PROJECT ADVISORY COMMITTEE (PAC) Thursday, March 31, 2016 9:00am-12:00pm Islandia Marriott Long Island Hosted by the Office of Population Health at Stony Brook Medicine 1
AGENDA Joseph Lamantia, Welcome Remarks 9:00 am – 9:10 am Chief of Operations for Population Health Stony Brook Medicine Alyssa Scully, Director Project Management Office, Ashley Meskill, RN, SCC DSRIP Program Clinical Project Manager, 9:10 am – 9:45 am Progress Reports Amy Solar Greco, Project Manager Susan Jayson, LCSW, BH & PC IC Implementation Specialist BREAK 9:45 am – 10:00 am Kristie Golden, PhD Integrating Behavioral Health Associate Director of Operations, Neurosciences 10:00 am – 10:40 am Across the Continuum of Care Neurology, Neurosurgery & Psychiatry Hospital Administration, Stony Brook Medicine Moderator, Kristie Golden, PhD Primary Care - Behavioral Health Associate Director of Operations, Neurosciences Integrated Care Practices Panel 10:40 am – 11:50 am Neurology, Neurosurgery & Psychiatry Discussion Hospital Administration, Stony Brook Medicine Joseph Lamantia, Closing Remarks 11:50 am – 12:00 pm Chief of Operations for Population Health Question & Answers Stony Brook Medicine 2
WELCOME REMARKS Presented by Joseph Lamantia Chief of Operations for Population Health Stony Brook Medicine 3
DY1 IS IN THE BOOKS! Five Stages of the DSRIP (Apologies to Kubler-Ross) Denial – You’re kidding right? Anger – You want us to do what? Bargaining – How many meetings do I have to go to? Depression – Are the days for fee-for-service really numbered? Acceptance – Where do I sign! 4
KEY THEMES – “BUILDING A FOUNDATION” 2015 PAC mtg Key Themes March 2015 IT Interoperability and Care Management CBO’s and PCMH June 2015 October 2015 Cultural Competency & Health Literacy and Value Based Purchasing December 2015 Partner Onboarding Program (Provider Contracting) “These key themes have and will continue to shape and provide form, function and purpose to the SCC” 5
STAY INFORMED • Project Advisory Committee Membership o Membership directory just over 1,100 • Communication Strategies: eNewsletters o Synergy and DSRIP In Action • Website at www.suffolkcare.org guide for partners/providers, community and project stakeholders Quarterly PAC Meeting Participation Text SUFFOLKCARES to 22828 to join our eNewsletters!
BEHAVIORAL HEALTH AND PRIMARY CARE INTEGRATION The “Burning Platform” Approximately 23% of our PPS Medicaid members are defined as behavioral health recipients (member* with 1+ claims with a primary or secondary behavioral health diagnosis) Behavioral health recipients cost, on average, 4.65 times more per recipient and represent 58% of total Medicaid spending Behavioral health recipients drive 48% of all ED visits; Behavioral health recipients represent 58% of admissions to hospital and on average have a 1.65X longer length of stay in hospital than non-behavioral health recipients 32% of all Primary Care visits are attributed to behavioral health recipients Source: CY 2013-2014 Medicaid claims data is the data source
BEHAVIORAL HEALTH AND PRIMARY CARE INTEGRATION PROGRAM This program is aimed at developing collaborative integrated care models between PCPs and behavioral health organizations. • BH → PC • PC → BH • IMPACT Behavioral Health Primary Care co- Evidence-based co-located in located in Care Coordination Primary Care Behavioral Health Model for Practices Practices Depression Care Model 1 Model 2 Model 3 8
MEETING OBJECTIVES DSRIP Program Progress Reports • The office of population health will highlight current status reports on the NYS DSRIP Program efforts, including project-specific updates and achievements to date. Integrating Behavioral Health Across the Continuum of Care • Dr. Kristie Golden, Associate Director of Operations, Neurosciences, Neurology, Neurosurgery & Psychiatry, Hospital Administration at Stony Brook Medicine and Project Lead of the SCC DSRIP Project 3ai, will be describing current trends in Primary Care – Behavioral Health Integrated Care practices, best practices in screenings, and integrated care implementation strategies. Behavioral Health & Primary Care Integrated Care Panel Discussion • A panel of health care leaders representing primary care and mental health will share thoughts and perspective on the Primary Care – Behavioral Health Integrated Care Model and discuss what can be leveraged for DSRIP PPS. 9
DSRIP PROGRAM PROGRESS REPORTS Presented by Alyssa Scully, Director Project Management Office, Ashley Meskill, RN, Clinical Project Manager, Amy Solar Greco, Project Manager Susan Jayson, LCSW, Implementation Specialist, Behavioral Health & Primary Care Integrated Care Program 10
PATIENT ENGAGEMENT SCORECARD DY1 Q1 - DY1 Q3 (APRIL 1 - DEC 31, 2015) Target 9,531 Target 2,216 Target 717 Target 7,950 Actual 22,397 Actual 2,400 Actual 1,294 Actual 8,471 Achievement Achievement Achievement Achievement Rate 235% Rate 108% Rate 180% Rate 106% Hospital Hospital Nursing Home CBO 2bvi: TOC 2bix: OBS 2bvii: INTERACT 2di: PAM Target 4,505 Target 2,180 Target 4,533 Target 2,180 Actual 11,473 Actual 3,609 Actual 5,246 Actual 3,081 Achievement Achievement Achievement Achievement Rate 255% Rate 165% Rate 115% Rate 141% PCP & BH PCP PCP PCP 3ai: PCBH 3bi: Cardio 3ci: Diabetes 3dii: Asthma Key: Checkmark means meeting or exceeding target, X=Not on Target SCC Project Management Office Report Template
BUILDING AN INTEGRATED DELIVERY SYSTEM (2AI) Approach Accomplishments Next Steps • Engage groups of • Expanded IDS/PHM • Complete Clinical SMEs to direct each of Workgroup Integration Strategy the 11 IDS Project • Clinical Integration • Complete Population Requirements Needs Assessment Health Management • Create an integrated Complete Roadmap delivery system • IT Clinical Data Sharing • Continue working with through clinically & Interoperable safety-net partners on integrating network Systems Roadmap RHIO enrollments providers aimed at Complete • Continue technical-on- achieving improved • Initial RHIO Gap boarding with population health. Analysis Complete partners in building the IDS Visit our program page: https://suffolkcare.org/aboutDSRIP/projects/2ai1 12
BUILDING AN INTEGRATED DELIVERY SYSTEM (2AI) TOC Workgroup PM: Ashley Meskil 2ai Project PHM/IDS Project Workgroup Committee IT Task Force PM: Ned Micelli PCMH Certification Workgroup IDS Project Key Themes PM: Althea Williams • Integrated Delivery System • Population Health Management Care Management & Care Coordination • Transitions of Care Workgroup • PM: Kelli Vasquez Clinical Integration/Clinical Interoperable Systems Performance Reporting & Management • RHIO/SHIN-NY Connectivity Workgroup • Meaningful Use PM: Kevin Bozza • PCMH Certification Value Based Payment Team • PCP access & capacity PM: Neil Shah • Care Coordination & Collaborative care Community Engagement Workgroup practices • PM: Althea Williams Care Management • Value Based Payment Community Health Activation Program • Community Navigation/Engagement PM: Amy Solar-Greco 13
ACCESS TO CHRONIC DISEASE PREVENTIVE CARE INITIATIVES (4BII) Approach Accomplishments Next Steps • Support promotional • Create a first draft • Initiate work on online activities to increase community resource Community Resource prevention and directory Directory on the SCC awareness efforts for website • HITE Online lung cancer, breast Community • Formalize materials cancer and colorectal Resource Directory for chronic-disease cancer screening website partnership prevention/education education, obesity formalized programs prevention and • Patient Education tobacco cessation in materials reviewed & clinical and approved by CC & HL community settings. workgroup Visit our program page: https://suffolkcare.org/aboutDSRIP/projects/4bii 14
SUBSTANCE ABUSE PREVENTION AND IDENTIFICATION INITIATIVES (4AII): SBIRT Approach Accomplishments Next Steps • Identify & train SBIRT • SCC Monthly SBIRT • Continue to host Monthly Hospital-based Facility Training Program SBIRT Trainings at all Champions to implement underway partner hospitals to train SBIRT Implementation staff • Stony Brook Medicine & Plan Brookhaven Hospital go- • Next Learning • Operationalize PPS-wide live complete Collaborative scheduled SBIRT Training Program to share collaborative • CHS held kick-off for for Hospital staff practices implemented Health System by Stony Brook Medicine • Workgroup & Committee • Continue learning from & Brookhaven Hospital engaged to collaborate Northwell Health on best practices, lessons • Begin collecting data to Southside’s experiences learned and risk support program in SBIRT roll-out mitigation strategies development efforts through “Learning Collaboratives ” Visit our program page: https://suffolkcare.org/aboutDSRIP/projects/4aii 15
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