DY6 Core Component & Sustainability Reporting July 2017

Milestone 3: Core Component Reporting Based on Project Category Each Core Component must be addressed Usually 3 or 4 of these ALL have a Continuous Quality Improvement (CQI) Element EXAMPLE 2.9.1 A,B,C,D,E A Identify frequent ED users and use navigators as part of a preventable ED reduction program. Train health care navigators in cultural competency. B Deploy innovative health care personnel, such as case managers/workers, community health workers and other types of health professionals as patient navigators. C Connect patients to primary and preventive care. D Increase access to care management and/or chronic care management, including education in chronic disease self‐management. E Conduct quality improvement for project using methods such as rapid cycle improvement. Activities may include, but are not limited to, identifying project impacts, identifying “lessons learned,” opportunities to scale all or part of the project to a broader patient population, and identifying key challenges associated with expansion of the project, including special considerations for safety‐net populations.

Milestone 4 : Sustainability Reporting

Levels of Evaluation PROJECT LEVEL PROVIDER LEVEL Collaboration with Medicaid Managed Care Value Based Purchasing/Alternative Payment Models Other Funding Sources Project Evaluation Health Information Exchange PROVIDER LEVEL Collaboration with Medicaid Managed Care Health Information Exchange

Assess Project’s Sustainability Potential Collaboration with Medicaid Manage Care Value Based Purchasing/ Alternative Payment Models Other Funding Sources Project Evaluation Health Information Exchange

Collaboration with Medicaid Managed Care List those enrolled as a network provider If NOT enrolled – Why NOT? APM – Alternative Payment Model VBP – Value Based Payment Methodologies APM/VBP Arrangements? Encounter reporting? Tracking of Services? Cost of Services? Incentives Earned? What is working? What is NOT working? If NOT doing APM/VBP – Why NOT?

Collaboration with Medicaid Managed Care Are MCO members being referred to your project? Why? Why NOT? Are Services of the project NOT billed to Medicaid (for MCO members)? Give Type of Service & Billing Code Are other non-Medicaid payers billed for Services of the project?

APM/VBP Methodologies FFS + Incentive and/or Disincentive Component? DRG + Incentive and/or Disincentive Component? Partial Capitation? Full Capitation? Bundled Payment? Episode Payment? "Non-financial Incentive (i.e. administrative relief, preferential provider status)“? Supplemental Payments? Shared Savings/Risk?

Value Based Purchasing/ Alternative Payment Models Discussing with MCO potential for payment for DSRIP services via APM/VBP methodology? If yes, what is being discussed? If no, WHY not? APM/VBP Arrangements with NON-Medicaid payers? If yes, who? And what are terms?

Other Funding Sources Does the project have other funding sources? Grant funding? Insurance Payments? Is the project pursuing agreements with other government agencies? Why NOT? City, County, School Districts, etc... Foundations? Other Organizations?

Project Evaluation Cost-benefit analysis, Return-on-investment analysis or Other quality related evaluation of this project Aspects of the Project to evaluate Evaluation Methodology (described) Quality Outcomes evaluated Positive Impact (based on formal or informal evaluation) Assets Successes Outcomes Improvements

Project Evaluation Areas for Improvement Adjustments to the project Barriers to success Remaining Needs Unmet Goals Adjustments to the project Already implemented OR Being considered Cost Effectiveness How is it evaluated and explored? **In the context of CONTINUING the intervention (project) Replicable Other states? Other providers? Key to Project Success Identify

Health Information Exchange Does project exchange health-related information between/among individuals/ organizations? Who is exchanging data? What type of data is being exchanged? Claims Data Clinical Data Case Notes Other

Health Information Exchange Describe data being exchanged What systems are used to exchange the data? Is it “real-time” data? If lags, what is the lag time? Actions being made to reduce lag time? Obstacles to exchange of health related data: Contract agreement(s) (too burdensome)? Inadequate Technology? Technology too costly? Project does not require data transfer? Other? Are there ACTIONS to overcome these obstacles? Formal HIEs being used on this project? Why NOT?