Before we begin, reminders for today’s webinarDec 11, 2018 · Before we begin, reminders for...
Transcript of Before we begin, reminders for today’s webinarDec 11, 2018 · Before we begin, reminders for...
OneCity Health Partner Webinar | December 11, 2018 1
Before we begin, reminders for today’s webinar
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OneCity Health Partner Webinar | December 11, 2018
OneCity Health Partner Webinar
Reviewing our PPS Performance, Gearing up for Phase IV Contracting and the Importance of RHIO Connectivity
December 11, 2018
OneCity Health Partner Webinar | December 11, 2018
Today’s Presenters
Rich Bernstock,
Hub Executive Director
Israel Rocha,
CEO, OneCity Health and Vice President, New York City Health + Hospitals
Ismael Carter,
Hub Executive Director
Ben Goldsteen,
Chief Analytics Officer
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OneCity Health Partner Webinar | December 11, 2018
OneCity Health Partner Webinar Series Logistics
General partner
questions and comments
will be addressed today
via the chat function.
We’ll stop and ask for
questions when you see
the following symbol:
4
If we are unable to answer a general
question, we will address it in a future
newsletter or webinar
For questions unique to you, we
recommend you contact our support desk
To ask a question, send a message to
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You can find slides from our previous
webinars in the “News” section of our
website. Slides are posted immediately
after the webinar, and shared in our
subsequent newsletter
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not trapped in your spam filters, please add
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OneCity Health Partner Webinar | December 11, 2018
Topics for Today’s Webinar
CEO Special Session
Phase IV Contracting
Phase III Metric Reminders and Upcoming Trainings
RHIO Connectivity Update
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OneCity Health Partner Webinar | December 11, 2018
Topics for Today’s Webinar
CEO Special Session
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OneCity Health Partner Webinar | December 11, 2018
OneCity Health PPS Performance
OneCity Health Partner Webinar | December 11, 2018
Note: As part of a December 2015 waiver amendment request to the federal Centers for Medicare and Medicaid Services, New York is seeking to slightly modify these percentages.
Source: New York State Department of Health, Attachment I—NY DSRIP Program Funding and Mechanics Protocol, April 2014.
Slide Source: The Commonwealth Fund
15%
45%
65%
85%
20%
25%
15%
15%
15%
80%
60%
40%
20%
DSRIP Year 1 DSRIP Year 2 DSRIP Year 3 DSRIP Year 4 DSRIP Year 5
Project progress milestones
Pay-for-reporting
Pay-for-performance
DSRIP is shifting from reporting to performance-based payments
In Measurement Year 5, 85% of payment is based on performance
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OneCity Health Partner Webinar | December 11, 2018
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5148
42 4139 38 38 37
35 33
0
10
20
30
40
50
60
New York City PPS MY3 PerformancePercentage of Claims-Based Metrics
Meeting Improvement Target* (%)
PPS achieved 48% of improvement targets for 33 claims-based metrics; 3rd highest
percentage of metrics achieved among downstate peers
How did we perform on our improvement targets in Measurement Year 3?
Management Recommendation
Overall, OneCity Health PPS performed
well on performance improvement targets
relative to downstate peers, however
there is significant room for improvement
on utilization measures.
*Metrics are calculated based on claims as opposed to survey or electronic medical record review. These metrics are available to all PPS through the Salient Interactive Miner tool provisioned by the New
York State Department of Health
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OneCity Health Partner Webinar | December 11, 2018
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OneCity Health PPS saw strong MY3 improvements but additional performance gains needed
to further narrow the gap to All-PPS average
Data Source: New York State Department of Health DSRIP MY3 Performance Summary
Preventable Readmissions(per 100,000 Medicaid members)
1000
900
678.7
575.4
800
700
600
500
400
MY0 MY1 MY2 MY3
1058
856
-18.5%
-15.2%
Preventable ED Visits
(BH Population)(per 100 Medicaid members)
120
98.4
83.7
100
60
40
20
0
MY0 MY1 MY2 MY3
99.5
116-14.2%
-14.9%
Preventable ED Visits(per 100 Medicaid members)
100
80
60
40 34.129.2
20
0
MY0 MY1 MY2 MY3
4248
-12.5%
-14.3%
OneCity Health PPS RateAll PPS Rate
Performance relative to PPS average for utilization measures
Management RecommendationDecreasing potentially avoidable utilization, has been challenging for the majority of NYC PPS. For OneCity Health performance is
improving but off-target and requires additional targeted strategies, including additional access to primary or urgent care services
and coordination of care to address social determinants of health.
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OneCity Health Partner Webinar | December 11, 2018
13.9 8.3
17.3
6.5
16.5
-
(24.7)
(6.3)
(51.8)
(6.5)
-
(32.5)
-60
-50
-40
-30
-20
-10
0
10
20
Earned
Unearned
MY3 Results on Pay-for-Performance Metrics
in Earned and Unearned Revenue ($M)
The PPS only earned 34% of pay-for-performance metrics in Measurement Year 3
Where are the biggest opportunities?
Access Behavioral
Health
CAHPS Chronic
Conditions
Project 11 Utilization
% Earned 36% 57% 25% 50% 100% 0%
*MY4 and MY5 revenue include $18.6M in palliative care P4P metrics 11
OneCity Health Partner Webinar | December 11, 2018 12
The Project Approval and Oversight Panel (PAOP) highlighted areas for improvement
Preliminary PPS MY4 results (MY4, Month 9)
High performance On-track Off-track
Pediatric asthma admissions
Adult access to preventive or
ambulatory care (20 – 44 years
old)
Adult access to preventive or
ambulatory care (45 – 64 years
old)
Statin therapy for patients with
cardiovascular disease –
received statin therapy
× Follow-up after psych
hospitalization for mental
illness within 30 days
× Anti-depressant medication
management
× Initiation of alcohol and other
drug dependence treatment
× Prevention quality indicators:
× Younger adult asthma
(18 – 39 years old)
× Heart failure
OneCity Health Partner Webinar | December 11, 2018
OneCity Way
OneCity Health Partner Webinar | December 11, 2018 14
The evolving role of OneCity Health
OneCity Health Partner Webinar | December 11, 2018
Topics for Today’s Webinar
CEO Special Session
Phase IV Contracting
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Guiding principles for Phase IV Contracting
It is imperative for OneCity Health to demonstrate rigor in performance provisions and connectivity of our contracting strategy with the New York State Department of Health (NYS DOH) Value-Based Payment (VBP) Roadmap
Phase IV contracting will overlap with last six months of Measurement Year 5 and the final DSRIP program year
Phase IV contract will serve as a test of our sustainability thinking including potential post-DSRIP contracting options with strategic partners
Guiding principles for Phase IV Contracting:
Reflect a continued shift to outcomes and performance
based payments in preparation for value-based
payment
Focus on investing in areas of strategic importance
post-DSRIP
Include standard conditions of participation for all
contracted partners to build necessary capabilities and
infrastructure post-DSRIP and for compliance
purposes
Drive high-value interventions including in the areas of
primary care access and behavioral health
Minimize administrative burden (contract metrics
should be aligned with PPS metrics and there should
be fewer total metrics)
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Contracting methodology aims to maximize performance opportunities for DSRIP MY5
and beyond
Timeline for Phase IV Contracting
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Executive Committee
and Business
Operations
Committee Approval
of contracting
methodology for
Phase IV Part One
Review contracting methodology for Part Two
Amendment with PPS Business Operations
Committee
(pended to Nov 15th)
Review contracting
methodology for Phase
IV Part Two with PPS
Business Operations
and Executive
Committees
Phase IV Part One
contracting
Amendment Issued
Oct 5 Nov 8 Nov 15
Issue
Phase IV Part Two
contracting
amendment
Nov 21 ~ Jan/Feb 2019
Phase IV Contracting
Content:
Phase IV Comprehensive Schedule B Part
One
• Extension of term of the Master Services
Agreement (MSA) through end of DSRIP
program and wrap-up of PPS activities
(June 30, 2020)
• Composite of PPS participation
requirements (workforce survey,
compensation and benefits survey,
financial assessment, compliance
attestation)
o Metric due dates: April 2019, October
2019, January 2020
Prerequisites:
MSA
Phase III Comprehensive Schedule B
(if applicable)
Completed 2018 DSRIP Compliance
Attestation
Logistics:
Part One Amendment and Phase III
Comprehensive Schedule B closeout letter
issued on November 21 to 164 partners
30 calendar days to sign Part One
Amendment
Notify OneCity Health immediately of any
changes to your organization’s signatory
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Overview
Phase IV Contracting Part Two
Align performance requirements and
expectations for partners with value-based
purchasing standards
Establish one or more minimum pre-requisites
for participation for applicable partner types:
• Phase IV Part One
• Quality rating
• Connectivity to regional health
information organization (RHIO) / health
information exchange (HIE)
• Meaningful use (MU)-certified electronic
health record
• Connectivity to NowPow PowRx
(closed-loop referral) module
Contract for high-value connections to
care and interventions that are expected
to positively impact priority outcome
measures targeted by OneCity Health
Align fee structure with standard
payment practices to reduce
administrative burden to partners and
PPS
Utilize available data sources to
establish performance baselines,
improvement targets and frequency of
performance measurement
Reflect principles of readiness and the shift to value-based purchasing
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Phase IV Contracting Part Two
Partner Type
(as applicable)
Impact on
Priority
Outcome
Measures
PPS Required
Pre-requisites
Community-Based
Organization
Health Home
Home Health Care
Hospitals
Mental Health
Nursing Home
Primary Care
Pharmacy
Substance Abuse
Use of
Technology &
Quality Rating
• MU-certified EHR
• RHIO / HIE
• NowPow
• Medicare Star Rating
Content Framework
Examples
Connections
to Care
• Primary care
• Behavioral health
• Care management
• Housing
• Insurance
• Other social and family supports (NowPow)
High-Value
Interventions
• Care management
• Community Health Worker engagement
• Critical time intervention
• Food and nutrition
• Medication delivery
• Medication adherence
• Legal services
• Respite beds
• Transportation
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Phase IV Contracting Part Two
Overarching funds flow allocation is
commensurate with New York State
Department of Health requirements for PPSs:
• Safety net partners: 95%
• Non-safety net partners: 5%
Types of pricing models:
• One-time
• Fee-for-Service (or hybrid: with incentive)
• Capitation (or hybrid: with FFS)
• Incentive-based
One-time costs for select services or activities
Fee-for-Service (FFS) contracts pay set rates
each time the service is utilized (for example,
pricing for community health worker service is
based on the number of home visits where the
unit of service is the “home visit.”)
Capitation contracts pay a set periodic rate for
each covered person (there is no fixed cap on
the amount of services an individual can receive
during a given period)
Incentive-based also referred to as “pay-for-
performance” or “royalty” models, incentive-
based contracts pay a percentage of resulting
revenues or profits, or a percentage of resulting
cost savings (for example from reduced
hospitalizations of a patient)
Funds Flow and Pricing Framework
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OneCity Health Partner Webinar | December 11, 2018
Topics for Today’s Webinar
CEO Special Session
Phase IV Contracting
Phase III Metric Reminders and Upcoming Trainings
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OneCity Health Partner Webinar | December 11, 2018
Upcoming Phase III Deadlines
Although the Phase III contract term ends December 31, 2018 and Phase IV begins January 1, 2019, there is no change to the Phase III metrics due in January 2019. These metrics cover reporting for the performance period ending December 31, 2018
Please refer to the OneCity Health Partner Reporting Manual and OneCity Health Partner Portal
for comprehensive information on completing all Phase III Process Metrics
As a reminder, you are only responsible for completing the Process Metrics in your Phase III
Comprehensive Schedule B
The next two slides will detail upcoming metrics
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OneCity Health Partner Webinar | December 11, 2018
Upcoming Phase III Deadlines
As Phase III winds down, there are several final process metrics due at the end of December and throughout January 2019
Due December 31, 2018: Process Metric N_011 (Nursing Home partners report on CMS Star Rating)
Due January 15, 2019: Three final process metrics
• Process Metric N_005: VBP Training (We will discuss this requirement more in the next slide)
• Process Metric N_006: PCMH Recognition (For Primary Care partners who have not previously submitted
this metric)
• Process Metric N_007: RHIO Connectivity (For partners who have not previously submitted this metric)
Due January 25, 2019: Seven recurring Process Metrics
Due January 31, 2019: Twelve additional recurring Process Metrics
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OneCity Health Partner Webinar | December 11, 2018
Value Based Payment Training: Process Metric N_005 is due January 15, 2019
Attending a Value Based Payment (VBP)
training is a PPS-wide metric that all
partners must meet
There are a wide variety of VBP trainings
available to partners. For the purposes of
completing Process Metric N_005, partners
may attend any relevant VBP training
There are several VBP trainings currently
available on the OneCity Health Learning
Management System (LMS)
You can also register on the LMS for an
upcoming VBP webinar for OneCity Health
partners that will be held on December 13,
2018: Cross-Sector Partnerships as a
Promising Strategy for Health System
Improvement
The New York State Department of Health
also offers VBP trainings, including their VBP
University
When reporting on this metric, partners will
be required to upload to the Portal proof of
training completion in 2018 for at least one
employee. This proof may include:
• Any certificate of completion of a VBP
training from the OneCity Health LMS or
any other external training
• A training sign-in sheet, along with an
agenda and/or copy of training materials
for any VBP training held at your
organization
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For registration and course description information please visit the OneCity Health Learning
Management System at lms.onecityhealth.org
One City Health: Supporting the Learning Needs of our Partners
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Upcoming Training Offerings
December 2018
• 12/13: Advanced Motivational Interviewing Techniques for Clinicians
• 12/13: CBO VBP Webinar #1: Cross-Sector Partnership as a Promising Strategy for Health
System Improvement
• 12/14: Addressing the Housing Needs of Patients
• 12/14: Enabling Safe Living Environments for Clients
• 12/19: Worker Connect
January 2019
• 1/17: CBO VBP Webinar #2: Cross-Sector Partnerships Producing Notable Results
• 1/18: Patient Engagement Strategies
• 1/28: Assessing and Managing Suicide Risk
• 1/28: e-Cigarettes Grand Round
OneCity Health Partner Webinar | December 11, 2018
Topics for Today’s Webinar
CEO Special Session
Phase IV Contracting
Phase III Metric Reminders and Upcoming Trainings
RHIO Connectivity Update
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OneCity Health Partner Webinar | December 11, 2018
What is the RHIO?
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The State Health Information
Network of NY (SHIN-NY) is a
secure network for sharing
electronic clinical records in New
York State.
The SHIN-NY comprises 8 regional hubs
(RHIOs - Regional Health Information
Organization) and the New York eHealth
Collaborative (NYeC).
NYeC is the technical hub that connects the
RHIOs to allow for cross-RHIO data exchange.
Once OneCity Health partners connect to one
RHIO, then they are connected to the others
through the SHIN-NY.
OneCity Health Partner Webinar | December 11, 2018
RHIO Function – Component Map
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RHIO COMPONENTS
Participation
Agreement
(PA)
Consent
Collection
Data
Sharing
Electronic
Medical Record
(EMR)
RHIO
Development
User
Experience/
Analytics
Adoption
FU
NC
TIO
NA
LIT
Y
Point of care clinical
and demographic
reference
X X X X X
Share data
with partnersX X X X
Population
health/registry
development
X X X X X
Alerts/Encounter
notificationsX X X X X
Centralized
analytics/value based
contracting support
X X X X
Referral
managementX X X X X X
OneCity Health Partner Webinar | December 11, 2018
OneCity Health RHIO Strategy
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1. Help partners, that request assistance,
build relationships with RHIOs - Participation
Agreement and Connection
2. Support RHIO consent collection process –
Quality and Quantity
3. Drive adoption and integration of RHIO functionality
into workflows through use cases
OneCity Health Partner Webinar | December 11, 2018
OneCity Health RHIO Strategy #1: Help partners build relationships with RHIOs
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Joining a RHIO
NYCIG and Healthix do not charge practices a fee to join them
Data Exchange Incentive Program (DEIP) and other funding available to
cover the cost due to the EMR vendor
Technical assistance is available from RHIOs and OneCity Health to develop
a physical connection
OneCity Health Partner Webinar | December 11, 2018
OneCity Health RHIO Strategy #2: Support RHIO consent collection process
Basics:
If provider is connected to RHIO, data
passively flows for ALL patients from
the provider to the RHIO.
Consent is given by a patient to a
provider for the provider to view the
patient’s PHI that might be in a RHIO.
Consent Status:
Yes – Consent is given for the
provider to receive patient’s
information from the RHIO
No – Consent is denied for provider to
receive patient’s information from the
RHIO
Emergency Only – Consent is given
for the provider to receive information
from the RHIO only in emergency
situations
Null – Consent value has not been
collected and communicated to the
RHIO
Carve Outs
Mental Health/Substance Abuse -
Substance Abuse and Mental Health
Services Administration (SAMHSA)
requires that people who have been
treated for substance abuse and
mental health issues sign a separate
consent that covers access to that
information.
Minors (<18 y.o.) – Services related
to sexual assault, pregnancy and
pregnancy related services, family
planning, sexually transmitted
diseases, alcohol and drug abuse, and
outpatient mental health treatment and
counseling.
RHIO Consent Overview
Provider
Providers
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OneCity Health Partner Webinar | December 11, 2018
Case Development - Submission
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1. Please submit cases to Ben Goldsteen and Diana
Amrom at [email protected] and
2. Submission should include:
a. The specific problem to be addressed
b. Impacted patient population
c. Description of providers involved, including the role of
each provider
d. How the project will address the Triple AIM or DSRIP
goals
3. Examples:
a. Specific Case: Primary care providers should receive
alerts when patients assigned to them by MCOs are
admitted to Emergency Departments with a specific
list of diagnostic codes.
b. Vague Case: We need more alerts.
OneCity Health RHIO Strategy #3: Drive adoption and integration of RHIO functionality
Case Development - Implementation
1. Identify and prioritize for engagement partners
who have relevant data
2. Assess the quality of the data and provide
support for improving data quality at the local
level
3. Assess whether the RHIO has the ability to
address the identified problem
4. RHIO and OneCity Health/NYC Health +
Hospitals teams develop solution to the
identified problem
5. OneCity Health/NYC Health + Hospitals
engages end users to adopt the solution
OneCity Health Partner Webinar | December 11, 2018
eCW Update
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1. NYCIG in combination with NYC Health + Hospitals will connect cloud-based
eCW partners to NYCIG (at no charge)
2. NYC Health + Hospitals’ IT function (EITS) will reach out to coordinate next
steps
3. If your organization uses a cloud-based eCW instance, is interested in
connecting to NYCIG, and has not heard from EITS by end of December,
please reach out to your hub representative
OneCity Health Partner Webinar | December 11, 2018
RHIO Connectivity - Next Steps
Stay tuned for information from DSRIPSupport on another webinar dedicated to the RHIO, including a more in-depth overview of consent and further discussion on the development of use cases
If your organization uses a cloud-based eCW instance and you are interested in connecting to the NYCIG RHIO, please reach out to us and let us know if you haven’t already
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OneCity Health Partner Webinar | December 11, 2018