1. Clinical Project Meeting
HIV
(4cii)
NYHQ PPS
Delivery System Reform Incentive Payment (DSRIP)
June 8, 2015

2. Agenda Welcome & Introductions Clinical Leadership Meeting Purpose
Scope of Clinical Sub-Committee
PPS Updates & Timeline
DSRIP Project Review
Clinical Case Vision & Example
Clinical Planning
SWOT
Next Steps / Next Meeting
Questions / Adjourn

3. Clinical Leadership
Chair: David Rubin, M.D. -

4. Meeting Purpose
Initiate the clinical planning process of the NYHQ PPS DSRIP projects in order to complete the Project Implementation Plans due July 31, 2015, develop strategies for actualization of projects, identify operational process, IT, budget, or workforce needs, and ensure all engaged partners are actively engaged in planning & implementation.

5. Scope of Clinical Sub-Committee
Engage PPS network partners to operationally plan, develop, and design the clinical program outlined in the DSRIP application submitted in December 2014
Focus on collaborative planning processes that meet project requirements, metrics, and scale & speed expectations associated with the clinical program
Complete the Project Implementation Plans due July 31
Inform budgets and operational needs such as workforce & IT
Guide partners by becoming a resource and communication channel to ensure effective engagement

6. Scope of Clinical Sub-Committee
Clinical planning will include, but is not limited to:
Implement project design to include all committed PPS partners
Establish and meet performance reporting expectations
Establish expectations for evidence based medicine protocols & best practice standards
Communicate internally and externally on program development and progress
Explain variances of project requirement or metric progress
Ensure success of the project by improving clinical quality and meeting expectations of project requirements, scale & speed, and metrics
Work with other committees and sub-committees to ensure cross communication & feedback

7. PPS Updates & Timeline Organization Implementation Plans – Submitted
PPS Valuation Notification – Received
Project Implementation Plans – Due 7/31/2015
Executive Committee Meeting – 6/11/2015
PAC Meeting – 6/19/2015
Workforce Data Due – 10/31/2015
Budgets, Funds Flow, Business Agreements – In Development
Clinical Planning Meetings – Begin week of 6/8/2015

8. PPS Updates & Timeline
Organization Development, Budget & Funds Flow Development, Committee & Governance Structure Development, Clinical Planning & Implementation, IT Development, Workforce Planning, Partner Engagement, etc.
Clinical Planning & Development
Project Implementation Plans Due (7/31/15)
DY1 Quarterly Report Due (7/31/15)
Workforce Data Due (10/31/2015)

9. PPS Updates & Timeline
DSRIP Year/Quarter
Dates Covered
Quarterly Report Due
Payment Date
DY1, Q1
April 1, 2015 – June 30, 2015
July 31, 2015
January 2016
DY1, Q2
July 1, 2015 – September 30, 2015
October 31, 2015
DY1, Q3
October 1, 2015 – December 31, 2015
January 31, 2016
July 2016
DY1, Q4
January 1, 2016 – March 31, 2016
April 30, 2016
DY2, Q1
April 1, 2016 – June 30, 2016
July 31, 2016
January 2017
DY2, Q2
July 1, 2016 – September 30, 2016
October 31, 2016
DY2, Q3
October 1, 2016 – December 31, 2016
January 31, 2017
July 2017
DY2, Q4
January 1, 2017 – March 31, 2017
April 30, 2017
Bi-annual payments driven by quarterly reports of milestone, metric, & scale & speed achieved deliverables 9

10. DSRIP Project Review: Project Requirements
Decrease HIV and STD morbidity and disparities; increase early access to and retention in HIV care.
Increase peer-led interventions around HIV care navigation, testing, and other services.
Launch educational campaigns to improve health literacy and patient participation in healthcare, especially among high-need populations, including: Hispanics, lesbian, gay, bisexual, and transgender (LGBT) groups.
Design all HIV interventions to address at least two co-factors that drive the virus, such as homelessness, substance use, history of incarceration, and mental health.
Assure cultural competency training for providers, including gender identity and disability issues.
Empower people living with HIV/AIDS to help themselves and others around issues related to prevention and care.
Promote interventions directed at high-risk individual patient, such as therapy for depression.
Promote delivery of HIV/STD Partner Services to at risk individuals and their partners.

11. Numerator Description Denominator Description Reporting Responsibility
DSRIP Project Review:
Clinical Project Requirements: Metrics
Measure Name
Numerator Description
Denominator Description
Reporting Responsibility
Payment: DY 2 & 3
Payment: DY 4 & 5
Newly diagnosed HIV case rate per 100,000
Number of people newly diagnosed with HIV, regardless of concurrent or subsequent AIDS diagnosis
Number of people
NYS DOH
P4R
Newly diagnosed HIV case rate per 100,000—Difference in rates (Black and White) of new HIV diagnoses
Rate of Black non-Hispanics newly diagnosed with HIV, regardless of concurrent or subsequent AIDS diagnosis
Rate of White non-Hispanics newly diagnosed with HIV, regardless of concurrent or subsequent AIDS diagnosis
Newly diagnosed HIV case rate per 100,000—Difference in rates (Hispanic & White) of new HIV diagnoses
Rate of Hispanics newly diagnosed with HIV, regardless of concurrent or subsequent AIDS diagnosis

12. DSRIP Project Review: Project Implementation Plan
4.c.ii Increase early access to, and retention in, HIV care (Focus Area 1; Goal #2)
1.   Measurable milestones and implementation risks
Major risks to implementation and mitigation strategies
A primary risk for the NYHQ PPS DSRIP project focused on HIV care is the current New York State process for HIV testing is cumbersome for providers. This includes the opt-in approach for testing, provider knowledge on HIV testing, and access to care for patients. The PPS will mitigate this risk by ensuring that all PCPs offer HIV testing, when clinically indicated, for patients and that they are well versed on the process of testing and requirements of this project. Patients with behavioral health diagnoses pose an additional risk as they tend to be more complicated to manage and ensure that testing, treatment, and necessary follow-up care are received appropriately. The HIV committee with work with the Behavioral Health committee to align strategies for engaging these patients. Additionally, the NYHQ PPS recognizes the risk to the existing workforce associated with collaboration, additional training and resources that will be required for participating in this domain. PPS providers will work collaboratively with the HIV Workgroup Charter to align protocols and procedures around the integration of HIV screening and an improved linkage system, align protocols and procedures around a viral load suppression initiative, align training, protocols, and procedures around peer support programs, work together on a patient education and/or social marketing campaign, align on protocols and procedures around an EHR tool to track patients and ensure linkage to appropriate care, and design a training curriculum and/or provide joint training to PPS providers around cultural competency and HIV patients. This best practice appreciated collaboration will be addressed in the workforce organizational component so that the NYHQ PPS can contribute correspondingly to the HIV domain charter. Finally, the lack of patient navigation poses a risk for this patient population. The PPS will work with health homes to enroll patients as appropriate and will collaborate with the workforce committee to determine the need for hiring care navigators to work with providers and patients across PPS projects.

13. DSRIP Project Review: Project Implementation Plan
Project Requirements/sub-steps
Target Completion Date
Unit Level Reporting
1. Decrease HIV and STD morbidity and disparities; increase early access to and retention in HIV care.
Step 1…
Step 2…
[Please add additional steps based on your plan and timeline]
2. Increase peer-led interventions around HIV care navigation, testing, and other services.
3. Launch educational campaigns to improve health literacy and patient participation in healthcare, especially among high-need populations, including: Hispanics, lesbian, gay, bisexual, and transgender (LGBT) groups.
4. Design all HIV interventions to address at least two co-factors that drive the virus, such as homelessness, substance use, history of incarceration, and mental health.

14. DSRIP Project Review: Project Implementation Plan
5. Ensure that EHR systems used by participating safety net providers must meet Meaningful Use and PCMH Level 3 standards by the end of Demonstration Year (DY) 3.
Step 1…
Step 2…
[Please add additional steps based on your plan and timeline]
6. Empower people living with HIV/AIDS to help themselves and others around issues related to prevention and care.
7. Promote interventions directed at high-risk individual patient, such as therapy for depression.
8. Promote delivery of HIV/STD Partner Services to at risk individuals and their partners.

15. Clinical Case Vision & Example

16. Clinical Planning Space / Location IT Needs Patient Tracking Billing
Clinical Implementation
Workforce Impact / Need
Non-Covered Services Anticipated

17. SWOT Analysis
Strengths
Weaknesses
Opportunities
Threats

18. Next Steps / Next Meeting
Additional webinar based clinical planning meetings – TBD
Project Implementation Plan drafting & distribution
Executive Team Development of budgets, funds flow, agreements
Executive Committee review & approval
Partner agreement completion
PAC meeting 6/19/15

19. Questions /
Open Discussion ?

20. Resources
Website: Maureen Buglino, VP, Community & Emergency Medicine Maria D’Urso, Administrative Director, Community Medicine Crystal Cheng, Data Analyst, DSRIP