1. DY6 Sustainability Planning
Beginning the process …

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

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

4. 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?

5. 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?

6. 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?

7. 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?

8. 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?

9. 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

10. 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

11. 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

12. 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?