PAC Meeting November 2014 - Nassau University Medical Center

Nassau - Queens PPS
PAC Meeting
November 13th, 2014
DSRIP Overview & Progress to Date
David Nemiroff, LCSW
Executive Director,
Long Island Federally Qualified Health Centers, Inc.
Vice President,
NuHealth, NUMC
2
What is DSRIP?
• The DSRIP program will promote community-level
collaborations and focus on system reform.
• Large public hospital systems and safety net
providers will collaborate with community
providers, organizations and physicians to
implement innovative projects.
• DSRIP creates a new provider entity, a Performing
Provider System (PPS).
3
Goals of DSRIP
• Achieve statewide a 25 percent reduction in
avoidable hospital use, including emergency
department, readmissions and admissions for
avoidable conditions, over five years.
• Focus on system transformation, clinical
improvement, and population health improvement.
4
DSRIP Funding
• Funding allocated based on project valuation and
outcomes.
• Pay-for-performance: Incentive payments based
on achieving improvements in care; must meet
milestones and metrics first to get paid in the 5year project period.
• Improvements based on metrics and goals for
Medicaid population in County.
• Achievement of metrics is based on performance
of whole PPS, not individual providers.
5
DSRIP Payments to Providers
• DSRIP payments for each provider are
contingent on them meeting program and
project metrics and milestones defined in
the DSRIP Plan.
• Incentive payment values will be calculated
for each metric/milestone domain in the
DSRIP project plan.
6
DSRIP Incentive Payments Distribution
• PPSs can choose how they will distribute DSRIP
incentive payments. Possible factors include:
– Attributed lives associated with PPS partners
– Pay-for-Performance for higher achievers within the PPS
– Project Costs
– Revenue Loss for Hospital Only
– Contribution to PPS achievement of metrics and
milestones
7
Nassau-Queens PPS Partnerships
Other
Healthcare
Providers
Devel.
Disability
Providers
Comm.
Agencies
Insurers
Hospices
NassauQueens
PPS
Health
Homes
CHHA/
LHAA/
LTHHC
Skilled
Nursing
Facilities
Behavioral
Health/
Substance
Abuse
Physician
Groups
Hospitals/
Health
Systems
Community
Health
Centers
8
PAC Definition
• Project Advisory Committee
• Serves as an advisory entity within the PPS
• Offers recommendations and feedback on PPS
initiatives.
• PAC meetings/conference calls serve as forum to
share and review proposals as well as discuss ideas
that will affect the PPS and its workforce.
9
Nassau-Queens DSRIP PPS Timeline
Executive Committee Meetings (ongoing)
10/15
Nassau
Stakeholder
Meeting
6/26
Submission
of Planning
Grant
Application
June-July
11/10
10/30
Queens
Stakeholder
Meeting
Aug-Sept
Oct
9/9
10/20
Nassau CBO
Info Session
Eastern Queens
CBO Forum
9/17
10/20
Nassau CBO
Forum
Rockaways
CBO Forum
9/22
10/28
Nassau CBO
Forum
Rockaways
CBO Forum
9/9 – 10/15
Community Survey Distribution
Submission
of Financial
Stability Test
Nov
12/22
Project Plan
Application Due
Dec
11/13
12/4
PAC
Meeting
PAC
Meeting
Project Workgroup Meetings (ongoing)
Development of Community Health
Needs Assessment
10
Community Needs Assessment
Summary
11
DSRIP Community Health Needs Data
Christopher Chewens
Manager, Accountable Care Analytics
North Shore-LIJ Health System
12
(N) Unique Medicaid Enrollees
Nassau = 223,518
Eastern Queens = 444,801
Total = 668,319
(N) Unique Uninsured Persons
Nassau = 49,511
Eastern Queens = 102,702
Total = 152,213
Source: Salient NYS Medicaid Data, accessed 9/26/2014
& Truven 2013 Insurance Estimates (Uninsured)
13
DSRIP Reduction Summary - Eastern Queens and Nassau - 2012
Reduction Bucket
Nassau
Eastern Queens
Total Number
25% of Total
PQIs1
2,284
3,818
6,102
1,526
PDIs2
285
456
741
185
Avoidable ED3
Readmissions4
Total
55,087
107,477
162,564
40,641
3,575
61,231
6,751
118,502
10,325
179,732
2,581
44,933
Source:
1) www.health.data.ny.gov - AHRQ PQIs – 2012
2) www.health.data.ny.gov - AHRQ PDIs – 2012
3) www.health.data.ny.gov - 3M PPVs (ED T&R) – 2012
4) SPARCS, 9/1/2014 – Readmission Index Admissions – 2012
Overlapping PQI/PDIs removed, average of total/MDC related
14
Community Health Data
•
In terms of chronic illnesses: 1) CVD (driven by hypertension), 2)
mental health, and 3) substance abuse are most associated with
inpatient and ED utilization. Of the given classifications, HIV is
least associated.
•
Roughly 30% of PQIs (adult ambulatory sensitive admissions) are
due to acute conditions, such as UTI or dehydration.
•
When considered together, psychiatric disorders and substance
abuse are the number one driver of 30 day readmissions, and are
largely non-dual eligible.
•
In Medicaid population, nearly 75% of ED T&Rs are avoidable.
Driven by 1) ill defined diagnoses ( ex. cough, headache), and 2)
respiratory illness (ex. viral infections).
15
DSRIP Community Member
Health Needs Assessment Survey
Nancy Copperman
Corporate Director of Public Health Initiatives,
Office of Community & Public Health,
North Shore-LIJ Health System
16
Distribution of Health Conditions
Overall (n=3,481)
Health Condition
Mental Health Issues/Depression
Diabetes
Ashthma/Lung Diseases
Obesity/Weight Loss Issues
Other
Drugs and Alcohol Abuse
Heart Disease/Stroke
Cancer
Pregnancy
Vaccine Preventable Disease
Kidney Disease
HIV/AIDS/STDs
Perinatal Care/Premature Births
Environmental Health
Number of Responses
Nassau
Queens
Total
1,091
562
414
365
311
303
206
134
58
92
73
49
18
10
331
226
160
95
122
73
93
49
102
32
27
0
0
0
1,422
788
574
460
433
376
299
183
160
124
100
49
18
10
Rockaway Wellness Partnership
Community Survey – Top 6 Health Conditions
Health Condition
Hypertension
High Cholesterol
Arthritis
Diabetes
Depression
Asthma
Overall
%
Hispanic
%
AA
%
N=234
N=109
N=85
21.3
15.4
14.3
11.9
10.4
7.2
37.6
37.6
24.8
23.9
20.2
11.9
58.8
36.5
35.3
29.4
27.1
20.0
18
Distribution of Place of Treatment
Overall (n=3,481)
Health Condition
Health Care Provider's Office
Clinic in Hospital
Community Health Center or Clinic
Hospital Emergency Department
Do Not Get Treatment
Other
Urgent Care Center
Traditional Healer's Office
Number of Responses
Nassau
Queens
Total
439
241
71
93
51
29
24
12
1,214
486
429
226
130
102
92
36
1,653
727
500
319
181
131
116
48
Reasons Preventing Access to a Healthcare Provider
Overall (n=3,481)
Health Condition
Did not have any problems getting to a health care provider
No health insurance
Could not afford to pay
Had to wait too long to get an appointment
Insurance would not pay
Transportation
Could not find a health care provider that took my insurance
They were hard to reach by phone
Other
Office hours are a problem
No time to go to appointment
Did not know how to find a healthare provider
Could not find a health care provider who spoke my language
Did not know how to make an appointment
Office was not physically accessible
Number of Responses
Nassau Queens Total
757
294
224
195
178
132
120
109
80
69
41
43
32
30
18
263
92
57
73
55
56
39
49
37
21
15
0
0
0
0
1,020
386
281
268
233
188
159
158
117
90
56
43
32
30
18
Reason for ED Visit
Overall (n=3,481)
Number of Responses
Nassau Queens Total
Health Condition
Problem too serious for doctor's office
Only hospital could help
Emergency room is closest provider
Arrived by ambulance
Doctor's office not open
Health provider said to go
Most care is at emergency room
No other place to go
Could not get an appointment with health care provider
Queens
No
48%
Yes
52%
Nassau
368
313
248
229
202
205
130
106
84
No
52%
132
120
98
89
77
63
64
41
47
Yes
48%
500
433
346
318
279
268
194
147
131
Nassau & Queens
Stakeholder Forums
Denise Soffel, Ph.D.
Principal,
Health Management Associates
22
Sessions & Participants
•
•
•
•
•
•
Immigrants and the Uninsured
Dual Eligibles – SNF
Dual Eligibles: Community-Based Long-Term Care
Chemical Dependency Services
Mental Health Services
Persons with Intellectual/Developmental
Disabilities
• Persons with Chronic Conditions
• Services for People with HIV
• Basic Needs
23
Common Themes
•
•
•
•
•
•
•
•
•
Communication
Clinical Assessment and Triage
Care Coordination
Patient Education and Self-Management
Cultural Competency
Transportation
Medication Adherence
Housing
Availability of Service & Service Support
24
Recommended Projects
Kristofer Smith, MD
VP and Medical Director,
CareSolutions,
North Shore-LIJ Health System
25
Results of Prioritization Exercise
60
E. Queens (Yes)
Domain 2
Nassau (Yes)
50
20
40
30
4
20
9
37
25
2
10
10
1
1
0
2.a.i
4
3
2.a.ii 2.a.iii 2.a.iv 2.a.v
2
2.b.i
5
1
3
2
3
2
6
4
4
6
2
16
11
9
0
2.b.ii 2.b.iii 2.b.iv 2.b.v 2.b.vi 2.b.vii 2.b.viii 2.b.ix 2.c.i
3
2.c.ii
2.d.i
26
Results of Prioritization Exercise
70
E. Queens (Yes)
Domain 3
60
50
Nassau (Yes)
16
40
30
20
43
10
5
10
9
10
0
1
4
3
6
1
7
3
3
11
4
3
4
8
0
2
1
3.a.i 3.a.ii 3.a.iii 3.a.iv 3.a.v 3.b.i 3.b.ii 3.c.i 3.c.ii 3.d.i 3.d.ii 3.d.iii 3.e.i
3
2
3.f.i
0
5
9
1
1
3.g.i 3.g.ii 3.g.iii 3.h.i
27
Results of Prioritization Exercise
60
E. Queens (Yes)
Domain 4
Nassau (Yes)
50
18
40
30
20
32
2
6
10
13
0
4.a.i
11
2
3
4.a.ii
3
4.a.iii
4.b.i
3
4.b.ii
4.c.i
1
4.c.ii
0
4.c.iii
0
4.c.iv
1
2
4.d.i
28
Recommended Project List
DOMAIN 2: SYSTEM TRANSFORMATION PROJECTS
2.a.i. Create an Integrated Delivery System focused on Evidence-Based Medicine and Population Health Management
2.b.ii. Development of co-located primary care services in the emergency department (ED)
2.b.iv. Care transitions intervention model to reduce 30-day readmissions for chronic health conditions
2.b.vii
Implementing the INTERACT project (inpatient transfer avoidance program for SNF)
.
Implementation of Patient Activation Activities to Engage, Educate and Integrate the uninsured and low/non-utilizing
2.d.i
Medicaid populations into Community Based Care (11th project)
DOMAIN 3: CLINICAL IMPROVEMENT PROJECTS
3.a.i. Integration of primary care and behavioral health services
3.a.ii. Behavioral health community crisis stabilization services
3.b.i. Evidence based strategies for disease management in high risk/affected populations (adults only)
3.c.i. Evidence based strategies for disease management in high risk/affected populations (adults only)
DOMAIN 4: POPULATION-WIDE PROJECTS: NEW YORK'S PREVENTION AGENDA
4.a.iii. Strengthen mental health and substance abuse infrastructure across system
4.b.i. Promote tobacco use cessation especially amongst low SES populations and those with poor mental health
29
Workgroups and Next Steps
Robert Ginsberg
System Director,
Strategy and Business Development,
Catholic Health Services of Long Island
30
Next Steps
• Workgroups meetings this afternoon
• Project workgroups to begin meeting
• Submit DSRIP application Dec. 22
31
Application Preparation for PAC
Meeting
Lynne Fagnani
Principal,
Health Management Associates
Meryl Price
Medicaid Subject Matter Professional,
KPMG
32
Application
• Organizational application – 30% of score
– governance, community needs assessment,
workforce strategy, data sharing plan, cultural
competency, etc.
• Project Plan application – 70% of score
– 11 projects (see handout)
• System Transformation Projects (5 projects)
• Clinical improvement Projects (4 projects)
• Population-wide Projects (2 projects)
33
Project Plan Applications
What’s Included in Each Project Section
•
•
•
•
•
Project description and justification
Scale of implementation
Speed of implementation
Project resource needs and other initiatives
Project milestones and metrics – must meet
these to be paid DSRIP funds.
34
Community Needs Assessment:
Prioritize and Justify Project Selections
•
•
•
•
Use broad data sources: Data >DOH website; regional results for metrics that will
be utilized to assess PPS outcomes
Identify and characterize health care resources
Identify service challenges facing the community
Stratify data where possible to make data-driven decisions
•
Serious Mental Illness (SMI) and co-morbid chronic conditions
•
Geographic variation
•
Variation by race, ethnicity and primary language
The ability to clearly justify your population based (and all other) DSRIP projects
using data from your CNA accounts for 20% of the total possible points for each
project
In addition, the CNA is worth 25% of the organizational application
35
And Most Important…
• Deadline is December 22; is December 16 for
speed and scope!
• Workgroups meet between now and then;
assistance with writing each section.
• 4 workgroups – care delivery and outcomes,
workforce, IT, finance.
• PAC advisory committee will participate in these
workgroup sessions. Workgroups have
participants from 3 hubs (NuHealth, North Shore
LIJ, and Catholic Health Services).
36

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