NewYork-Presbyterian/Queens PPS Town Hall Delivery System Reform Incentive Payment (DSRIP) Program March 14, 2016 DSRIP Program Overview
Delivery System Reform Incentive Payment (DSRIP) Program • Health Transformation program being led by the NYS DOH
Goals of DSRIP: • Reduce avoidable hospitalizations & ED visits by 25% in 5 years • Improve access and utilization of Clinical Population Infrastructure System primary care & preventative care Outcome Focused Development Redesign services Improvements Improvements • Collaborate with community providers to improve care for patients
Why is this important to residents? New York State ranks in the bottom 25% nationally for ‘Potentially Avoidable Hospital Use and Cost of Case’1
Shift to Value Based Payments (VBP) for Care • Goal is to shift provider payments from MCOs from fee for service to value based payment (VBP) Improved collaboration between providers Improved access and quality to primary care and behavioral health services
1Source: Commonwealth Fund, October 2009 ‐”Aiming Higher: Results from a State Scorecard on Health System Performance, 2009”
DSRIP Opt-Out Letter
DOH is sending out letters to all Medicaid members about DSRIP
Letter allows patients to opt-out of sharing their health data with providers in the DSRIP system
• Opting out means the PPS will not have Medicaid information about that member and may not be able to direct services to that member
• Providers still share information with each other for patient treatment as they do today NYP/Q PPS Overview
PPS has over 1400 partners from 130 organizations • Contracting process underway Collaborating with neighboring PPSs Projects are focused on Primary Care, Long Term Care, and Behavioral Health
5 PPS Partner Network NYP/Q PPS Clinical Projects Clinical Projects Increase certification of primary care practitioners with PCMH PPS is implementing 9 2.a.ii certification and/or Advance Primary Care Models clinical projects 2.b.v Care transitions intervention for skilled nursing facility residents 2.b.vii Implementing the INTERACT project for SNF • Selected based on the community needs assessment 2.b.viii Hospital – Home Care Collaboration Solutions completed in 2014 3.a.i Integration of primary care and behavioral health services Evidence-based strategies for disease management in high 3.b.i risk/affected populations (Cardiovascular Disease – Adults Only) Expansion of asthma home-based self-management program 3.d.ii (Pediatric Only) 3.g.ii Integration of palliative care into nursing homes 4.c.ii Increase early access to, and retention in, HIV care NYP/Q PPS Updates
PPS earning 100% of Achievement Values for DY1, Q2 Report
• This resulted in the PPS receiving the total amount of eligible funding
Engaging partners in project implementation
Capital Funding (CRFP)
• PPS submitted 17 applications for capital projects in 2015
• 1 partner received funding for expansion of Primary Care & Behavioral Health Services
• CC/HL Strategy Submission
Cultural Competency & Health Literacy Strategy . PPS has completed a CC/HL strategy for the PPS & submitted for IA approval . Strategy Highlights: • Identifying factors to improve access to quality primary, behavioral, and preventive care services • Strategically inventory partners on current cultural competency and health literacy trainings/ programs • Enhancing communication with the community members on services available and techniques to improve communication during interactions with healthcare providers • Deploying assessments/tools to assist patients with compliance on self-management goals • Leveraging community-based interventions to reduce health disparities and improve outcomes
ASTHMA COALITION OF QUEENS 44% not well ASTHMA IN NYS controlled or very poorly 1 in 12 . Prevalence highest in non-Hispanic Black controlled.. adults children (15.4%)
1 in 11 . Hispanic asthma mortality rate more than 3.5 45% of above did not children times higher than non-Hispanic White mortality use asthma rate. controller medications. . Compared to the nation, NYS 1.9 ED visit and hospitalization rates higher for all age groups M 71% had never . Non-Hispanic Black hospital discharge rates been given an almost 5x higher than non-Hispanic White rate. asthma action.
$262 M . Non-Hispanic Black ED visit rate 6x times higher than non-Hispanic White rate. cost to (NYS DOH Asthma Surveillance Summary Report) 55% never been NYS advised to MMC modify their environment.
ALANE
Lincoln Mental Whitney M. Young Jr. Health and Family Health Center Medical Center, HHC ALANE NY Presbyterian Hospital ALANE Woodhull Mental Health and Medical ALANE Center, HHC Working together to improve the quality of life for people with asthma in the diverse county of Queens by engaging patients, families, healthcare providers, institutions and the community.
Hadi Jabbar, MD, Chair
Claudia Guglielmo, MPA, AE-C, Director
Cynthia Rosen, AE-C, Program Manager
COALITION PARTNERS
410 General Pediatric Clinic First Presbyterian Church in Jamaica NYS Department of Health Addabbo Family Health Center GlaxoSmithKline NYU Langone Medical Center Aerocrine Health4Youths Pediatric Asthma Center -NYHQ American Cancer Society Health First Queens Comprehensive Perinatal HealthPlus Amerigroup American Lung Association of the Northeast Council Asthma Coalition of Erie County Hudson Valley Asthma coalition Queens Hospital Center Asthma Coalition of Long Island Jamaica Hospital Medical Center Astra Zeneca Jamaica Hospital SBHC Queens Smoke-Free Partnership Boys Club of NY Make the Road NY Riis Settlement House, LIC Campaign for Tobacco Free Kids Meda Pharmaceuticals SBHC- Far Rockaway Chinese American Planning Council Merck Pharmaceuticals St Albans Medisys ACC Clergy United for Community Empowerment Mount Sinai Medical Center St. John’s University Cohen Children’s Medical Center Neighborhood Hunger Network Sunovion Committee for Early Childhood Development NSLIJ Health System Sutphin Medisys ACC East Harlem Asthma Center NY Hospital – Queens Take Care NY Emblem Health NYC Department of Health Thermo Fisher Scientific NYC Human Resources Administration Excelsior IPA Visiting Nurse Assoc. of Long Island NYC Office of School Health Wyckoff Hospital YMCA of Greater NY WHO DO WE WORK WITH?
people with asthma and families of people with asthma
especially those disproportionately affected by asthma, such as children and low income minority populations
in geographic areas with high asthma-related hospitalization rates and emergency department visit rates.
WHAT WE WORK TO DO
the # of hospitalizations
the # of emergency department visits
the # of school/work days lost
the # of clinic/provider office urgent care visits
the quality of life among people living with asthma
HOW DO WE DO IT ?
Measures of assessment Education for a partnership in and monitoring asthma care
Control of environmental Pharmacologic conditions and therapy comorbid conditions DSRIP 3DII Expansion of Asthma Home-Based Self-Management
Objective – Implement an asthma self-management program to reduce avoidable ED and hospital care
Home environmental trigger reduction Self-monitoring Medication use Medical follow-up
Care is at the heart of everything we do
An overview of St. Mary’s Healthcare System for Children St. Mary’s Healthcare System for Children St. Mary’s a national leader in intensive rehabilitation, specialized care, and education for children with special needs and life-limiting conditions.
St. Mary’s opened the first medical facility for children in New York City in the 1870s, and today remains the City’s only pediatric post- acute care hospital – and one of the State’s largest providers of long-term care services to children with medical complexity. Pioneers in Care St. Mary’s is internationally recognized for introducing innovative new treatment strategies that have revolutionized care for kids: • Pediatric Traumatic Brain Injury and Neuro-Rehabilitation – The first in the NY Metropolitan area • Interdisciplinary Feeding Disorders Program – The only program in NY State • Pediatric Home Care – The first in NY State and the only program designed specifically for children and young adults with medically complex conditions • Pediatric Palliative Care – The first of its kind in the US • Pediatric AIDS Home Care – The first program in NY State Our Network of Care St. Mary’s cares for 2,000 children every day. We provide care wherever it’s needed – at home, in the community, and at St. Mary’s Hospital for Children. • St. Mary’s Hospital for Children – 97 Beds • St. Mary’s Pediatric Day Healthcare Program • St. Mary’s Early Education Center • St. Mary’s Home Care, a special needs Certified Home Health Agency (CHHA) • St. Mary’s Kids at Roslyn, a community-based therapy center • St. Mary’s Community Care Professionals, a licensed home care services agency New York City’s One and Only
St. Mary's is the only pediatric post-acute facility in New York City, operating at nearly 100% capacity every day. St. Mary’s Healthcare System for Children
www.stmaryskids.org St. Mary’s Telehealth Program for the Medically Complex Population
Elvira F. Roveto, FNP B-C Home Care Administrator, DPS
Donna Mapp-Reid, RNC, CCM Telehealth Supervisor St. Mary’s Telehealth Program Background • In July 2014, St. Mary’s was awarded $928,668 from the NYS Balancing Incentive Program Innovation Fund (BIP) • Grant allows St. Mary’s to enhance its home care services through the use of an Interactive Voice Response System (IVR) • Original BIP contract period August 1, 2014 to September 30, 2015. DOH extension through 2017
St. Mary’s Telehealth Program Goals
1. Decrease the risk of re-hospitalizations
2. Increase medication adherence
3. Increase patient/family satisfaction St. Mary’s Telehealth Program Telehealth Targets The program targets children with medical complexity, with diagnoses including but not limited to: Seizure Disorder
Asthma
Respiratory (non-asthma)
Dehydration St. Mary’s Telehealth Program How IVR works • Patients / Caregivers sign consent to participate in the program • Patients / Caregivers agree to accept calls and they specify day/time/frequency that is most convenient for them • Automated calls are scheduled and monitored • Alerts are triggered based upon responses • Action is taken based on the type of alert Actions Taken When Alerts are Received • Each family that has triggered an alert receives a call by a Registered Nurse with extensive pediatric experience to determine appropriate interventions. • Common interventions resulting from the follow-up calls include: • Educating about the disease process, complications, and when to contact healthcare provider or seek emergency treatment • Providing education regarding medications and treatments • Identifying the need for an unscheduled home visit from their primary care Nurse. • Contacting the physician, pharmacy or vendor
St. Mary’s Telehealth Program
General Interactive Call Demonstration
Interactive Voice Response (IVR) allows patients to have St. Mary’s “eyes & ears” in the home in addition to regular scheduled in-person visits. St. Mary’s Telehealth Program Sample Template (Asthma) Asthma Program: Is the patient having any of the following: • Coughing at night? • Less physical activity? • Fast breathing? • Using the rescue inhaler more • Noisy breathing or wheezing? than usual • Signs of a cold or flu?
If yes for any above, alert triggered: - Yes: Alert Level: High » We will let the nurse know - No: Alert Level: None
St. Mary’s Telehealth Program October, 2014 – October, 2015 2000 1844 50% 1800 45% 45% 1600 40% 1400 35% 1200 30% 1000 837 26% 25% 800 20% 474 19% 600 348 5% 3% 15% 400 10% 200 100 54 5% 0 0%
Number of Alerts Percent of Total Medication Adherence • St. Mary’s recognizes the correlation between medication adherence and positive patient outcomes: • increased patient satisfaction • fewer hospitalizations and ED usage • reduced costs
• Medication teaching and monitoring is a key component of patient care.
• This program is an opportunity to influence medication adherence more consistently.
• All patients in the Telehealth program are asked questions about medication. St. Mary’s Telehealth Program
10 9 8.6 8 7 6 6.4 6 4.9 5 4 3 2 1 0 Hospitalizations Per Patient Percent of Patients Hosptialized 266 Patients in Cohort 1 BEFORE TH enrollment, First Qtr., 2014 Same 266 Patients in Cohort 1 ACTIVE TH , First Qtr., 2015 St. Mary’s Telehealth Program Program Achievements 500 patients enrolled
Successful DOH onsite survey - March 30, 2015
Patient and staff satisfaction has improved
Decrease in avoidable hospitalizations & medication issues
St. Mary’s Telehealth Program Testimonials “The Telehealth program has helped so much, I am able to explain problems to the Nurse and the interventions on the phone help and prevent me from going to the ER. Having the Nurse come out to visit after the phone call is also very helpful. I love the fact that someone always calls back and I am not alone.” “The program helps me, once I took him to Urgicenter but he was still not better. The call came and it was helpful to speak to the Nurse on the phone and then have another nurse visit. This stopped me from having to take him back to the ER. My child is not normal so the additional expert advice benefits him.” “ The program makes me feel safe.” “I have come to rely on the program, knowing I am not alone and have help even when life gets so busy.”
St. Mary’s Telehealth Program The Future • Use the data from this grant to help develop a care management model that will allow us to provide those services under managed care in the future for our children.
• Currently grant funded- Our ultimate goal is to work with Managed Medicaid and insurers to recognize the importance of the program in reducing hospitalizations and costs - and make this a reimbursable service.
• Our goal is to continue to innovate and find cost effective ways to better serve our medically complex children. St. Mary’s Telehealth Program
A costly ER visit or hospitalization can be avoided by the push of a button.
St. Mary’s at your fingertips is the solution….
St. Mary’s Healthcare System for Children
Elvira Fardella-Roveto, FNP B-C Donna Mapp-Reid, RNC, CCM 718-281-8723 718-281-8935 [email protected] [email protected]
www.stmaryskids.org BIP Transformation Grant utilizes “Federal funding” per section G, page 20 of 26 of the Master Contract for Grants.
NYS DOH Key Upcoming Dates
March 16 Revised PPS Third Quarterly Report due from PPS
March 31 Approval of PPS Third Quarter Report
April 1 DSRIP Year 2 Begins
April 8 DOH Holds All PPS Meeting
April 30 PPS Fourth Quarter Report due from PPS
Mid May DOH All PPS Learning Symposium
42 43 Contact Us! PPS Website: http://www.nyp.org/queens/dsrippps PMO Office: 718-670-1968 Executive Leadership: PMO Staff: • Maureen Buglino, RN, MPH • Sarah Kalinowski • Crystal Cheng Vice President, Community Medicine DSRIP Director Sr. Data Analyst [email protected] skalinowski@nexer [email protected] • Maria D’Urso, RN, MSN ainc.com Administrative Director, Community Medicine • Coleen Dunkley [email protected] DSRIP Program Coordinator • Amanda Simmons [email protected] Executive Director
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