1. 1 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. NYHQ DSRIP High Risk Committee Kick-Off Meeting March 2015

2. 2 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Welcome & Introductions PPS Overview & Organizational Structure DSRIP Updates Progress To Date Implementation Plan Committee Purpose Implementation Plan Draft – Review Revision process Resources Next Steps » Implementation Plan – Final Submission (April 1, 2015) » Next Committee Meetings Agenda

3. 3 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Executive Committee Executive Committee PAC AuditCompliance PPS Organizational Structure *Sub-Committees & Workgroups will be formed as needed. NYHQ NYHQ Lead Hospital Practitioner Engagement NYHQ Board of Directors Cultural Comp & Health Literacy Long Term Care High Risk Population Behavioral Health & Primary Care Integration Communications Workforce IT & Performance Reporting Clinical Integration & Population Health Mgmt Finance PMO PMO

4. 4 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. PPS Org Structure: Committees

5. 5 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. CNA Completed & Projects Selected – DSRIP Updates

6. 6 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. DSRIP Plan – December 2014 Scale & Speed – January 2015 Implementation Plan – April 2015 Actualization of Plans – Begin April 1, 2015 DSRIP Updates Documents Available: -DSRIP Applications -Scale & Speed by Project -Implementation Plan Draft Current State

7. 7 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Organizational Sections Key Steps & Milestones Major Risks to Implementation & Mitigation Strategies Major Dependencies on Other Workstreams Roles & Responsibilities Key Stakeholders IT Expectations Progress Reporting Project Sections Major Risks to Implementation & Mitigation Strategies Scale & Speed Implementation Plan Structure

8. 8 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. DSRIP Updates Distribution Year QuarterReporting PeriodQuarterly Report Due Payment Date Project Plan & Implementation PlanN/AApril 20, 2015 DY1 - Q2April 1, 2015 - June 30, 2015July 31, 2015October 29, 2015 DY1 - Q3July 1, 2015 - September 30, 2015October 31, 2015 April 1, 2016 DY1 Q4October 1, 2015 - December 31, 2015January 31, 2016 DY2 - Q1January 1, 2016 - March 31, 2016April 30, 2016 October 1, 2016 DY2 - Q2April 1, 2016 - June 30, 2016July 31, 2016 DY2 - Q3July 1, 2016 - September 30, 2016October 31, 2016 April 1, 2017 DY2 - Q4October 1, 2016 - December 31, 2016January 31, 2017 DY3 - Q1January 1, 2017 - March 31, 2017April 30, 2017 October 1, 2017 DY3 - Q2April 1, 2017 - June 30, 2017July 31, 2017 DY3 - Q3July 1, 2017 - September 30, 2017October 31, 2017 April 1, 2018 DY3 - Q4October 1, 2017 - December 31, 2017January 31, 2018 DY4 - Q1January 1, 2018 - March 31, 2018April 30, 2018 October 1, 2018 DY4 - Q2April 1, 2018 - June 30, 2018July 31, 2018 DY4 - Q3July 1, 2018 - September 30, 2018October 31, 2018 April 1, 2019 DY4 - Q4October 1, 2018 - December 31, 2018January 31, 2019 DY5 - Q1January 1, 2019 - March 31, 2019April 30, 2019 October 1, 2019 DY5 - Q2April 1, 2019 - June 30, 2019July 31, 2019 DY5 - Q3July 1, 2019 - September 30, 2019October 31, 2019 April 1, 2020 DY5 - Q4October 1, 2019 - December 31, 2019January 31, 2020 First Due Date

9. 9 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Develop a structure for collaboration to focus on organizational functions and project implementation and outcomes specific to DSRIP deliverables according to the need of PPS partners and the community they serve. Committees will: Committee Purpose- Planning Phase Refine & finalize Implementation Plans – Due April 1, 2015 High level milestones / Risks & Mitigations / Financial Milestone Dates

10. 10 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Develop plans for actualization of functions or projects Project Plans Budgets Partner Expectations Engage key-stakeholders specific to project or function need Provide guidance for best practice standards & evidence based protocols Recommend strategies or policies to the Executive Committee Establish monthly reporting expectations & communication channels for progress updates Partner with PMO to monitor monthly & quarterly deliverables Create workgroups to continue development or implementation Committee Purpose- Operational Phase

11. 11 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 3.b.i Evidence-Based Strategies for Disease Management in High Risk/Affected Populations (Adults Only) 3.d.ii Expansion of Asthma Home-Based Self- Management Program 4.c.ii Increase early access to, and retention in, HIV care (Focus Area 1; Goal #2) High Risk Patient Projects

12. 12 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Project Objective: To support implementation of evidence-based best practices for disease management in medical practice for adults with cardiovascular conditions. (Adults Only). Project Goal: Ensure clinical practices in the community and ambulatory care setting use evidence based strategies to improve management of cardiovascular disease Focus on improving practitioner population management, adherence to evidence based clinical treatment guidelines, and the adoption of activities that will increase patient self-efficacy and confidence in self- management Utilizing strategies from the Million Hearts Campaign (http://millionhearts.hhs.gov) are strongly recommended 3.b.i Project Overview

13. 13 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Risk 1: Coordination with the implementation speed of the Patient Centered Medical Home recognition (Project 2.a.ii) and meeting PCMH level 3 targets Mitigation: coordinate timing of standardized strategies with implementation of the PCMH initiatives Risk 2: Coordination of activities within the different project work plans to ensure collaboration with the PCMH initiatives Mitigation: Current state assessment of cardiovascular disease prevention initiatives that are already a component of the existing PCMH framework will be used as a springboard to enhance collaboration with health care providers to heighten awareness as a means to improve patient outcomes. Risk 3: Inability to meet patient engagement and improvement in health outcomes due to a shortage of community health workers in the targeted community Mitigation: align with the resources of workforce plan to collaborate with community leaders to develop, strengthen and empower community health team workers to integrate culturally sensitive patients into the engaged population. Project 3.b.i Risks & Mitigations

14. 14 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Risk 4: limited provider enrollment and engagement in learning sessions related to the Stanford model for chronic disease management Mitigation: The local Community Action Advisory Committee (CAC), a multi-ethnic liaison to the community at large will be used to be a focal point for training purposes on the Stanford model. Project 3.b.i Risks & Mitigations

15. 15 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 3.b.i Evidence-Based Strategies for Disease Management in High Risk/Affected Populations (Adults Only) Counting Methodology: A count of patients that meet the criteria over a 1-year measurement period. Duplicate counts of patients are not allowed. The count is not additive across DSRIP years. Engaged Patient Definition: The number of participating patients receiving services from participating providers with documented self- management goals in medical record (diet, exercise, medication management, nutrition, etc). Engaged Patient Definition

16. 16 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 3.b.i: Project Implementation Speed

17. 17 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 3.b.i: Patient Engagement Speed

18. 18 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Project Objective: Implement an asthma self- management program including home environmental trigger reduction, self-monitoring, medication use, and medical follow-up to reduce avoidable ED and hospital care. Project Goal: Develop home-based services to address asthma exacerbation factors Focus will be emphasized on children, where asthma is a major driver of avoidable hospital use 3.d.ii Project Overview

19. 19 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Risk 1: Adherence to home based treatment regimens Mitigation: A population health management strategy will be developed using IT software that will be determined to best connect with the attributed patient population, to serve as a trigger for compliance, with medication reminders, appointment reminders, and general asthma health reinforcement Risk 2: Interconnectivity with school systems within the PPS service area Mitigation: Electronic school based health records are in different stages of technology development and the connection to an Asthma Resource Center will have to be recognized by the PPS leads to ensure that pathways to share the Medication Administration Form (MAF) with providers to coordinate care for the children associated with the project. Project 3.d.ii- Risks & Mitigations

20. 20 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Risk 3: Ability of providers to gain access to conduct the initial environmental assessment for trigger identification Mitigation: Use the Pediatric Asthma Center to serve as a model for PPS best practice Risk 4: Lack of financial reimbursement and funding for home based visits Mitigation: Link with funds flow to support home management, including repeat home visits when necessary with financial components/incentives Project 3.d.ii- Risks & Mitigations

21. 21 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 3.d.ii Expansion of Asthma Home-Based Self-Management Program Counting Methodology: A count of patients that meet the criteria over a 1-year measurement period. Duplicate counts of patients are not allowed. The count is not additive across DSRIP years. Engaged Patient Definition: The number of participating patients based on home assessment log, patient registry, or other IT platform. Engaged Patient Definition

22. 22 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 3.d.ii: Project Implementation Speed

23. 23 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. 3.d.ii: Patient Engagement Speed

24. 24 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Project Objective: This project will increase early access to, and retention in, HIV care. Project Description: Increase the percentage of HIV-infected persons with a known diagnosis who are in care by 9% to 72% by 12/31/17 Increase the percentage of HIV-infected persons with known diagnoses who are virally suppressed to 45% by 12/31/17 4.c.ii Project Overview

25. 25 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Risk 1: Unnecessary redundancy across area PPS’s and an overlap of NYHQ activities with the HIV workgroup charter Mitigation: Actively collaborate with organizations, other PPS and resources to address needs of this sub-population to improve overall project design which will ultimately improve patient outcomes Risk 2: Risk to the existing workforce associated with collaboration, additional training and resources that will be required for participating in this domain Mitigation: Align protocols and procedures around the integration of HIV project Project 4.c.ii- Risks & Mitigations

26. 26 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. NYHQ Project Management Office (PMO) – Maria D’Urso – mda9005@nyp.orgmda9005@nyp.org Louisa Low – lil9084@nyp.orglil9084@nyp.org Crystal Cheng – crc9038@nyp.orgcrc9038@nyp.org NYHQ PPS Website - http://www.nyhq.org/dsripppshttp://www.nyhq.org/dsrippps NYS DSRIP Website - https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/ https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/ Applications - https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_applicati ons/ https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_applicati ons/ Resources

27. 27 PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Implementation Plan Revision Committee Feedback KPMG Feedback Committee Meetings Additional Members Implementation Plan Finalization Actualization Planning First Quarter Deliverable – Q2 DY1 Next Steps

28. PROPRIETARY & CONFIDENTIAL – © 2014 PREMIER, INC. Questions?