AMCH PPS. Clinical & Quality Affairs Committee

Transcription

1 AMCH PPS Clinical & Quality Affairs Committee Kallanna Manjunath MD, FAAP, CPE George Clifford, PhD Brendon Smith, PhD Susan Kopp, MBA, BSN, RN February 24, 2016

2 AMCH PPS: Clinical & Quality Affairs (CQA) Committee Presentation Objectives: NYS DSRIP Mid-Point Assessment Overview Project Implementation Updates PHM System Acquisition Bridge solution

3 NYS DSRIP Program: Mid-Point Assessment Overview The Mid-Point Assessment is a required component of the DSRIP Program as outlined in the Special Terms & Conditions of the 1115 Waiver that governs the program. Intended to provide a review of PPS progress towards the implementation of the approved DSRIP Project Plans and to determine any modifications necessary. The requirements include an assessment of: Compliance with the approved DSRIP Project Plan; Compliance with the required core components for DSRIP projects; Non-duplication of Federal funds; 3

4 NYS DSRIP Program: Mid-Point Assessment Overview The requirements include an assessment of: (contd.) Analysis and summary of relevant data on performance on metrics and indicators Benefit of the project to the Medicaid and uninsured population and to the health outcomes of all patients served by the project; Project governance including recommendations for how governance can be improved to ensure success; Opportunity to continue to improve the project by applying any lessons learned or best practices Current financial viability of all lead providers participating on the DSRIP project. 4

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6 NYS DSRIP Program: Mid-Point Assessment Process The Independent Assessor (IA) will be responsible for conducting the Mid-Point Assessment and will rely on the following key data sources: Approved DSRIP Project Plans PPS Quarterly Reports DY1, Q1 through DY2, Q1 Claims and non-claims data for P4R/P4P measures PPS Lead Financial Stability Test The IA will review the PPS project plan for overall compliance & assess likelihood of project success. Final Mid-Point Assessment recommendations, inclusive of Independent Assessor and PPS recommendations (see Timelines), will be subject to review by the Commissioner of Health, Project Approval and Oversight Panel (PAOP) and CMS. PPS will be expected to implement any recommended project plan modifications by March 31,

7 NYS DSRIP Program: Mid-Point Assessment Process Recommendations from IA may include, but are not limited to, the following: Continuation of PPS Project Plan; Modifications to the approved project plans, such as a change in a project or projects selected for implementation by a PPS; Changes to the PPS Lead entity; Consolidations of multiple PPS in to a single PPS; Discontinuation of a PPS Project Plan; Other remediation or improvements to increase the likelihood of PPS project success Adding new providers to PPS network to assist in meeting PPS performance goals; or Replication of best practices of other PPS. 7

8 AMCH PPS: Project Updates

9 AMCH PPS: Project Sequence - Update Project name Project ID Start date 1. Integrated Delivery Systems 2.a.i Nov/Dec ED Care Triage 2.b.iii Nov/Dec Patient Engagement PAM & CFA 2.d.i Nov/Dec Asthma Evidence-Based Guidelines 3.b.iii Dec 2015/Jan Cardiovascular - Hypertension 2.a.iii Dec 2015/Feb Integration of PC & BH Part I (Models 1 & 3) 3.a.i Jan 2016/Feb Health Home At-Risk Intervention Program 3.b.i Jan 2016/ Feb BH Community Crisis Stabilization 3.a.ii Jan 2016/Feb Integration of BH & PC Part II (Model 2) 3.a.i Jan 2016/Mar Medical Village SNF 2.a.v Apr Tobacco Cessation 4.b.i Jun Cancer Screening 4.b.ii Jun 2016

10 Create an Integrated Delivery System focused on Evidence-Based Medicine and Population Health Management (2.a.i) Project Overview Updates All providers interested in participating in any DSRIP project initiatives must be involved in Project 2ai as this is an all encompassing project 2ai addenda is formally approved and will be sent out for signature Upcoming Milestones: 09/30/2016 Project Involvement/Engagement All PPS Providers must be included in the integrated Delivery System. (Milestone 1) Engage patients in the integrated delivery system through outreach and navigation activities, leveraging community health workers, peers, and culturally competent community-based organizations as appropriate (Milestone 11) Population Health / IT Perform population health management by actively using EHRs and other IT platforms, including use of targeted patient registries, for all participating safety net providers (Milestone 6) Value Based Purchasing Contract with Medicaid Managed Care Organizations and other payers, as appropriate, as an integrated system and establish valuebased payments (Milestone 8) Reinforce the transition toward value-based payment reform by aligning provider compensation to patient outcomes (Milestone 10)

11 2.a.iii- Health Home at-risk Intervention Program Project Introductory Webinar held on February 18 th Core Components of the Project Review of the Project Summary and milestones Reporting requirements and outcome measures Subcommittee Membership If interested in joining the subcommittee, please First subcommittee meeting will be held in the next 4-6 weeks. 11

12 Create a Medical Village/Alternative Housing Using Existing Nursing Home Infrastructure (2.a.v) Project Overview Updates All SNFs interested in participating in 2av will be receiving summary information and an assessment survey related to this project. Still waiting to receive information from the NYSDOH regarding capital funding requests for this project. Upcoming Milestones: 03/31/2017 Project Involvement/Engagement Identify specific community-based services that will be developed in lieu of these beds based upon the community need. (Milestone 5) Information Technology Use EHRs and other technical platforms to track all patients engaged in the project. (Milestone 6) Quality Outcomes Provide a clear statement of how the infrastructure transformation program with promote better service and outcomes for the community. (Milestone 2) Provide a clear description of how the reconfigured facility will fit into a broader IDS that is committed to high quality care. (Milestone 3)

13 ED Care Triage Subcommittee Update Second Subcommittee Meeting on February 1 st, 2016 Subcommittee Chair: Dr. Denis Pauze Agenda: Subcommittee roles and responsibilities Proposed job descriptions of care coordinators Outcome measures Stakeholder Engagement Meetings ED Diversion and Crisis Stabilization Project Meeting in Hudson on February 29th Meeting with EmUrgent Care Leadership on March 4th Columbia Memorial Hospital: presentation to the ED department in March Next Meeting: March 7th at 10am via WebEx and in-person at AMCH Contact: Mingie Kang (kangm1@mail.amc.edu).

14 Implementation of Patient Activation Activities to Engage, Educate and Integrate the uninsured and low/ non-utilizing Medicaid populations into Community Based Care (Project 2.d.i) December 2015 roll out the PAM Train the trainer method. Initial PAM Trainings facilitated with our 3 major hospital partners (AMCH, Columbia Memorial & Saratoga Hospital). CBO partners & local government entities were also trained on PAM (Catholic Charities, Planned Parenthood, Healthcare Consortium, Columbia County Mental Health, Greene County Family Planning & Community Caregivers) Total PAM Trained Individuals as of 02/09/2016 is 108. Total number of PAM Surveys completed as of 2/09/2016 is 840 The PMO Project Team continues to roll out the train the trainer method across our PPS network.

15 Integration of Primary Care and Behavioral Health Services 3.a.i The 3.a.i Project Summary is completed and distributed. 3.a.i Models 1 and 3 webinar was held on Thursday, February 11, a.i Model 2 webinar to be held the week of March 7, The Behavioral Health Sub-Committee is continuing to be populated with the first Sub-Committee meeting to be held in March 2016.

16 Behavioral Health Community Crisis Stabilization Services 3.a.ii The Behavioral Health Sub-Committee for this project continues to be populated. The 3.a.ii Project Summary is being finalized and will be distributed soon. A 3.a.ii webinar is planned for Monday, February 29, A Sub-Committee meeting is being proposed for March 2016.

17 CVD Project: Evidence-Based Strategies for Disease Management in High Risk/ Affected Populations (3.b.i) WebEx meeting held February 8: AMCH PPS: Review of Organizational and Project Components Burden of Hypertension/Cardiovascular Disease (CVD) AMCH PPS CVD Project details: Project overview Million Hearts Initiative Achievement Values (AVs) & Performance Measures Documentation requirements for project milestones Next steps: Project Subcommittee formation and meeting

18 Asthma Project: Implementation of EBM Guidelines for Asthma Management (3.d.iii) WebEx meeting held January 21 (Pilot of project-specific WebEx meetings): Burden of Asthma AMCH PPS Asthma Project details: Project overview Project implementation plan Project Specific Performance Measures Documentation requirements for project milestones Next steps: Project Subcommittee formation and meeting Project Subcommittee to be led by Dr. Ron Dick Pediatric Hospitalist with a special interest in asthma

19 Insight Driven Health AMCH DSRIP IT Interim Solution CQAC February 24, 2016 Copyright 2016 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. Copyright 2015 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 19

20 Contents Long Term Solution Update Interim Project Assumptions Copyright 2015 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 20

21 Long Term Solution Status DRAFT FOR DISCUSSION Reference checks are being performed on the final 2 vendors and site visits will be scheduled, but contracting cannot move forward without NY State capital funding Identification RFI Scoring Demonstration Vendor Selection 14 vendors were identified based on Accenture s SMA survey, knowledge of the population landscape, and best of breed analysis The Requirement Traceability Matrix (RTM) informed the RFI and vendor responses were validated and scored against the 7 categories from the TOM 4 vendor demonstrations were held to illustrate product capabilities and assess strategic fit TOM user scenarios were incorporated into a unified patient story for affiliates to provide input on The demos were evaluated, bringing us to 2 final vendors, Cerner and Optum Reference checks have been performed on Optum, with Cerner upcoming; site visits will follow with the goal of having one partner selected when capital funding is released Evaluation Sources High-level TOM TOM User Scenarios Contracting The selected vendor can then be contracted with and aligned to DSRIP and broader Population Health needs. Copyright 2015 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 21

22 DRAFT FOR DISCUSSION Interim Project Assumptions The scope of the detailed project work plans can be categorized by milestone requirement and focused based on assumptions 115 Project Milestones 74 milestones within next 18 months 35 milestones requiring Technology Assumptions There are 115 total milestones across 11 projects Interim solutions will be built for the next 18 months, so milestones ending before or on 9/30/17 were considered Focus on Tier 1 affiliates Based on these assumptions, 35 milestones were reviewed to identify enabling activities to complete each milestone; these milestones span 12 functional categories Work plans were developed around the 12 functional categories Focus on Tier 1 12 functional categories Copyright 2015 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 22

23 DRAFT FOR DISCUSSION Interim Project Overview and Deliverables Three deliverables were completed during the month of January Milestone Breakdown Functional Category Identification Work Plans Worked with PMO to: Review each milestone and understand, based on DOH reporting and validation protocols, activities across people / process / technology Identify enabling activities to complete each milestone Created visual diagrams to represent involved activities Identified functional categories across milestones based on enabling activities (18 mths) Functional categories were used to organize and align projects to impact several project metrics simultaneously Developed work plans for each functional category (18 mths) Technology inputs identified in the milestone breakdown were entered in an estimator, which produces a work plan Copyright 2015 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 23

24 DRAFT FOR DISCUSSION Functional Categories Overview Analytics Functional Categories Requirement Description Low Cost Solution Description Budget and finance Care coordination Compliance Contracts and QE agreements Population Health Management (PHM), cohort identification, and hot spotting Incentive payments tracked per provider Services offered in the same facility and transfers between facilities Meaningful Use and PCMH certification; status and vendor credential tracking Tracking of contracts, contract changes, and QE agreements PPS self-submission; PMO to perform analysis for state submissions MCO report self-submission; PMO to configure Performance Logic to receive reports and audit Care plan exchange via Hixny; shared care plan system at home health locations Affiliate self-reporting via Performance Logic Contract with providers and track agreements using Performance Logic 6 Document management Administrative submissions (e.g. State reports, training material and process documents) Performance Logic 7 8 HIE integration Learning management system Connectivity to QE; (e.g. Hixny, RHIO, SHIN-NY) Training documentation and execution PPS affiliates self-submit via Performance Logic Affiliates integrate with Hixny based on standard spec Potential use of affiliate LMS solution as an interim/ long-term solution Patient engagement Registries and patient tracking System configuration and integration Performance mgmt Patient survey and analysis Tracking patient encounters from PPS systems; EHR subcommittee to define Data element integration and standardization; includes EHR user security Monitoring of provider or healthcare worker performance PPS self-submission via Performance Logic Inter-related with Registries and document management solutions Integrate with Hixny (PHM/patient tracking capabilities Develop other project-specific registries; leverage tracking mechanism from Hixny PPS to define standards Affiliate to configure systems to standards Affiliate self-reporting via Performance Logic Copyright 2015 Accenture All Rights Reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. 24