TRANSFORMING HEALTHCARE & REDESIGNING MEDICAID Delivery System Reform Incentive Payment May 18, 2016 MEDIA - Medical Education and Information Association

“The healthcare industry is undergoing a period of fundamental transformation in which the very model of healthcare delivery is being questioned and changed.” Moody’s Investors Service, U.S. Not-for-Profit Healthcare

Improve general health of population Increased preventative care & wellness initiatives Enhance patient care experience  Quality  Safety  Satisfaction New care delivery model using evidence-based standards of care. –Focus on Population Health – Stratify and Manage Critical Populations  High Risk for Inpatient or Emergency care  Rising Risk  Low Risk – Wellness / Prevention Reduce healthcare costs National Healthcare Reform

New York State Medicaid Redesign Global spending cap for all Medicaid services Shift from institutional ( hospitals, skilled nursing facilities ) to community-based services ( primary care physicians, patient-centered medical homes, health homes, home health care agencies, rural health networks ) Maintenance of the healthcare safety net for Medicaid and uninsured population ( Vital Access Providers )

Shift from volume based (payment per visit) to value-based (payment for performance) Include performance metrics  Clinical  Safety  Satisfaction Form integrated care networks who share bundled payments New York State Managed Care Payment Reform

W HAT IS DSRIP ? The Delivery System Reform Incentive Payment (DSRIP) is the main mechanism by which New York State will implement the Medicaid Redesign Team (MRT) Waiver Amendment. DSRIP´s purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with a goal of reducing avoidable hospital use by 25% over 5 years. 6

W HAT IS DSRIP? Statewide initiative open to all hospitals and a wide array of safety-net & other providers Collaboration amongst providers & formation of integrated care networks as Performing Provider Systems (PPS) Slate of projects approved by Center for Medicare and Medicaid Services (CMS) reducing avoidable hospitalizations and Emergency Department visits by 25% DSRIP payments based on performance results 7

DSRIP A N OVERVIEW OF D ELIVERY S YSTEM R EFORM By 2020, NYS Medicaid fully transitions from volume-based fee for service to value-based payment methodology putting payments at risk based on provider performance. Managing risk requires existing Medicaid safety net providers to: Create integrated regional care delivery network structure with sufficient Medicaid covered lives to manage risk-based payments. Organize provider network to effectively & efficiently deliver care to Medicaid beneficiaries. Develop analytical & financial core competencies for population health management.

Performing Provider System (PPS) Roles and Responsibilities  Integrating care across settings through collaboration: IP/OP, institutional, and CBOs.  Accountability for patient outcomes & healthcare costs (e.g., Population Health Management).  Exploring ways to improve public health.  Sharing data and electronic health records.  Accepting & distributing bundled & risk-based payments: negotiating as single entity with Managed Medicaid. 9

Care Compass Network Region

Hospitals (UHS, Lourdes, Cortland RMC, Cayuga Medical Center, Guthrie) Health Homes Skilled Nursing Facilities Diagnostic & Treatment Centers & Federally Qualified Health Centers (FQHCs) Physicians & Allied Health Professionals (PCPs, Specialists) Behavioral Health Providers Home Health Care Agencies Community Partners (DSS, DOH, Human Service Organizations, Office of Aging etc.) 11 C ARE C OMPASS N ETWORK PPS OF THE S OUTHERN TIER REGION COLLABORATION & LOCAL PARTNERSHIPS

Care Compass Network Lourdes and UHS made the decision to partner UHS was determined to be lead entity due to Medicaid Health Home experience and experience in large mother/baby and behavioral health programs Lourdes and UHS reached out to Guthrie, the CBO community and encourage them to come to a meeting to learn about DSRIP CBOs reached out to other CBOs An open stakeholders group was formed, which evolved into the Project Advisory Committee (PAC) Collaboration

A stakeholders meeting with over 120 in attendance was held to select a project slate for the newly developed PPS Cost: Time The inclusive approach became a foundation for an enduring bond among the organizations Teams and leadership were formed around each project and initiative such as work force, information management, governance etc….. A largely voluntary effort produced the application. Once application was awarded, formal organization structure implemented Collaboration

Care Compass Network Vision 14 The Care Compass Network PPS Vision is to improve the health and life of Medicaid beneficiaries who engage in coordinated, culturally sensitive services that utilize the most appropriate, effective setting given medical, behavioral, social, and health literacy needs.

Care Compass Network Overview Care Compass Network valued at $213-$224 million by the Department of Health Payments quarterly throughout year Staffing of PPS Care Compass Network has 20 FT employees Formation of 4 Regional Performance Units (RPUs) 15

The Care Compass Network includes four Regional Performing Units (RPU’s) which will allow for execution of DSRIP related projects and efforts at a localized level. RPU by County North RPU – Cortland, Tompkins, & Schuyler South RPU – Broome & Tioga East RPU – Chenango & Delaware West RPU – Steuben & Chemung C ARE C OMPASS N ETWORK R EGIONAL PERFORMANCE UNITS ( RPU ) 16

17 Develop & implement model of care that right sizes, realigns, & integrates continuum of community-based & institutional services to achieve DSRIP goals. Retrain & redeploy healthcare workforce to align with & support transformed service delivery model. Implement community-based care coordination to deploy early intervention & prevention to people with rising risk for chronic illness & facilitate access & movement through care settings in service continuum. Build organizational infrastructure for population health management, financial operations, contracting & electronic information management needed to support the PPS in achievement of DSRIP quality & utilization goals. C ARE C OMPASS N ETWORK GOALS

ProjectDescription DOMAIN 2 – SYSTEM TRANSFORMATION 2ai – Integrated Delivery System (IDS) Create a clinically integrated provider network focused on evidence-based medicine and population health management. 2biv – Care Transitions Provide a 30-day supported transition period post discharge to reduce readmissions for patients with chronic disease. 2bvii - INTERACT Interventions to Reduce Acute Care Transfers from Skills Nursing Facilities. 2ci – Community-Based Healthcare Navigation Develop health navigation services to assist patients in accessing healthcare services efficiently. 2di – Patient Activation “Project 11” Address patient activation measures (PAM) so that the uninsured (UI), non-utilizers (NU) and low-utilizers (LU) of Medicaid services are impacted by DSRIP projects and become more activated over time. C ARE C OMPASS N ETWORK 11 PROJECTS 18

ProjectDescription DOMAIN 3 – CLINICAL IMPROVEMENT 3ai – Integration of Primary Care and Behavioral Health Services Integration of mental health and substance abuse with primary care services to ensure coordination of care for both services. 3aii – Crisis Stabilization Provide accessible behavioral health and substance abuse crisis services that will allow access to appropriate level of service and providers, supporting rapid de-escalation of the crisis. 3bi – Chronic Disease Management - CVD Support implementation of evidence-based best practices for disease management in medical practice for adults with cardiovascular conditions. 3gi – Palliative Care in PCMH Primary Care Offices Integrate palliative care services within the PCMH primary care setting. DOMAIN 4 – POPULATION HEALTH 4aiii – Strengthen Infrastructure Across MH/SA Programs (Prevention) Support collaboration among leaders, professionals and community members working in MEB health promotion. 4bii – Chronic Disease Mgmt/Prevention COPD Increase access to high quality COPD preventative care and management. C ARE C OMPASS N ETWORK 11 PROJECTS 19

How to Get Involved Regional Performance Unit Meetings Monthly Stakeholders Meetings Operational Committees Access the Care Compass Website Questions? Reach out to partner Relations