and Personalized Recovery Oriented Service Programs Eligible Organizations Preferred eligibility criteria:    Applicants committing matching funds to the proposed project  Strong preference for one to one match with grant funds  If it can be clearly demonstrated that equity, borrowing or other sources of Matching Funds are not available to the applicant or are not sufficient to match the requested grant, the application may nevertheless be considered for funding  Matching Funds may be provided for defined Excluded Expenses, and can be provided by CRFP non-applicants Applicants with projects that demonstrate transformational change to the health care delivery system from a fee-for-service system to a value based system Applicants who demonstrate significant financial need Eligible Projects include but not limited to  Capital projects that support development of primary care service capacity         (including primary care services co-located with OP behavioral health services) Asset acquisitions Capital projects that support consolidation of service lines among providers Improvements to infrastructure Capital projects that support closures, mergers, and/or restructurings Capital projects that support development of tele-health infrastructure Capital projects that support development of coordinated co-located ambulatory care services including primary care, specialty care, surgery, urgent care, and diagnostic imaging Capital projects leading to integrated delivery systems that strengthen and protect continued access to essential health care services Other transformational capital projects which further DSRIP Program Goals Eligible Expenses include but not limited to  Planning or design for acquisition, construction,     demolition, replacement, major repair or renovation of a fixed asset or assets Construction costs Renovation costs Asset acquisitions Equipment costs, including capital costs for health information technology Excluded Expenses include but not limited to  Personnel costs  Supplies and non-capital equipment  Utilities  General operating costs, including operating costs     associated with tele-medicine programs Working capital, including pay down of liabilities Loans and other debt obligations Routine training and maintenance costs related to implementation of HIT Lease payments Evaluation Criteria Evaluation of the CRFP application is highly aligned with achieving the DSRIP goals. Capital projects that are likely to be evaluated favorably are those that will:  Create or expand primary care capacity  Promote care coordination among providers (tele-health, medical villages, co     located primary, specialty and behavioral outpatient services) Promote patient-centered care (medical and health homes) Reduce avoidable hospital and nursing home admissions and emergency visits Benefit the largest number of Medicaid enrollees and uninsured individuals Include as much funding as possible from other funding sources and represent a significant investment beyond CRFP funding Result in a reduction of inpatient beds and the continuation or expansion of ambulatory care and emergency services in a community  See pages 9 & 10 of the RFA for a complete list of evaluation criteria Sections of the Application  Application Prequalification through Grants Gateway   Please see pages 12 & 13 of the application for detailed steps It is recommended to complete this process as soon as possible to ensure all requirements are met prior to the application deadline  Technical Proposal  Project description, relationship to community need, relationship to DSRIP goals and transformational change of system  Financial Proposal  Project funding and match, project budget, cost-effectiveness, financial sustainability and demonstration of financial need Technical Proposal  Technical Proposal (not to exceed 15 pages)  Executive Summary  Project Description, including Work Plan (10 points)  Organizational Info, Participants, Project Readiness (Not scored)  Relationship of Eligible Projects to Community Need (20 points)  Relationship of Eligible Capital Projects to DSRIP Goals (25 points)  Transformational Change (10 points)  Regulatory Waivers Financial Proposal  Financial Proposal  Project Funding and Match (15 points)   Project Budget (5 points)     Project Expenses and Justification Project Fund Sources Cost Effectiveness (5 points) Project Financial Viability and Applicant Long-Term Sustainability (10 points)     Applicants proposing no matching funds will receive no points under this section Discussion of how project supports financial sustainability of PPS Financial projections for applicant for ~3 years past project completion Evidence of financial stability of applicant Demonstration of Significant Financial Need (10 additional pts)   Evidence of IAAF funding Evidence of all other funding sources exhausted Today’s Agenda  Overview of Application (15 minutes)  Key dates  Submission process and eligibility  Key sections  Role of AHI North Country PPS (25 minutes)  Supporting development of submissions  HIT investments  Prioritization criteria  Q&A (20 minutes) Supporting Application Development  The AHI North Country PPS will provide support to application development in the following ways:      Today’s webinar and Q&A Availability of Community Needs Assessment data presentation to support Technical Proposal development Q&A through [email protected] Review and editing/discussion/feedback on application submissions received by December 10th Select application development support as identified and approved by Steering Committee and AHI leadership HIT Investments  HIT investments are a crucial element in developing a successful integrated delivery system and in meeting the DSRIP goals over the next five years  AHI North Country PPS hopes to provide guidance to help structure those PPS participants wishing to pursue CRFP dollars to support HIT investments  The next slide represents a 1st draft of the PPS Landscape inclusive of existing and potential HIT Infrastructure, as it pertains to PPS Performance Management / Reporting AHI North Country PPS HIT Overview DRAFT: 3 Layers of the HIT Infrastructure Potential PPS Measures Population Health Management Solution(s) – Performance Measures (PPS, PCMH, Health Home, Adk ACO, Others...) Potential PPS Measures Interfaces Interfaces Interfaces Interfaces Data Sharing – Health Information Exchange (RHIO’s) Statewide Network (SHIN-NY) PCMH PCMH QDC QDC Clinical Clinical ROCHESTER RHIO Interfaces Interfaces Interfaces Interfaces Interfaces Interfaces PCMH: Treo Solutions (3M) Payers Payers (Claims) (Claims) Current PCMH Reporting/Measures PPS Organizational Categories: Systems, PPS Related HIT Costs & Considerations Primary Care (PCP) Hospitals (HOSP) Post-Acute, including Long-Term Care, Home and Community Based Services (LT/HCBS) Behavioral Health / Substance Abuse (BH/SA) Public Health and/ or Prevention (PREV) EMR Adoption, Upgrades, Integration, Training, NCQA EMR Upgrades, Legacy Systems, Integration, Training EMR Adoption, Upgrades, Training, Integration, Telemedicine, Etc… EMR Adoption, Upgrades, Training, Integration with Primary Care TBD (HCR Homecare – Rochester RHIO) Note: Organizations may span multiple categories... HIT Capital Request Guidance  Assume in the short term that data sharing will occur through usage of the RHIO(s)  Assume that population health management functions will be housed at the PPS Lead level (individual entities do not need to submit capital requests for population health management tools and reporting capabilities to support DSRIP) PPS Application Prioritization  DOH has specified through ‘Process A’ that the PPS Lead must rank all DSRIP participant applications received, and submit all project applications together on behalf of the PPS  The AHI North Country PPS interim Steering Committee will prioritize the applications using criteria mirroring the CRFP evaluation criteria PPS Prioritization Criteria  Is the application aligned with a particular DSRIP project and the investment required to achieve success in that chosen DSRIP project?  Will the project result in a significant impact/improvement in care delivery for the target population?  Does the application create or expand primary care capacity for the North Country?  Does the application create or expand mental health and/or substance abuse capacity for the North Country?  Does the application promote care coordination among providers?  Will the application help reduce avoidable hospital and nursing home admissions and emergency visits?  Will the project result in a significant impact/improvement in care delivery for the target population?  Does the application include as much funding as possible from other funding sources and represent a significant investment beyond CRFP funding?  Will the application result in a reduction of inpatient beds and the continuation or expansion of ambulatory care and emergency services in the North Country?  Does the project improve crucial infrastructure that protect access to essential services?  Does the project support the financial sustainability of the organization as the healthcare environment moves towards value-driven care and reimbursement? Submitting Successful Projects  This capital application process is highly competitive and is designed to favor requests that are highly aligned with meeting DSRIP goals  In order to ensure the most successful application that will be 1) highly ranked by the PPS and 2) highly scored by DOH, please focus on submitting projects that are highly aligned with the DSRIP goals and the prioritization criteria AHI North Country PPS Submissions  If you are a participant in the AHI North Country PPS, please look for the two-page project summary template to be distributed next week  The two-page summary will be due back to AHI on December 30 Today’s Agenda  Overview of Application (15 minutes)  Key dates  Submission process and eligibility  Key sections  Role of AHI North Country PPS (25 minutes)  Supporting development of submissions  HIT investments  Prioritization criteria  Q&A (20 minutes) AHI North Country PPS Projects  2.a.i Create an integrated delivery system focused on Evidence Based Medicine and Population Health Management  2.a.ii Increase Certification of Primary Care Practitioners with PCMH Certification (NCQA 2014 Level 3 PCMH)  2.a.iv Create a Medical Village Using Existing Hospital Infrastructure  2.b.viii Hospital-Home Care Collaboration Solutions  2.d.i Implementation of Patient Activation Activities to Engage, Educate and Integrate the uninsured and low/non-utilizing Medicaid populations into Community Based Care  3.a.i Integration of Primary Care and Behavioral Health Services  3.a.ii Behavioral Health Community Crisis Stabilization Services  3.a.iv Development of Withdrawal Management (e.g., ambulatory detoxification, ancillary withdrawal services) Capabilities and Appropriate Enhanced Abstinence Services within Community-Based Addiction Treatment Programs  3.g.i Integration of Palliative Care into the PCMH Model  4.a.iii Strengthen Mental Health and Substance Abuse Infrastructure across Systems (Focus Area 3)  4.b.ii Increase Access to High Quality Chronic Disease Preventative Care and Management in Both Clinical and Community Settings