2018 learning collaborative series - cares · 2018 learning collaborative series cbos: positioning...

2018 Learning Collaborative Series

CBOs: Positioning For Value Based PaymentJune 5, 2018 10:00-12:00PM

Welcome/Introductions• CBOs Role in Value Based Payment: Overview

• Partnerships between Healthcare and CBOs: Building Capacity

• How CBOs can add value in a VBP world: Pilot Overview

• Group Discussion

• Wrap Up• Next Meeting August 7, 2018 10:00AM-12:00PM

CBOs are uniquely positioned to address root causes of poor health due to:

• Their understanding of community needs.

• Their community focus, coupled with the clinical services of other health care providers (Hospital, ACO, IPA, etc.) can make a significant positive impact on population health and generate savings for entities involved.

• They are in a strong position to impact social determinants of health.

CBOs: Positioning For Value Based Payment

Introduction: Value Based Payment for Providers

Video Content: https://www.youtube.com/watch?v=_mvfd5GXvvs

SDOH

Education• Early Childhood Education

and Development • High School Education• Enrollment in Higher

Education• Language and Literacy

Social and Community Context• Social Cohesion• Civic Participation• Perceptions of

Discrimination and Equity • Incarceration/Institutionali

zation

Health and Health Care• Access to Health Care-

gaining entry into Health System

• Access to Primary Care/Trusted Provider

• Health Literacy

Neighborhood and Environment • Affordable/Quality Housing

Environmental Conditions• Access to Health Foods• Crime and Violence

Economic Stability • Poverty• Housing Security and

Stability• Employment • Food Security• Transportation

Social Determinants of Health 101

Source: NYS DOH VBP Bootcamp Social Determinants of Health & Community Based Organizations

Social Determinants of Health: Structural conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.

Video Content: https://www.youtube.com/watch?v=qmsYfouVwtQ&feature=youtu.be

Video Content: https://www.youtube.com/watch?v=pdnAiLdeQGw&feature=youtu.be

Social Determinants of Health, CBOs, and VBP

• Addressing social determinants can have a significant impact on health outcomes

• Social determinants of health interventions can be less costly than traditional medical interventions

• Under VBP the aim is to realize cost savings while achieving high quality outcomes

Social Determinants of Health, CBOs, and VBP

Picture Source: http://www.bridgewater.nhs.uk/haltonsthelens/healthforthehomeless/Source: NYS DOH VBP Bootcamp Social Determinants of Health & Community Based Organizations

http://www.bridgewater.nhs.uk/haltonsthelens/healthforthehomeless/

Addressing SDOH, Better Health Outcomes, Lowering Healthcare Cost, Better Coordinated Care

Community Based

Organizations

Managed Care Organizations

Healthcare Systems

CBOs: Positioning For Value Based Payment

Source: NYS DOH VBP Bootcamp Social Determinants of Health & Community Based Organizations

Health Foundation for Western and Central New York

Advocating for improved health and health care.

Children (birth to 5 years)

impacted by poverty

Community Health Capacity Older Adults

Health Foundation Regions

Central New York Counties

• Cayuga• Cortland• Herkimer• Madison• Oneida• Onondaga• Oswego• Tompkins

Western New York Counties

• Allegany• Cattaraugus• Chautauqua• Erie• Genesee• Niagara• Orleans• Wyoming

Partnerships Between Healthcare and CBOs: Building

Capacity

“Change of any kind requires courage” 勇

Presenter

Presentation Notes

Years ago, I saw a greeting card with this symbol on the front and the saying on the inside. It was in the “inspirational” section of the card shop. It struck me because I thought that so much of life is about change – and as a 20something, it hadn’t occurred to me until then that living takes courage. According to Merriam-Webster, courage is having the ability to do something that frightens you. Throughout the years, this quote would pop into my head once in a while, but it wasn’t something that I consciously thought about on a regular basis. However, as I was reviewing notes from one of my graduate courses on this topic, I found that I had written it in a couple of different places. Now I don’t know if I was thinking that I needed courage to get through that class, or if there was actually something about the changing healthcare environment that caused me to write it, but it was there. Courage was also a word that jumped out at me as I was reading a new report about partnerships between CBOs and HCOs. And so, it made sense to me that this bridging of healthcare and human services work may make some people fearful and may challenge us in ways that require us to summon the courage to change.

Healthcare Reform in NYS

Value Based Payments Performance based payment strategies that link

financial incentives to provider performance on a set of defined measures Goal is to improve quality and slow growth in

healthcare spending DSRIP requires all Medicaid MCOs to employ VBP

systems for 80% – 90% of provider payments

A National Imperative

• A growing number of human services CBOs are not financially strong or sustainable

• ~ 1/2 run persistent operating deficits• ~ 1/3 have less than one month of

operating expenses in reserve• CBOs often lack access to capital for

investment in tech, staff development and evaluation

Partnerships Make Sense• Healthcare costs are high• Healthcare providers not trained in SDoH• Limited time during medical visit/episodic• Human service CBOs focus on SDoH• CBOs often have longstanding

relationships in/with community –therefore, more opportunity to engage

• CBOs and HCOs have shared goals

Social Determinants of Health

Image by: vaeenma

“A growing body of evidence revealsthat investment in selected socialservices and partnerships betweenhealth care and social services canlead to substantial health benefits andreduce health care costs for targetedpopulations.”

~ The Commission on Value-Based Care

Benefits of Partnering

• For CBOs:– Training and Professional Development– Expanded Services for Clients– Increased Access to Funding

• For HCOs:– Training and Professional Development– Quality Services for At-Risk Populations– Improved Access to Care for Patients

Challenges of Partnering

• Knowing who to talk to• Speaking a different language• Defining, agreeing on, and measuring

outcomes• Funding/regulatory Issues• Service value/ROI and cost• CBO capacity• HCO complexity• Data sharing/privacy concerns

Creating Successful Partnerships –Setting the Stage

• Be Strategic– Mission and Goals– Areas of Expertise

• Build Trust• Sharing Risk• Communicate• Recognize Value

Creating Successful Partnerships – Digging Deeper

• Identify a project/partnership leader• Formalize the partnership• Assess capacity• Address imbalances• Technology and data collection• Funder and regulatory requirements• Establish funding and payment structures• Develop a referral process

Presenter

Presentation Notes

Example: MOW partnered with a local hospital to deliver medically prescribed meals after the hospital realized it had very high 30-day readmission rates for dehydration and nutrition related issues. It was looking into hiring a private company to do that work in the exact neighborhoods in which MOW already had a presence and relationships with the residents. Example 2: In NYC, the Jewish Association Serving the Aging developed the capacity to address issues related to care transitions for high-risk patients recently discharged from the hospital. They looked at various public data sources including readmission rates to determine what hospitals to partner with, developed a business proposition based on information relevant to the organization and the hospital, shared it with the CEO at a local medical center and received a contract to conduct the work.

Building Capacity – Setting the Table

• The legs of the table:– Management– Governance– Financial Resources– Administrative Systems

• The top of the table:– Programs

• The decorative centerpiece:– Organizational Mission

Presenter

Presentation Notes

Based on Nonprofit Lifecycles by Susan Kenny Stevens

Capacity Building 101• Ready or Not/Get Set – Health Foundation and other funders

– Help health and human service organizations improve their ability to respond to needs in the community and improve population health outcomes by providing grant funding and organizational development consultation in the areas of program, governance, financial, and administrative processes

• StoryGrowing – Health Foundation, CNY Community Foundation & Gifford Foundation– Helps non-profits strengthen their storytelling culture and skills

through intensive workshops, group training, and one on one coaching

• ADVANS (Advancing and Developing the Assets of Nonprofits in Syracuse) – Gifford Foundation– Strengthen nonprofit’s operating capacity to sustain mission-critical

programs

Capacity Building 201

• Social Determinants of Health• Value-based and other payment structures• Mentoring/Coaching• Building networks• Learning collaboratives• Developing successful partnerships across

sectors

Health Foundation for Western and Central New York

• Program & organizational sustainability– Advocacy

• Access to high quality care• Healthy communities

References• A National Imperative: Joining Forces to Strengthen

Human Services in America, Alliance for Strong Families and Communities, 2018

• Partnerships Between New York City Health Institutions and Community Based Organizations, Greater NY Hospital Association and NY Academy of Medicine, 2018

• Integrating Health and Human Services: A Blueprint for Partnership and Action, Human Services Council of New York, 2018

Marnie Annese, MPH, CPHProgram Officer

431 East Fayette St, Suite 250Syracuse, NY 13202

315-671-0057 ext. [email protected]

How CBOs can add value in a VBP world: Pilot Overview and Data DiveJune 4, 2018

Agenda

• Salient Interactive Miner Overview

• Medicaid Population Demographics

• 13202 Zip Code Performance Overview

• CBO/Behavioral Health Performance Overview

• Questions

Overview• Source

• Medicaid claims data warehouse

• Content• De-identified patient level data• Most data elements from claims

history for CNYCC’s attributed population

Opportunities• Ad Hoc Analysis

• CNYCC can query the data directly to gain insights that are not available in the dashboards

• Diagnosis Codes• Procedures including

counts• Visits including counts

• Partner Attribution• Ability to create collections

using CPT codes which can identify attribution to Partners throughout the PPS

• Multi Dimensional • Ability to evaluate multiple

factors simultaneously (e.g. disease burden and geographic distribution)

Challenges• Data Age

• 6+ months lag due to claims adjudication process

• Data Accuracy• Same underlying data that

feeds the MAPP dashboards• Analysis approach impacts

outcomes

• Processing Time• Single query can take 4+

hours to complete

• Partner Access• Access limited by State to

PPS

Salient Interactive Miner

Presenter

Presentation Notes

Joe

Medicaid Population Demographics – July 2016 to June 2017

• 242,373 Attributed Patients in 63 Counties/Boroughs• 226,941 (93.6%) Patients located in CNYCC’s six (6) county region

15572 3591

10776

60226

106508

30268

15432

County of Fiscal Responsibility(Number of Lives)

Cayuga Lewis Madison Oneida

Onondaga Oswego Other

00-0512%

06-1111%

12-179%

18-4441%

45-6420%

65+7%

Current Age

White69%

Black18%

Asian5%

Unknown5%

Other3%

Race

Medicaid Population Demographics – July 2016 to June 2017

611 Medicaid Members enrolled at the Organization 1 for Care Management Services

96%

3% 1%

Care Management Agency Enrollment

Not Health Home Enrolled CNYCC Partner Organizations

Non-CNYCC Partner Organizations

40%

60%

Medicaid Insurance Type

Fee-for-Service Managed Care

96%

4%0%

Health Home Enrollment

Not Health Home Enrolled CNYCC Partner Organizations

Non-CNYCC Partner Organizations

Zip Code 13202 – Performance Overview• CNYCC has 48 Pay for Performance Measures

• Utilization• Access• Behavioral Health• Cardiovascular • CAHPS Survey (Clinician & Group and Hospital)

• For introductory purposes, CNYCC will focus on:• Potentially Avoidable Readmissions (PPR)• Potentially Preventable Emergency Room Visits (includes Urgent Care) (PPV)• Potentially Preventable Emergency Room Visits (for persons with a BH Diagnosis) (PPVBH)

• Does not have to be a Behavioral Health visit

Zip Code 13202 – Performance Overview

1308.97

613.82599.06

0

200

400

600

800

1000

1200

1400

13202Result

CNYCC

Potentially Avoidable Readmissions

CNYCCTarget

56.6

34.2133.93

0

10

20

30

40

50

60

13202Result

CNYCC

Potentially Preventable ED Visits

CNYCCTarget

159.67

81.6689.39

0

20

40

60

80

100

120

140

160

180

13202Result

CNYCC

Potentially Preventable ED Visits (BH)

CNYCCTarget

4,034 Patients Residing in the 13202 Zip Code (1.67%)

Medicaid Member Roster

• 94 Unique Lines of Data Submitted

• 91 De-duplicated Unique Members• 5 Patients with no CIN

• 86 Unique Members• 7 Members have had an intervention with Organization 1

• 79 Successfully Uploaded into Salient Interactive Miner• Possible that CINs were incorrect

• 57 out of the 79 Members have been attributed to CNYCC at one point in time• Roster is from April 2015 to current (May 2017)

Medicaid Member Utilization

• 56 Unique Members have had 127 out of CNYCC’s 154,647 ED Visits from July 2016 to June 2017

• Members can have multiple visits as well as no visits

• 127 ED Visits Occurred At:ED Visit Count

Provider Name Visit Count

Upstate University Hospital 66St. Joseph’s Health 33

Crouse Health 20Eastern Niagara Hospital 5

St. Elizabeth Medical Center 2Faxton St. Luke’s Healthcare 1


• 56 Unique Members have had 50 out of CNYCC’s 40,321 Inpatient Admissions from July 2016 to June 2017


• 50 Inpatient Admissions Visits Occurred At:Inpatient Admissions

Provider Name Visit Count

Upstate University Hospital 18Crouse Health 10Not Available 6

St. Joseph’s Health 6St. Elizabeth Medical Center 4

Conifer Park 3Syracuse Brick House 2

McPike Addiction Treatment Center 1


• 56 Unique Members have had 162 out of CNYCC’s 594,216 Primary Care Physician Visits from July 2016 to June 2017


• 162 Primary Care Physician Visits Occurred At:Primary Care Physician Visits

Provider Name Visit CountSyracuse Community Health Center 47

Syracuse Behavioral Healthcare 25Upstate University Hospital 15Syracuse Recovery Services 13

NOCHSI 11Crouse 9

Community Health Center of Buffalo 8St. Joseph’s Health 8

Family Care Medical Group 5UB Family Medicine 4

Eastern Niagara Hospital 3Liberty Resources 3

Community Care Physicians 2Faxton St. Luke’s Healthcare 2

Not Available 2Other 5

Medicaid Member Performance

• CNYCC has broken down data provided by the organizations into 3 categories for comparison purposes:

• All Members that were submitted from both organizations (Total)• Patients with Organization 1 Interventions (O1)• Patients with only interventions from Organization 2 (O2)

• The following slides will show the performance for the 3 categories listed above for PPRs, PPVs & PPVBHs

MC PCP Identified

Relevant Measures Selected

CINs uploaded

to SIM

CINs provided

by Partner

Potentially Avoidable Readmissions

6000

33333.33

4255.32

613.82599.060

5000

10000

15000

20000

25000

30000

35000

Total O1 O2 CNYCC

CNYCC Target

Rate

per

100

,000

Potentially Preventable Emergency Room Visits

134

200

129.79

34.21

33.93

0

50

100

150

200

250

Total O1 O2 CNYCC

CNYCC Target

Rate

per

100

Potentially Preventable Emergency Room Visits - BH

223.08

250

220.83

81.66

89.39

0

50

100

150

200

250

300

Total O1 O2 CNYCC

CNYCC Target

Rate

per

100

Managed Care Assigned PCPs

Potentially Avoidable ED Visits – BH

MC PCP Name Result Numerator Denominator

NO MC PCP 187.50 15 8Provider 4 650.00 13 2Provider 5 700.00 7 1Provider 6 350.00 7 2Provider 7 700.00 7 1Provider 8 200.00 6 3Provider 9 100.00 1 1

Provider 10 100.00 1 1Provider 11 100.00 1 1

Potentially Avoidable ED Visits


Provider 1 100,000.00 1 1Provider 2 100,000.00 1 1Provider 3 100,000.00 1 1

Managed Care Assigned PCPs

Potentially Avoidable ED Visits


LAPPIN SARAH 700.00 7 1COLQUHOUN JANELLE 700.00 7 1

GREEN-EL DIANE 350.00 7 2SMITH ROY 242.86 17 7

AUGUSTIN YOLA 200.00 6 3NELSEN ELIZABETH 200.00 2 1

NO MC PCP 114.29 16 14LAMANNA SUZANNE 100.00 1 1

LEE SYLVIA 100.00 1 1TAYLOR VIVIENNE 100.00 1 1

AZIZ SURAIYA 50.00 1 2RUTAGARAMA YVONNE 50.00 1 2

Questions

Value Based Payment Readiness

How would you rate your readiness for VBP?(A) This is the first I have heard about the CBOs role in VBP(B) I have prior knowledge, but I am still unsure of the process to begin VBP(C) I have good knowledge of VBP, my organization has began the VBP process(D) I have full knowledge of VBP, my organization has already entered into a VBP

contract

A: Now that you have some knowledge of VBP, what are you going to take back to your organization? What are your next steps?

B: How do you see your organization fitting into VBP? What do you need to begin the VBP process?

C and D: What have you learned along the way?

Group Discussion

Learning Collaborative 2018

• Series 1: Access To Care Access

• Series 2: CBOs: Positioning For VBP (June, August)• Tuesday August 7th, 2018 10:00AM-12:00PM

• Series 3: Cardiovascular: Monitoring & Treatment (September, October)

• Series 4: Behavioral Health (November, December)

2018 learning collaborative series - cares · 2018 learning collaborative series cbos: positioning...

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