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AGENDA Our DSRIP: ACP / AW Medical What it means for community providers like us? The Physician and DSRIP: Pay for performance Patient engagement:

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Presentation on theme: "AGENDA Our DSRIP: ACP / AW Medical What it means for community providers like us? The Physician and DSRIP: Pay for performance Patient engagement:"— Presentation transcript:

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2 AGENDA Our DSRIP: ACP / AW Medical What it means for community providers like us? The Physician and DSRIP: Pay for performance Patient engagement: Simple steps to higher payment

3 Our DSRIP: ACP / AW Medical

4 NYCPP North Shore - LIJ MEDISYS SYSTEM LEAD: AW MEDICAL

5 NEW YORK COMMUNITY PREFERRED PROVIDER
COMMUNITY PREFFERED NETWORK RENAISSANCE COLLABORATIVE

6 Community Provider Network (CPN)
Asian American ACO Chinese American IPA Chinese Community ACO Eastern Chinese American Physicians IPA Korean American Physicians IPA CBW Community Health Center

7 Renaissance Collaborative (RC)
Balance Medical ACO Balance Medical IPA Breukelen Community Network IPA Corinthian Medical IPA Excelsior Medical IPA Queens County IPA

8 NYCPP Leadership Team Dr. George Liu, Co-Chairman
Dr. Ramon Tallaj, Co-Chairman Dr. Henry Chen, Treasurer Dr. Emilio Villegas - Secretary Dr. Bing Lu, Board of Manager Dr. Hanbin Zheng, Board of Manager Dr. Jonathan Chang, Board of Manager Dr. Michael Li, Board of Manager Dr. Sunhoo Foo, Board of Manager Dr. Vincent Wang, Board of Manager Dr. Hal Sadowy, Co-Chief Operating Officer Ms. Peggy Sheng, Co-Chief Operating Officer

9 What it means for community providers like us?

10 We have brought over 2,000 physicians together as ONE
我們是一家人 Somos uno

11 Non-physician partners
AW Medical PPS is not just made up of Physicians Behavior Health and other important providers Physicians Hospitals Non-physician partners

12 Bronx ACMH, Inc. Center for Urban Community Services
Rain (Regional Aid For Interim Needs) Kings Harbor Multicare Ctr. Success Counseling Services, Inc Affinity Health Plan Riverdale Mental Health Association Sus-Mental Health Programs, Inc. Alpine Home Health Care Kingsbridge Hieghts Rehab And Care Center Centerlight Healthcare Inc. Rosselle Estrella, Pt Terrace Health Care Center, Inc Amazing Home Care Centerlight Healthcare Diagnostic & Treatment Center Mvp Housing Development Fund Company Inc. Scheuer Gardens Limited Partnership The Bridge Amber Court At Home The Pac Program Of The Bronx, Inc Scheuer Plaza Limited Partnership CL Healthcare Inc Narco Freedom, Inc Amber Court Of Pelham Gardens University Consultation & Treatment Center For Mental Hygiene, Inc. Community Access Inc Schnurmacher Center For Rehabilitation And Nursing New York Dialysis Services, Inc. Arms Acres, Inc Daughters Of Jacob Nursing Home Company Inc. Best Choice Home Health Care, Inc. New York Psychotherapy And Counseling Center Seniorcare Emergency Medical Services University Nursing Home Beth Abraham Health Services Doshi Diagnostic Imaging Services, P.C. Palisade Nursing Home Company, Inc. VIP Community Services Boris Dubrovsky, Phd Seniorride Sheryll Garcia, Pt Westchester Family Health Center Bronx Center For Rehabilitation & Health Care Eli Leiter, Phd Park Housing Development Fund Company Inc. St Barnabas Hospital Health System Friends And Family Weston United Community Renewal, Inc. Hebrew Home At Riverdale Bronx Lebanon Hospital Center Phoenix Houses Of New York, Inc. St Joseph's Hospital Jewish Association For Services For The Aged (Jasa) Williamsbridge Manor Nursing Home Bronx Park Rehab & Nursing Center Postgraduate Center For Mental Health Steinway Child And Family Services, Inc Bronx Supported Housing Jewish Board Of Family And Children'S Services Project Renewal Bronx-Lebanon Hospital Center

13 Brooklyn MJHS License Home Care Service Agency
Bushwick Center for Rehabilitation and Health Care Guidance Center of Brooklyn Ohel Childrens Home and Family Services Health Homes Phoenix House Foundation, Inc. AlphaCare CAIPA Social Day Care Center Homecrest Community Services, Inc Amber Court at Home Phoenix Houses of New York, Inc. Amber Court of Brooklyn Catholic Charities ICL Americare Certified Specialty Services, Inc. Center for Nursing and Rehabilitation ICM Brooklyn Postgraduate Center for Mental Health Jewish Board of Family and Children's Services Anna Sidorkina, LAC Center for Urban Community Services Preventive Diagnostics Best Choice Home Health Care, Inc. John J. Pershing Intermediate School 220 Rockaway Park Center CenterLight Certified Home Health Agency Shiel Medical Laboratory BETH ISRAEL MEDICAL CTR Lawton Street Community Residence St. Joseph's Hospital Central Brooklyn ACT St. Mark's MICA Supported Housing BGR Services, Inc. CL Healthcare Inc Linden House Community Residence Boro Park Center for Rehabilitation & Health Care Cobble Hill Health Center, Inc. St. Mark's Scattersite Supported Housing Livonia Avenue Breukelen Community Network IPA Community Access Inc./ Warren Street LUTHERAN MEDICAL CENTER Steinway Child and Family Services, Inc. Bridge Back to Life Center, Inc. Community Radiology of NY Marizza Dulfo, PT Steppingstone Congregate Treatment Doshi Diagnostic Imaging Services, P.C. Menorah Center for Rehabilitation and Nursing Care Bridger Summit Home Health Care BRIDGING ACCESS TO CARE East Brooklyn ACT Team Supported Housing for Women with HIV/AIDS Elderplan MJHS Long Term Care Brooklyn Center for Rehabilitation and Residential Health Care Emerson TAP New York Congregational Nursing Center SUS Empire City Laboratories Tillary Street Women's Shelter Federation of Organizations for NYS Mentally Disabled New York Psychotherapy and Counseling Center Brooklyn Community Services Williamsburg Physical Therapy Fresenius NEW YORK THERAPEUTIC COMMUNITIES, INC Bushwick Brooklyn ACT God's Love We Deliver, Inc

14 Manhattan 181 Street Medical PC
Chinese Community Accountable Care Organization Harlem East life Plan 3rd Street Men's Shelter Healthfirst ACMH, Inc CL Healthcare Inc Heritage Health Home Network Alberto De Castro, PT Community Access Inc. Heritage Healthcare Network Aleksey Kleyman, LAC Community Association of Progressive Dominicans (ACDP) ICL Broadway Community Residence Americhoice Comunilife Inc Amerigroup MLTC Isabella Nursing Home Coordinated Behavioral Care, Inc Pathways to Wellness HH Amerigroup/Healthplus Jason Waterman Asian American Accountable Care Organization, LLC Jewish Board of Family and Children's Services Corinthian Medical IPA, Inc Diana Badillo Balance Medical ACO Kenneth Ged Doshi Diagnostic Imaging Services, P.C. Balance Medical IPA, Inc Kenton Hall Men's Shelter Beacon of Hope House L&L Orthotics, LLC Elizabeth Uzor BETH ISRAEL MEDICAL CTR Manhattan Supportive Housing Elmont Open MRI Bridge Back to Life Center, Inc. Mary Claire Arbilo, PT Empire State Dental CareNext MARY MANNING WALSH Geffner House Center for Alternative Sentencing and Employment Services Melida Knibbs Good Sheperd Services Metroplus Health Plan Gouverneur Healthcare Services - Skilled Nursing Facility Center for Urban Community Servcies Metropolitan Center for Mental Health Gramercy Park Digestive Disease Center, LLC Charles B. Wang Community Health Center Metropolitan Jewish Home Care Inc. d/b/a MJHS Home Care Greenwich House, Inc. Chinese American IPA, Inc.

15 Manhattan (continued)
MIH Experience LTD Senior Whole Health The PAC Program of The Bronx, Inc Mitzy Baldovino, PT Seong Chul Ha, LAC MJHS Hospice and Palliative Care Service Program for Older People, Inc. United Rx Buying Group LLC National Association on Drug Abuse Problems, Inc. University Settlement Early Intervention Program Shiel Holdings, LLC New York Dialysis Services, Inc. Shiel Medical Laboratory Vidyasagar Pamulapati, PT New York eHealth Collaborative (NYeC) ST LUKES ROOSEVELT HOSP-ROOSEVELT HOSP Vijayalakshmi P. Davuluri, PT Visiting Nurse Service of New York Home Care NEW YORK EYE & EAR INFIRMARY ST LUKES ROOSEVELT HOSP-ST LUKES HOSP VNS Choice Ninel Platsman, PT St. Nicholas House VNSNY Palladia, Inc. SUS- Mental Health Programs, Inc. VNSNY Behavioral Health Phoenix House Foundation, Inc. VNSNY Hospice and Palliative Care Postgraduate Center for Mental Health TERENCE CARDINAL COOKE The Bridge Washington Heights Imaging Project Renewal The Fifth Avenue Counseling Center, Inc. WellCare Health Plan Rapid Care Solutions WellCare MLTC Rowell Arguelles, PT The First Chinese Presbyterian Community Affairs Home Attendant Corp. Weston United Community Renewal, Inc. Salcare Home Health Services, Inc Women In Need THE MOUNT SINAI HOSPITAL SCAN New York The National Alliance for the Mentally Ill of New York City, Inc. Senior Health Partners

16 Queens ACMH, Inc. Fishman Center Total Eye Care
Postgraduate Center For Mental Health Alvin Orodio, Pt Flushing Manor Care Center Amber Court Of Westbury Flushing Manor Dialysis Center Qsa Services, Inc. Arms Acres, Inc Flushing Manor Nursing Home Queens Center For Rehabilitation & Residential Health Care Bleuler Psychotherapy Center, Inc. Goodwill Industries Queens County Ipa Holliswood Center For Rehabilitation And Healthcare Bridge Back To Life Center, Inc. Queens Treatment Apartment Program Catholic Charities Jewish Board Of Family And Children'S Services Samaritan Village Center For Urban Community Services/Rikers Island Single Stop Liberty Physical Medicine & Rehab Samuel Field YM/YWCA CL Healthcare Inc Shiel Medical Laboratory Conifer Park, Inc Long Island Care Center South Shore Physician Group Cornerstone Medical Arts Center Hospital Long Island Consultation Center St Joseph's Hospital Margaret Tietz Nursing And Rehabilitation Center Steinway Child And Family Services, Inc. Cuatro Llc Dba Access Medicare Ny Michael K.T. Mangubat, Pt Supportive Services For Veteran Families Doshi Diagnostic Imaging Services, P.C. Milestone Supportive Housing New Horizon Counseling Center Sus- Mental Health Programs, Inc. Dr. William O. Benenson Rehab Pavilion New York Psychotherapy And Counseling Center The Mount Sinai Hospital Of Queens Eastern Chinese American Physicians Ipa Ohel Childrens Home And Family Services Union Plaza Nursing Home Dba Union Plaza Care Center Excelsior Medical IPA Parker Jewish Institute For Healthcare & Rehabilitation Venture House Fed Of Org For Nys Mentally Disabled Xeron Labs Phoenix House Foundation, Inc. Fidelis Care Phoenix Houses Of New York, Inc.

17 The Physician and DSRIP:

18 ABOUT DSRIP Delivery System Reform Incentive Payment
Incentive payments are performance based Patient engagement is KEY for incentive payment calculation which starts 01/01/2015 Goals are to achieve transformation of the health care safety net provider system, improving healthcare quality, improving population health, reducing avoidable hospital and ED use, and lowering healthcare cost.

19 ACHIEVING THE GOAL Implementing collaborative models of patient care
Enhanced care coordination and care management models Monitoring specific performance measures Adherence to evidence-based protocols Adherence to standardized processes across the PPS EDI and PCMH level 3 certification

20 Projects Selection 2.a.i Integrated Delivery System 2.a.iii Health Home At-Risk Intervention Program 2.b.iii ED care triage for at-risk populations 2.b.iv Care Transition 3.a.1 Integration of Primary Care & Behavioral Health 3.b.1 Cardiovascular Disease Management 3.c.1 Diabetes Disease Management 3.d.iii Asthma Management 4.b.i Tobacco Use Cessation 4.b.ii Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings

21 Patient engagement:

22 2.a.i Create Integrated Delivery Systems that are focused on Evidence Based Medicine / Population Health Management Target: All patients and Providers Engagement: Every patient has a sign RHIO consent form.

23 PCMH (2014 Version) Level 3 by 2017
2015 3/31/2015 2016 3/31/2016 2017 3/31/2017 Action Attest Data EHR Adopt, Implement, Upgrade (AIU) to 2014 Certified EHR AIU to Certified EHR AIU any 90-day period from 2014 Use Certified EHR MU Stage 1-Y1 any 90-day period from 2015 MU Stage1-Y2 & meet MU Stage 2 criteria full yr. 2016 MU Stage 1-Y2 full yr. 2015 MU Stage 2-Y1 MU Stage 2-Y2 MU Stage 3-Y1 PCMH Upgrade to PCMH 2014 version Prepare PCMH Level 3 Submit PCMH Level 3 Achieve PCMH Level 3 by 6/2017

24 2.a.iii Health Home At-Risk Intervention Program Target: Patients with one progressive chronic disease, serious mental Illness or traumatic brain Injury Engagement: Every patient that has a documented comprehensive care plan in place

25 2.b.iii ED care triage for at-risk populations
Target: Every patient seen in the ED Engagement: Every patient is given an appointment with their PCP or Health Home

26 2.b.iv Care transitions intervention model to reduce 30 day readmissions for chronic health conditions Target: Every patient with a Hospital admission or ER visit Engagement: Every patient in with pre-discharge planning and transitional care visit

27 3.a.i Integration of primary care and behavioral health services
Target: Every patient seen in the Primary Care or Behavioral Health setting Engagement: Every patient must have PHQ9 screening performed and documented

28 3.b.i Evidence based strategies for disease management in high risk/affected populations (adult only) (Cardiovascular Health) Target: Every adult patient with Cardiovascular disease or Hyperlipidemia Engagement: Every patient must have life style change counseling documented

29 3.c.i Evidence based strategies for disease management in high risk/affected populations (adults only) (Diabetes Care) Target: Every adult patient with Diabetes Engagement: Every patient must have a documented HgbA1C

30 3.d.iii Evidence based medicine strategies for asthma management (Asthma)
Target: Every patient with Asthma Engagement: Every patient must have a documented Asthma action plan in place

31 4.b.i Tobacco Use Cessation
Target: All smokers Engagement: Every patient must be screened for tobacco use and smokers counseled on cessation and referral to NY QUITS documented

32 4.b.ii Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings Target: All patients Engagement: Document and Prescribe Colonoscopy, Mammogram, Pap Smear, Prostate exam, HPV Vaccination, Safe Sex Education

33 Support Team Lidia Virgil 212-567-4918 lvirgil@rapidcaresolution.com
John Dionisio Susan Lau Liz Webb

34 Q & A


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