Collaboration • Catalyst • Community

PRESENTED BY:

AHI PPS All-Partner Meeting

AHI PPS Team

October 8,

2015

AHI: Who We Are

AHI is an independent, non-profit organization that partners with regional health care providers and community-based organizations to improve care, lower costs and realize a healthier future.

1. Promote population health

best practices and

implementation strategies.

2. Manage programs for health

advancement; and

3. Ensure individuals have

access to care.

How We Accomplish Our Goals

5

AHI Timeline

Where We Work…

9Counties

ClintonEssex

FranklinFulton

HamiltonSaratoga

St. LawrenceWarren

Washington

700,000Total Population

11,000Square Miles

9Payors

Medicare (FSS), Medicaid, BSNENY,

CDPHP, Empire BCBS, Empire UHC, Excellus,

Fidelis, MVP

7

Shared Vision: Regional Population Health

8

• Integrated Delivery System (IDS): Network of organizations

that provides a coordinated continuum of services, and is

willing to be clinically and fiscally accountable for outcomes

and health status. The goals of the IDS include improving

efficiency, quality and access to care.

Integrated Delivery System

• DOH mandated establishment of a Project Advisory Committee during the planning period; and establishment of formal governance during the implementation phase.

• AHI obtained legal consult

• AHI PPS Steering Committee reviewed proposed structure and charter in August, revisions were made, final model and charters were endorsed by Steering 9/29/2015. AHI BOD to finalize at November meeting.

Evolution of the PPS Governance

Roles and Responsibilities of AHI

AHI Governance

Board of Directors

Adirondack Health Institute

Executive Committee

Finance Committee

Audit & Compliance Committee

Governance Committee

DSRIP Steering

Ad HocCommittees

Population Health

Improvement Program

Health Home

Adirondack Rural Health

Network

Standing Committees

AHI BOD Representation by County

St. Lawrence

Franklin

Clinton

Fulton

Saratoga

Washington

Warren

Essex

Hamilton

AHI BOD Representation by Sector

Education

Hospital

Business

Community

Insurers/

Other

Payers

Workforce

Public Health/

Other Officials

Providers

Consumer

Behavioral

Health

Post-Acute

PPS Governance Structure

Steering Committee

Collaborative Contracting ModelAHI will enter into a DSRIP Participation Agreement with each participant in the AHI PPS that will

govern the operation of the PPS.

Among other things, the DSRIP Participation Agreement will:

• Set forth the responsibilities of AHI and the participants with respect to the establishment and

operation of the PPS

• Establish the governance model set forth above

Adirondack Health Institute

Reviews all

actions/decisions of the

other Committees

Holds contract with

State; final approval

rights over all

actions/decisions of the

Steering Committee and

the other Committees

Clinical

Governance

& Quality

Committee

Workforce

Committee

Community

&

Beneficiary

Engagement

Committee

IT & Data-

Sharing

Committee

Finance

Committee

Network

Committee

Adirondack

ACO LLC

Provides certain support

services to the PPS

pursuant to a contract

with AHI

• Strategic Planning

• Finance

• Data Analytics

• Clinical Integration

• Provider Relations / Engagement

• HIT

• Clinical Quality

• Operations

Governing Members: Knowledge/Skills

Governance: Operation of Committees

Committee Charter Outline

Charge: Description of scope

Composition: List of members or types of individuals/ organizations that should be represented

Meeting Frequency: Projected meeting frequency and duration

Responsibilities & Expectations: Description of specific duties and time commitment (i.e., development of project plan, care model and protocols)

Deliverables: List and description of key deliverables

Timeline: Expected timeline for achieving above deliverables and activities

•Governed by a charter

•Adhere to a consensus-based process for decision-making that facilitates Participant and community stakeholder engagement

•Decision-making process of each Committee will be transparent to all Participants

Governance Committees

20 30one

Governance Committees

15fiveAHI

10 20one

Governance Committees

five 15

one

AHI

10 20

Governance Committees

10 20

AHI

five 15one

Governance Next Steps

• October: AHI PPS Steering Committee is surveyed for representation by

sector, geography, and knowledge/skill set; determine if membership changes

are needed to fulfill Charter. Nominate Chair.

• October: Subcommittees are convened, review charter and composition,

make recommendations for expanding or revising committee membership.

• The AHI PPS Steering Committee’s recommendations are taken forward to the

newly reconfigured AHI Board of Directors (1st meeting, November 2015).

Performing Provider System

Governance

• Represents the vision of the owners of

the organization

• Sets priorities & policies

• Oversees management

• Evaluates performance of the

organization as a whole

Management

• Carries out the functions of the

organization

• Sets procedures & implements processes

• Provides Governance with information

• Evaluates performance of the parts of

the organization against targets

New York State Health Innovation Plan

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PHIP Goals

Improved Population Health

Improved patient experience of care including quality and satisfaction

Reduced Health Care Costs

Promote the Triple Aim…..By actively:

• Convening neutral forums

• Sharing, disseminating

and helping implement

best practices and

population health

• Working to reduce health

care disparities by using

data to drive decisions

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Regional Initiatives ~ Population

Adirondack ACO

25,000

Medical Home

100,000

PPS

144,000

(Medicaid: 94,000

Uninsured: 50,000)

Participating Insurers

ADK ACO AHI PPS Medical Home

Medicare (MMSP) NY Medicaid Medicare (FFS)

Medicaid

BSNENY

CDPHP

Empire BCBS

Empire UHC

Excellus

Fidelis

MVP

ADK ACO AHI PPS Medical Home

Clinton Clinton Clinton

Essex Essex Essex

Franklin Franklin Franklin

Hamilton Fulton (part) Hamilton

Warren Hamilton (Warren)

Washington St. Lawrence (part) (Washington)

Saratoga (part)

Warren

Washington

Geography

Metrics Healthcare Sections Reporting Process and Schedule

New York State Health Innovation Plan

Population Health Management

Competencies ~ Capabilities

1. Information & Communications Infrastructure

2. Clinical Management

3. Financial & Risk Management

4. Network Development & Physician Alignment

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Timeline

• Consolidation ~ 50+ letters of intent, 25 PPSs today.

• Variety of Governance Models ~ Collaborative Contracting

predominant

• Regional AHI PPS Partners:

Performing Provider Systems Across NYS

• North Country Initiative (Samaritan, FDRHPO)

• Alliance for Better Health Care (Ellis/St.Peter’s)

• Albany Med

• CRFP Re-opened in August: opportunity for applicants

previously disqualified to re-submit; new applications

also allowed.

• AHI PPS did NOT receive any new applications.

• No changes in CRFP rankings.

• On September 1, 2015, proposals that were previously

disqualified, were resubmitted to NYS DOH to be

considered for funding.

Capital Restructuring Financing Program

The Value Based Payment “Roadmap” was approved by CMS on July 22, 2015

CMS/DOH have agreed that the “Roadmap” will be updated/revised on an annual basis as more information and decisions are made

Subcommittees formed to assist with the implementation of VBP• Technical design• Integrated care services• VBP and social determinants of health• Regulatory impact• Community based organization• Advocacy and engagement• Performance management

The DSRIP Path to Value Based Payment

Opt-Out Process

• Opt-Out process is being handled at the State level

• Purpose: opportunity for beneficiaries to opt-out of data sharing

• Timeline: DSRIP Notice & Opt-Out Letters will be mailed to beneficiaries in November

• Letters & Forms: see copies in your packets

Networks To Reopen

• Performance Networks to open mid-October for 2 week period.

• Opportunity to ADD providers to the network (does not affect attribution for valuation)

• “Unaffiliated Provider List” distributed last week

• No major additions expected

Speed & Scale

• Commitments were made in January 2015

• Speed: pace at which providers meet the project requirements

• Scale: number of actively engaged patients over time

• Speed & Scale ~ part of Plan scoring, and subsequent valuation methodology

• DOH recently announced changes to speed & scale targets

Project Approval & Oversight Panel

• November 9th & 10th: Meeting of the PAOP / each PPS presents

• Panel reviews work of the independent assessor (IA); advises the Commissioner of Health whether to accept, reject or modify the recommendations made by the IA.

• The Panel will serve as advisors and reviewers of Performing Provider Systems status and project performance during the 5-year DSRIP duration.

• Co-Chair: Ann F. Monroe, President, Health Foundation for Western & Central New York• Co-Chair: William Toby Jr., Former Administrator of the Centers Medicare and Medicaid Services (CMS), MRT Brooklyn Work Group member• Steven Acquario, Executive Director, NYS Association of Counties• John August, Associate Director of the Healthcare Transformation Project within Cornell University´s School of Industrial and Labor Relations• Stephen Berger, Former Chair of the Commission on Health Care Facilities in the 21st Century; MRT• Kate Breslin, President & CEO, Schuyler Center for Analysis & Advocacy• Patrick R. Coonan, EdD, RN, Dean, Adelphi University, College of Nursing and Public Health• William Ebenstein, Ph.D., Senior Fellow, John F. Kennedy, Jr. Institute for Worker Education, City University of New York• Lara Kassel, Coordinator, Medicaid Matters New York (MMNY)• Mary McKay, Ph.D., McSilver Professor of Poverty Studies; Director, McSilver Institute for Poverty Policy and Research at New York University

Silver School of Social Work• Philip Nasca, Ph.D., Dean, University at Albany, School of Public Health• Marilyn Pinsky, Immediate Past President, NYS AARP• Sherry Sutler, Consumer Representative• Chau Trinh-Shevrin, DrPH, Director of the NYU Center for the Study of Asian American Health and Assistant Professor at the NYU School of

Medicine• Jaime R. Torres, DPM, MS, Former Regional Director, US Department of Health & Human Services, New York Regional Office, 2010-2014• Judith B. Wessler, MPH, Former Director of Commission on the Public's Health System, Community Health Policy Advocate• Mary Louise Mallick, Former Policy Advisor to the State Comptroller• William Owens, Former Congressman, New York´s 21st Congressional District• Cesar Perales, Secretary of State of New York, appointed March 2011, former Regional Director, US Department of Health and Human Services,

Region II-New York

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PAOP Voting Members

Meetings & Events

First Annual Statewide PPS Learning Symposium, September 17th & 18th

• AHI PPS Leadership & PPS Partners Attended: Irina Gelman, Linda Beers,

Tracy Mills, Sue Hodgson, Jorge Grillo, Dr. Tucker Slingerland.

• Meeting Materials:

http://www.publicconsultinggroup.com/client/nysdsrip/

In the DOCUMENTS Square, click the button to get to login screen, login: nysdsrip, Password: learning2015

Implementation Plan

Includes Milestones & Tasks for the 11 selected projects, and organizational components:

– Governance

– Financial Sustainability & Budget

– Cultural Competency & Health Literacy

– IT Systems & Processes

– Performance Reporting

– Population Health Management

– Clinical Integration

– Physician Engagement

– Workforce Strategy

Implementation Plan: Quarterly Reporting

PPS Submits Quarterly ReportDY1Q1 submitted 8/7/15

Independent Assessor (PCG) Provides Feedback

Feedback Received 9/8/15

PPS Responds within 15 Days

Response Submitted to DOH 9/24/15

IA Validates Successful Quarterly Report

Anticipated 10/13/15

• Org Chart; Charters & MembersFinalize Governance

Structure

• AHI Board has adopted new by-laws.

• AHI PPS Steering Committee Charter

• Policies – Terms of Participation

Finalize Bylaws & Policies

• Plan in place; to be reviewed & endorsed by Community & Beneficiary Engagement Committee

Finalize Community Engagement Plan

Milestones Due September 30, 2015

Performance Based Payment Model

• Final elements of the payment model have been established

• Method for earning “Achievement Values”, and weighting, now final

• Achievement Values: tied to Milestones in the Implementation Plan AND to Clinical Quality Targets

• Scenario-based modeling tool has been developed

Clinical Quality Measures

• Claims based measures: baselines established, performance goal & first annual target set

• Methodology: annual target ~ 10% gap to goal

• Measures are at PPS network level – no file received, no ability to drill-down to region, provider, etc.

• Measures requiring chart review: DOH contracted with IPRO / centralized process at least for year 1