Download Spring 2016 DSRIP slides - MEDIA

TRANSFORMING HEALTHCARE &
REDESIGNING MEDICAID
Delivery System Reform Incentive Payment
May 18, 2016
MEDIA - Medical Education and Information Association
“The healthcare industry is
undergoing a period of
fundamental transformation in
which the very model of
healthcare delivery is being
questioned and changed.”
Moody’s Investors Service,
U.S. Not-for-Profit Healthcare
National Healthcare Reform
• Improve general health of population
• Increased preventative care & wellness initiatives
•
Enhance patient care experience
 Quality
 Safety
 Satisfaction
•
New care delivery model using evidence-based standards
of care.
– Focus on Population Health – Stratify and Manage Critical Populations
 High Risk for Inpatient or Emergency care
 Rising Risk
 Low Risk – Wellness / Prevention
• Reduce healthcare costs
New York State Medicaid Redesign
• Global spending cap for all Medicaid services
• Shift from institutional (hospitals, skilled nursing
facilities) to community-based services (primary
care physicians, patient-centered medical homes, health
homes, home health care agencies, rural health networks)
• Maintenance of the healthcare safety net for
Medicaid and uninsured population (Vital
Access Providers)
New York State Managed Care
Payment Reform
•
Shift from volume based (payment per visit) to
value-based (payment for performance)
•
Include performance metrics
 Clinical
 Safety
 Satisfaction
•
Form integrated care networks who share bundled
payments
WHAT IS DSRIP ?
The Delivery System Reform Incentive Payment
(DSRIP) is the main mechanism by which New York
State will implement the Medicaid Redesign Team
(MRT) Waiver Amendment.
DSRIP´s purpose is to fundamentally restructure the
health care delivery system by reinvesting in the
Medicaid program, with a goal of reducing avoidable
hospital use by 25% over 5 years.
6
WHAT IS DSRIP?
• Statewide initiative open to all hospitals and a wide
array of safety-net & other providers
• Collaboration amongst providers & formation of
integrated care networks as Performing Provider
Systems (PPS)
• Slate of projects approved by Center for Medicare and
Medicaid Services (CMS) reducing avoidable
hospitalizations and Emergency Department visits by
25%
7
• DSRIP payments based on performance results
DSRIP
AN OVERVIEW OF DELIVERY SYSTEM REFORM
By 2020, NYS Medicaid fully transitions from volume-based
fee for service to value-based payment methodology putting
payments at risk based on provider performance.
Managing risk requires existing Medicaid safety net providers
to:
• Create integrated regional care delivery network
structure with sufficient Medicaid covered lives to
manage risk-based payments.
• Organize provider network to effectively & efficiently
deliver care to Medicaid beneficiaries.
• Develop analytical & financial core competencies for
population health management.
Performing Provider System (PPS)
Roles and Responsibilities

Integrating care across settings through
collaboration: IP/OP, institutional, and CBOs.

Accountability for patient outcomes & healthcare
costs (e.g., Population Health Management).

Exploring ways to improve public health.

Sharing data and electronic health records.

Accepting & distributing bundled & risk-based
payments: negotiating as single entity with
Managed Medicaid.
9
Care Compass Network Region
CARE COMPASS NETWORK
PPS OF THE SOUTHERN TIER REGION
COLLABORATION & LOCAL PARTNERSHIPS
 Hospitals (UHS, Lourdes, Cortland RMC, Cayuga Medical
Center, Guthrie)
 Health Homes
 Skilled Nursing Facilities
 Diagnostic & Treatment Centers & Federally Qualified
Health Centers (FQHCs)
 Physicians & Allied Health Professionals (PCPs, Specialists)
 Behavioral Health Providers
 Home Health Care Agencies
 130 + Community Partners (DSS , DOH, Human Service
Organizations, Office of Aging etc.)
11
Collaboration
 Care Compass Network
 Lourdes and UHS made the decision to partner
 UHS was determined to be lead entity due to Medicaid
Health Home experience and experience in large
mother/baby and behavioral health programs
 Lourdes and UHS reached out to Guthrie , the CBO
community and encourage them to come to a meeting
to learn about DSRIP
 CBOs reached out to other CBOs
 An open stakeholders group was formed, which
evolved into the Project Advisory Committee (PAC)
Collaboration
 A stakeholders meeting with over 120 in attendance was
held to select a project slate for the newly developed PPS


Cost: Time
The inclusive approach became a foundation for an enduring
bond among the organizations
 Teams and leadership were formed around each project
and initiative such as work force, information
management, governance etc…..
 A largely voluntary effort produced the application.
 Once application was awarded, formal organization
structure implemented
Care Compass Network Vision
The Care Compass Network PPS Vision is to improve the
health and life of Medicaid beneficiaries who engage in
coordinated, culturally sensitive services that utilize the
most appropriate, effective setting given medical,
behavioral, social, and health literacy needs.
14
Care Compass Network Overview
• Care Compass Network valued at $213-$224 million by
the Department of Health
• Payments quarterly throughout year
• Staffing of PPS
• Care Compass Network has 20 FT employees
• Formation of 4 Regional Performance Units (RPUs)
15
CARE COMPASS NETWORK
REGIONAL PERFORMANCE UNITS (RPU)
The Care Compass
Network includes four
Regional Performing Units
(RPU’s) which will allow for
execution of DSRIP related
projects and efforts at a
localized level.
RPU by County
• North RPU – Cortland, Tompkins, & Schuyler
• South RPU – Broome & Tioga
• East RPU – Chenango & Delaware
• West RPU – Steuben & Chemung
16
CARE COMPASS NETWORK GOALS
• Develop & implement model of care that right sizes, realigns, &
integrates continuum of community-based & institutional
services to achieve DSRIP goals.
• Retrain & redeploy healthcare workforce to align with & support
transformed service delivery model.
• Implement community-based care coordination to deploy early
intervention & prevention to people with rising risk for chronic
illness & facilitate access & movement through care settings in
service continuum.
• Build organizational infrastructure for population health
management, financial operations, contracting & electronic
information management needed to support the PPS in
achievement of DSRIP quality & utilization goals.
17
CARE COMPASS NETWORK
11 PROJECTS
Project
Description
DOMAIN 2 – SYSTEM TRANSFORMATION
2ai – Integrated Delivery System (IDS)
Create a clinically integrated provider network focused on
evidence-based medicine and population health
management.
2biv – Care Transitions
Provide a 30-day supported transition period post discharge to
reduce readmissions for patients with chronic disease.
2bvii - INTERACT
Interventions to Reduce Acute Care Transfers from Skills
Nursing Facilities.
2ci – Community-Based Healthcare
Navigation
Develop health navigation services to assist patients in
accessing healthcare services efficiently.
2di – Patient Activation “Project 11”
Address patient activation measures (PAM) so that the
uninsured (UI), non-utilizers (NU) and low-utilizers (LU) of
Medicaid services are impacted by DSRIP projects and
become more activated over time.
18
CARE COMPASS NETWORK
11 PROJECTS
Project
Description
DOMAIN 3 – CLINICAL IMPROVEMENT
3ai – Integration of Primary Care and
Behavioral Health Services
Integration of mental health and substance abuse
with primary care services to ensure coordination of
care for both services.
3aii – Crisis Stabilization
Provide accessible behavioral health and substance
abuse crisis services that will allow access to
appropriate level of service and providers, supporting
rapid de-escalation of the crisis.
3bi – Chronic Disease Management - CVD
Support implementation of evidence-based best
practices for disease management in medical practice
for adults with cardiovascular conditions.
3gi – Palliative Care in PCMH Primary Care
Offices
Integrate palliative care services within the PCMH
primary care setting.
DOMAIN 4 – POPULATION HEALTH
4aiii – Strengthen Infrastructure Across
MH/SA Programs (Prevention)
4bii – Chronic Disease Mgmt/Prevention
COPD
Support collaboration among leaders, professionals
and community members working in MEB health
promotion.
Increase access to high quality COPD preventative
care and management.
19
How to Get Involved
 Regional Performance Unit Meetings
 Monthly Stakeholders Meetings
 Operational Committees
 Access the Care Compass Website
www.carecompassnetwork.org
Questions? Reach out to partner Relations
[email protected], [email protected],
[email protected]