PROJECT ADVISORY COMMITTEE (PAC) Thursday, September 20, 2018 9:00 - PowerPoint PPT Presentation

PROJECT ADVISORY COMMITTEE (PAC) Thursday, September 20, 2018 9:00 am - 12:00 pm Hilton Garden Inn – Stony Brook Hosted by the Office of Population Health at Stony Brook Medicine 9/20/2018

WELCOME REMARKS Presented by Linda S. Efferen, MD, MBA Executive Director & VP, Medical Director Suffolk Care Collaborative 9/20/2018 2

TODAY’S MODERATOR William Wischhusen, LMHC, NCC Assistant Director Care Management and Care Coordination Suffolk Care Collaborative 9/20/2018 3

MEETING AGENDA 8:30 am – 9:00 am Registration Office of Population Health 9:00 am – 9:05 am Welcome Remarks Linda S. Efferen, MD, MBA Executive Director & VP Medical Director, SCC 9:05 am – 9:50 am True Population Health in the Context of Value Based Ryan Ashe, MPA, PMP Payment Director of Medicaid Payment Reform at NYS Department of Health 9:50 am – 10:05 am Break 10:05 am – 10:45 am Jeff Steigman, PsyD Chief Administrative Officer Family Service League’s Christian Racine, PhD Crisis Services Continuum Senior Director of Clinics Jessica Aquino, LCSW-R Director, DASH (Diagnostic, Assessment and Stabilization Hub) 10:45 am – 11:25 am William Bishop, MHA Leveraging Regional Health Information Organization (RHIO) Director, Clinical Programs Innovation, SCC Alerts to Improve Outcomes Diana Cappabianca, RN Education and Care Coordinator, Meeting House Lane Medical Practice, PC 11:25 am – 11:30 am Closing Remarks Linda S. Efferen, MD, MBA Executive Director & VP Medical Director, SCC 11:30 – 12:00 pm Networking 9/20/2018 4

TRUE POPULATION HEALTH IN THE CONTEXT OF VALUE BASED PAYMENT Presented by Ryan Ashe, MPA, PMP Director of Medicaid Payment Reform at NYS Department of Health 9/20/2018 5

6 Agenda • Update on Value Based Payment progress • NYS VBP Model and Population Health  VBP Roadmap requirements • SDH / CBO VBP Roadmap Requirements • Considerations as VBP Moves Forward

7  VBP Roadmap requirements Update on Value Based Payment Progress

8 September 2018 VBP Progress & Key Milestones Meeting DSRIP year 3 VBP statewide goals • Reviewing provider progress in VBP • Conducting Pilot Lesson Learned Webinars Clinical Advisory Groups NYS Payment Reform Bootcamps VBP Pilots 2016 2017 2018 2019 2020 DSRIP Goals April 2017 April 2018 April 2019 April 2020 Performing Provider > 10% of total MCO > 50% of total MCO 80-90% of total MCO Systems (PPS) expenditure in Level 1 expenditure in Level 1 expenditure in Level 1 requested to submit VBP or above VBP or above. VBP or above growth plan outlining > 15% of total payments > 35% of total payments path to 80-90% VBP contracted in Level 2 or contracted in Level 2 or higher higher

9  VBP Roadmap requirements NYS VBP Model & Population Health

10 New York State Value Based Payment Framework Support a model that: Requires a broad network of provider partners that requires population health  VBP Roadmap requirements spans the complete care capabilities spectrum

11 New York State Value Based Payment Design of the Model Core Components of VBP Model • 3 Levels of risk • Quality measures • Attribution • Finance and target budget setting • VBP Arrangements  VBP Roadmap requirements • Population based (total care for a population) • Episodic (primary care and chronic condition) • Social Determinants of Health Interventions & Community Based Organizations

12 VBP Arrangements: Population Based & Episodic • General Population Approach Behavioral Physical • Specialty Population Approach Health Health • Behavioral Health • HIV/AIDS • Managed Long Term Care • Intellectually & Developmentally Disabled • Integrated Primary Care Diabetes, Depression, • (Preventive Care, Sick Care, 14 chronic Conditions) Anxiety, Trauma, Substance Use Disorder, bi-polar • Maternity disorder, Lower back pain, • ( Pregnancy, Delivery, Post Delivery (Mom & Baby) hypertension

13 Evolving provider networks Develop and build partnerships to include: • Behavioral health providers • Substance use providers • Hospitals • PPS  VBP Roadmap requirements • Community based organizations • Investors

14 Population Health Capabilities Investment in: • primary care infrastructure • care coordination • referral pattern and discharge management activities • care integration… partner primary, acute, home and community based care, physical  VBP Roadmap requirements and behavioral health • Population health data and analytics  Reduce health inequities or disparities among different population groups and address social determinants of health.

15  VBP Roadmap requirements SDH/CBO VBP Requirements

16 VBP Roadmap Requirements for CBO & SDH Interventions Social Determinants of Health Interventions & Community Based Organizations are critical components to the NYS VBP model • Level 2 & 3 arrangements must include at least one CBO and one SDH intervention. • MCOs will provide upfront funding (seed money) to providers which implement SDH interventions in level 2 and 3 arrangements  VBP Roadmap requirements • SDH interventions must address one of five key social determinant of health domains 1. Economic Stability 2. Education 3. Health and Healthcare 4. Neighborhood and Environment 5. Social, Family, and Community Context

17 How is DOH operationalizing CBO & SDH inclusion? • As part of internal contract review process: o Internal contract review to ensure compliance with VBP Roadmap requirements o SDH/CBO Template to support SDH/CBO requirements o On Menu/ Off Menu Checklist • Ongoing efforts to strengthen and support CBO engagement  VBP Roadmap requirements o Outreach to private investment & philanthropic organizations o Continuing VBP Bootcamps 10/10 o Planning SDH & CBO Collaboratives o CBO Directory o SDH Summit 9/26

18 April 2018 SDH Intervention Menu The SDH intervention menu provides examples of evidence-based interventions to address SDH For more information, access the VBP Resource Library on the DOH website https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/vbp_subcommittee_info.htm

19 April 2018 SDH Template The SDH template was created to assist CBOs and MCOs with contracting for SDH The Social Determinants of Health (SDH) Template will: • identify the contracted CBO • identify the SDH intervention • explain why the SDH intervention was selected • illustrate how the intervention will be measured • understand funds utilization For more information, access the VBP Resource Library on the DOH website

20  VBP Roadmap requirements Considerations as VBP moves forward

21 Key considerations as MCOs, providers and CBOs move forward in VBP • Streamline contracting between parties, MCOs, providers and CBOs • Consider CBO hub “concept” • Explore opportunity for third party investment in shared savings arrangements • Engage partners early and often  VBP Roadmap requirements • Keep in mind the VBP milestones • 50% Level 1 & 15% Level 2 by April 2019 • 80% Level 1 & 35% Level 2 by April 2020

22 CBOs: Determine the pathway forward General Guidelines: • Your organization’s proposal may be different depending on your partner • Define your proposal, cost, timeline, impact, outcomes (health & financial) • Streamline contracting • Keep in mind 5 main buckets 1. Identify the intervention: • Align intervention to your potential partners  • Regional considerations (rural – access to care, opioids) VBP Roadmap requirements • Global, national or local recognition that intervention is successful Define the concept • Start w/ manageable size, then expand • Is it a Food security initiative or food security that combines wellness visit for seniors?

23 CBOs: Determine the pathway forward 2. Identify your contracting mechanism & support: • MCO or provider contract • Philanthropy (local) • Private equity • Combination of approaches:; contract with MCO and include philanthropy)  VBP Roadmap requirements 3. Build the value proposition • Necessary upfront investment • Determine ROI (health outcomes and financial) • Metrics • Timeline • Scalability • Impact

24 CBOs: Engaging in value based payment 4. Engage your partners: • Engage early and often • Understand the members MCOs and/or providers serve (overlap) • Providers are an option • Be flexible • Build relationships!!  VBP Roadmap requirements 5. Make the pitch • Prepare • Build support (foundations, government, MCOs, providers, philanthropy, advocates, etc.) • Stay connected to your partners

BREAK 15 minutes 9/20/2018 25

FAMILY SERVICE LEAGUE’S CRISIS SERVICES CONTINUUM Presented by Family Service League Team Jeff Steigman, PsyD Chief Administrative Officer Christian Racine, PhD Senior Director of Clinics Jessica Aquino, LCSW-R Director, DASH (Diagnostic, Assessment and Stabilization Hub) 9/20/2018 26