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State of New York Department of HealthDelivery System Reform Incentive Payment (DSRIP) ProgramProject Design Grant Application

Application Due on: June 26, 2014There will be no extensions for this application. Any application submitted past the due date will not be considered.

Section 1Lead Applicant Info & Project Point of ContactSection 6List of VendorsSection 2Partner Organization - Contact InfoSection 7Design Grant TimelineSection 3Partner Organizations & Service AreaSection 8Data RequestSection 4Project Program Overview & DescriptionSection 9Design Grant BudgetSection 5Community Needs Assessment & Stakeholder Engagement**Section 10 Project Advisory Committee (PAC) Form - (RELOCATED)^ Due to changes, this section has been RELOCATED and made as a separate form which still needs to be filled out and can be found on the DSRIP website under "DSRIP Project Design Grant Application".

To understand the Project Design Grant Application, carefully and thoroughly read through the Instructions before completing this application.

As a reminder and an addition to the instructions, you MUST read through the following state documents which are provided on the DSRIP website (see link below).

Special Terms & ConditionsAttachment IAttachment J(Recommend)- PowerPoint/WebinarDSRIP LINK:https://www.health.ny.gov/health_care/medicaid/redesign/delivery_system_reform_incentive_payment_program.htm

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https://www.health.ny.gov/health_care/medicaid/redesign/delivery_system_reform_incentive_payment_program.htm

Section 1_Lead Info

Project Point of ContactLead Applicant InformationPrimary ContactContact Person:Phil Hirschhorn, DDS1.1)Organization Name:AMERICAN DENTAL OFFICES PLLCAddressCityStateZip CodeOperating Certificate # (Opcert):Organization Address:390 N. BROADWAY, SUITE 110JERICHONY11753Provider Type:OtherContact Phone Number:5168228700Extension:108Provider Type - OTHER:LARGE DENTAL PROVIDER ACTING AS DENTAL HOSPITALContact Email:[email protected] MMIS:30474181.4)Billing Entity ID:Secondary ContactNPI #1: 1295997724Contact Person:KATHY BECCARINONPI #2: AddressCityStateZip CodeFederal Employer ID (FEIN):Organization Address:390 N. BROADWAY, SUITE 110JERICHONY11753Contact Phone Number:5168228700Extension:249Contact Email:[email protected]

1.2)Please provide a brief statement as to why the lead organization is qualified to serve in this capacity. ( Restricted to 3000 characters)We are the largest provider of private dental services in New York State. We have treated over 1 million patients in our 50 years of business! Our dental health delivery system is different and more efficient than a typical dental office. Our facilities are called dental super-centers because they are large in size and have a large capacity to see many families at the same time. These facilities are more like dental hospitals where each one has a full complement of general dentists as well as specialists. As the largest Dental care provider organization in the State of NY, American Dental Offices PLLC (ADO) has pioneered the concept of delivering quality care at a reasonable cost while making a profit. We are like a Dental Hospital, however we do not operate like hospitals and do not have any form of inpatient care. Through the use of technology, the inclusion the patients at the center of their care, the use of highly qualified professionals to deliver and manage the care, we have been growing our Medicaid patient volume over the past 5 years to the point we are now the preferred dental organization for a number of Managed Care and TPA in the NY region. Having been such a model of efficiency for 50 years, ADO is best placed to lead the formation of the PPS in our region and truly work towards reducing hospital admissions by 25% over the next 5 years of the program. Being in dentistry, ADO has learned to manage on lower levels of reimbursement and developed protocols, policies and procedures along with the proper governance to ensure success to any PPS. These lessons learned can serve as a basis to model after in all other areas of medical care delivery to ensure a higher level of care and patient satisfaction while keeping cost in line.In order to truly redesign Medicaid and improve care delivery to the recipients while reducing cost, we have to have a new approach and in our opinion, it will have to come from outside of the main stream care delivery system that has been less than fully willing and capable of delivering on the promise of better care at lower cost. American Dental Offices PLLC have successfully demonstrated this is possible and we are willing to take the lead role in the formation of PPS and share our experience with the rest of the care delivery system.

Characters used:2327

1.3)Based on the lead applicant provider type, please fill out the applicable section below to verify that you meet the DSRIP safety- net definition (Either Hospital OR Non-hospital based) :

Hospital: A hospital must meet one of the three following criteria to participate in a performing provider system:ORNon-Hospital Based Provider - Must meet the following criteria:

#1Is the lead applicant one of the following providers? None of the aboveNot participating as part of a state-designated Health Home, must have at least 35 percent of all patient volume in their primary lines of business and must be associated with Medicaid, uninsured and Dual Eligible individuals. (Please indicate what %)%ORSelect One#2 - Must pass both A & B test (Please indicate what % for both tests)%A.At least 35 percent of patient volume in their outpatient lines of business must be associated with Medicaid, uninsured, and Dual Eligible individuals2ASelect OneB. At least 30 percent of inpatient treatment associated with Medicaid, uninsured, and Dual Eligible individuals2B

ORMust serve at least 30 percent of all Medicaid, uninsured and Dual Eligible members in the proposed county or multi-county community. (The state will use Medicaid claims and encounter data as well as other sources to verify this claim. The state reserves the right to increase this percentage on a case by case basis so as to ensure that the needs of each community's Medicaid members are met.(Please indicate what %)#3YES337.51

For Safety-net definition, please see link: https://www.health.ny.gov/health_care/medicaid/redesign/docs/safety_net_definitions.pdf

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&12NYS DOH DSRIP_Project Design Grant Application &12Page 1&12Applicant Info_Project Contact_Partner Organizations

&12NYS DOH DSRIP_Project Design Grant Application &12Page 1&12Applicant Info_Project Contact_Partner Organizations

&12NYS DOH DSRIP_Project Design Grant Application &12Section 1&12Applicant Info_Project Contact_Partner Organizations

https://www.health.ny.gov/health_care/medicaid/redesign/docs/safety_net_definitions.pdf

Section 2_Partner Org.

2.1)Partner Organizations - Contact Information

1Organization Name:2Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

3Organization Name:4Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

5Organization Name:6Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

7Organization Name:8Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

9Organization Name:10Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

11Organization Name:12Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

13Organization Name:14Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

15Organization Name:16Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

17Organization Name:18Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

19Organization Name:20Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

21Organization Name:22Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

23Organization Name:24Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

25Organization Name:26Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

27Organization Name:28Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

29Organization Name:30Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

31Organization Name:32Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

33Organization Name:34Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

35Organization Name:36Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

37Organization Name:38Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

39Organization Name:40Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

41Organization Name:42Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

43Organization Name:44Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

45Organization Name:46Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

47Organization Name:48Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

49Organization Name:50Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

51Organization Name:52Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

53Organization Name:54Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

55Organization Name:56Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

57Organization Name:58Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

59Organization Name:60Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

61Organization Name:62Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

63Organization Name:64Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

65Organization Name:66Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

67Organization Name:68Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

69Organization Name:70Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

71Organization Name:72Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

73Organization Name:74Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

75Organization Name:76Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

77Organization Name:78Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

79Organization Name:80Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

81Organization Name:82Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

83Organization Name:84Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

85Organization Name:86Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

87Organization Name:88Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

89Organization Name:90Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

91Organization Name:92Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

93Organization Name:94Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

95Organization Name:96Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

97Organization Name:98Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

99Organization Name:100Organization Name:Qualified Under Safety Net Definition?Select One(Please select Yes or No)Qualified Under Safety Net Definition?Select One(Please select Yes or No)AddressCityStateZip CodeAddressCityStateZip CodeOrganization Address:Organization Address:Contact Person:Contact Person:Contact Phone Number:Extension:Contact Phone Number:Extension:Contact Email:Contact Email:Provider Type:Select OneProvider Type:Select OneProvider Type - OTHER:MMIS:Provider Type - OTHER:MMIS:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:Operating Certificate Number (OPCERT):Billing/Provider Entity ID:NPI #1: NPI #1: NPI #2: NPI #2: Federal Employer ID (FEIN):Federal Employer ID (FEIN):

&D&F

NYS DOH DSRIP_Project Design Grant Application Section 2Partner Organizations' - Contact Info

Section 3_PO_Service Area

Partner Organizations

3.1)Do any regulations need to be waived to accomplish a DSRIP partnership within your emerging Performing Provider System? Yes

Provide explanation (Restricted to 2000 characters):Our model: one body one health record (OBOHR) In order to have success in the PPS, ADO strongly feels that at the PPS level, each covered life needs to have a single health record that all providers contribute to and can access on an as needed basis. This is critical for care coordination that will lead to improved quality at lower cost. Since care coordination will be at the core of the PPS operation, we will need our care coordinators to know what is happening with the covered lives as they seek to receive care and NOT after the fact. This will give the PPS the ability to intervene and direct the care so it delivered efficiently at the lowest possible cost. In line with this philosophy, some of the current rules governing carte delivery will need to be relaxed to some extents. The top five are:1. HIPAA One release form per patient to PPS and all PPS providers have access to health record on an as needed basis as managed by the PPS2. PPS needs to have access to all claims data from all payers for the covered lives3. Relaxing the Starks rules: referrals within the PPS will be managed by the PPS Care Coordination team4. Single patient portal per covered life: when a patient accesses the portal, all treating providers receive credit for patient engagement as required by all government programs such as Medicare ACO, PPS, MU, etc

Characters used:1356Service Area

3.2)Briefly describe the proposed service area for your entire emerging Performing Provider System below. (e.g. general overview, geographic location, any notable characteristics specific to your population, etc.) ( Restricted to 3000 characters)ADO PPS proposes to cover the counties of Nassau, and Suffolk. This area is known as Long Island although the true definition of Long Island comprises not only Nassau and Suffolk counties, but also Kings (Brooklyn) and Queens Counties. As the name dictates, the Island is stretch of land that is narrow (about 24 miles) and long (about 100 miles).According to the 2010 census Nassau and Suffolk counties have a population of 2,832,882 people; Suffolk County's share at 1,493,350 and Nassau County's at 1,339,532. That population grew by 2.3% in the 2013 Census. Suffolk County has twice the land mass as Nassau. *Owing to economic growth and the suburbanization after World War II, Nassau was the fastest growing county in the United States from the 1950s to the 1970s. In its easternmost sections, Suffolk remains small-town rural, as in Greenport on the North Fork and some of the outward areas of The Hamptons, although summer tourism swells the population in those areas. Western Suffolk, such as the towns of Huntington and Babylon, are becoming increasingly populated and are beginning to resemble towns in Nassau. *According to a 2000 Report on Religion, which asked congregations to respond, Catholics are the largest religious group on Long Island, with non-affiliated in second place. Catholics make up 52% of the population of Nassau and Suffolk, versus 22% for the country as a whole, with Jews at 16% and 7%, respectively, versus 1.7% nationwide. Only a small percentage of Protestants responded, 7% and 8% respectively, for Nassau and Suffolk counties. This is in contrast with 23% for the entire country on the same survey, and 50% on self-identification surveys. Long Island has a substantial Italian-American population. About 26% of total Long Island residents claim Italian ancestry and 28% of Suffolk County residents claim Italian ancestry.*

Today, we are seeing a very different trend as the majority of the new Long Island inhabitants are immigrants enjoying a very different social economic status. Although the change in total population is not very significant (2.3% from 2010 to 2013) the turnover in the makeup of the population is remarkable. The Latino population is the fastest growing on long island claiming largest percentage in a number of areas. Other immigrant groups have made Long Island their new homes as well. *These trends speak very loudly in the number of Long Island residents that are now Medicaid eligible and will be part of the PPS covered lives. With a mix of the wealthiest social-economic classes and some of the poorest living next to each other, the challenges to deliver sensible care is real.We have to have a PPS capable of being sensitive to the changes the Long Island population has been going through and is prepared to embrace such changes and thrive in providing quality care at a the lowest possible cost to the residents. * SOURCE: Wikipedia

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3.3)Check off with a "X" of all the counties that are within your emerging Performing Provider System proposed service area.

Please type in the letter "X" OR you can use the drop down menu:

AlbanyHerkimerRichmond (Staten Island)AlleganyJeffersonRocklandBronxKings (Brooklyn)Saint LawrenceBroomeLewisSaratogaCattaraugusLivingstonSchenectadyCayugaMadisonSchoharieChautauquaMonroeSchuylerChemungMontgomerySenecaChenangoXNassauSteubenClintonNew York (Manhattan)XSuffolkColumbiaNiagaraSullivanCortlandOneidaTiogaDelawareOnondagaTompkinsDutchessOntarioUlsterErieOrangeWarrenEssexOrleansWashingtonFranklinOswegoWayneFultonOtsegoWestchesterGeneseePutnamWyomingGreeneQueensYatesHamiltonRensselaer

&D&F

NYS DOH DSRIP_Project Design Grant Application Section 3Partner Organizations & Service Area

Section 4_Project Desc.

Project Program Overview

DSRIP Projects - Must choose a Minimum of 5, Maximum of 10:

Domain 2 - Must select 2 projects, Maximum of 4 - At least 1 from sub list A, and 1 from sub list B or C.Domain 3 - Must select 2 projects, Maximum of 4 - At least 1 from sub list A, and 1 from sub list A, B, C, D, E, F, G or H.Domain 4 - Must select 1 project, Maximum of 2 - At least 1 from sub list A, B, C or D.** Please see Appendix B in the Instructions for details of each Domain. For further information, see link below for the DSRIP Project Toolkit**DSRIP Project Toolkit:https://www.health.ny.gov/health_care/medicaid/redesign/docs/dsrip_project_toolkit.pdf

4.1)Domain 2 (System Transformation) - Applicants must select a minimum of two projects, maximum of 4 from this domain (one of which must be from sub-list A and one of which must be from sub-list B or C)

Project #1- Sub-list AI.S.(REQUIRED) Must choose 1 from sub list A-->2.A.ICreate Integrated Delivery Systems that are focused on Evidence Based Medicine / Population Health Management 56

Project #2- Sub-list B or CI.S.(REQUIRED) Must choose 1 from sub list B or C-->2.B.IIDevelopment of co-located primary care services in the emergency department (ED) 40

Project #3I.S.(NOT REQUIRED) Can choose 1 from sub list A, B or C-->2.C.IDevelopment of community-based health navigation services 37

Project #4I.S.(NOT REQUIRED) Can choose 1 from sub list A, B or C-->2.A.IIIncrease certification of primary care practitioners with PCMH certification and/or Advanced Primary Care Models (as developed under the New York State Health Innovation Plan (SHIP))37

Provide reasoning regarding why your emerging Performing Provider System has selected the projects listed above from Domain 2 (Restricted to 4000 characters)ADO selected these projects for domain 2 because they are in line with our philosophy of transforming the system, one provider at a time. Our goal is to transform the participating organizations, groups, and provider practices (one member at a time) using proven methodologies, which have resulted in delivering better care at lower cost. At the center of it all will be the use of our unique technology called ADO Connects.

Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level below. Hence, we will avoid unnecessary hospitalization, and get rid of all other forms of waste or abuse currently embedded in the current system.

ADO will provide access to an EHR system to all providers of the PPS who wish to use it at no charge to the participants.

The other major tenor of the ADO System is its support staff. ADO proposes to create a PPS certification program that every member must go through over the first 6 months of participating in the PPS. Once the PPS Certified status has been obtained, it must be maintained in order to continue receiving the added incentives. Every two years, the PPS provider has to go through a re-certification process.

With the ADO Connects technology widely made available across the PPS, the need for standard data collection and reporting becomes critical. PCMH solves that challenge; all primary care providers will receive the necessary help to become PCMH Level III accredited in their first year of participation. Not only will we have access to the standard data set PCMH requires, we will also capitalize off of the concept of a community of providers working together to deliver care centered around the patient.

The Medicaid data shows clearly that non-compliance with primary care orders and a lack of access to primary care has led to a great number of unnecessary hospitalizations. In order to combat this very expensive habit of seeking care in the ER or only when the case has reached a critical stage, PPS participating hospitals will need to help with the development of Primary Care services in the ER and the payers have to support adequate reimbursement and have penalties for PPS providers who do not follow the rules or deliberately break/bend the rules. Hence the need for community based health navigation services to work in conjunction with the PPS and participating providers to engage the Medicaid recipients and educate them where they live, play, work and bring them into the system so they can receive care in primary care settings and remain compliant with their doctors orders.

Characters used:28644.2)Domain 3 ( Clinical Improvement) Applicants must select at least two projects from this domain (one of which must be A. Behavioral Health), but can submit up to 4 projects from Domain 3 for scoring purposes Project #1- Sub-list AI.S.(REQUIRED) Must choose 1 from sub list A-->3.A.IIntegration of primary care services and behavioral health 39

Project #2- Sub-list A - HI.S.(REQUIRED) Must choose 1 from sub list A, B, C, D, E, F, G or H-->3.C.IEvidence-based strategies for disease management in high risk/affected populations (adults only)30

Project #3- Sub-list A - HI.S.(NOT REQUIRED) Can choose 1 from sub list A, B, C, D, E, F, G or H-->3.B.IEvidence based strategies for disease management in high risk/affected populations (adult only)30

Project #4- Sub-list A - HI.S.(NOT REQUIRED) Can choose 1 from sub list A, B, C, D, E, F, G or H-->3.D.IIIEvidence based medicine guidelines for asthma management 31

Provide reasoning regarding why your emerging Performing Provider System has selected the projects listed above from Domain 3 (Restricted to 4000 characters)At the center of it all will be the use of our proprietary technology called ADO Connects. Once the technology is widely used across the PPS, all the clinical data will finally be in one single location and we will be able to use our proprietary technology to create one single and complete health record per PPS member for the benefit of the PPS as a whole.

Coupled with the PCMH accreditation for PCP within the first year of participation, ADO will have access to standard data sets through the PCMH reporting process.

Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level below.

It is therefore a normal extension of ADO to be able to jointly develop protocols with the PPS members and code the workflows into the software program to match such protocols for full integration of primary care and behavioral health. For example, the protocol may call for a behavioral health patient seeking services from a behavioral health provider must have a medical exam first and the results of such exam must be made available to the behavioral health provider. ADO Connect will have the capabilities to recognize when the protocol is not followed so that the ADO staff can intervene and bridge the gap. Furthermore, ADO can facilitate access to the health record of the patient so the behavioral health care provider is fully aware that the required medical exam took place and the full set of results is available.

The above approach can be used very effectively to develop evidenced based strategies for all sorts of diseases including cardiovascular, diabetes, asthma and more. The technology is simply the enabler for easy identification, intervention and control. The true measure of success is in having the PPS, the Care Navigators, the Providers, the Payers and the State Medicaid Program acting in unison to achieve the goal of Domain 3: clinical improvement.

PPS proposes to develop programs and engage the patients, providers, payers, State Medicaid Program and other stakeholders in a number of ways in order to ensure success with a single goal: clinical improvement. ADO will conduct in wide-ranging activities such as: Targeted educational campaigns to increase awareness about heart disease prevention, diabetes control, asthma control and empower patients to take control of their heart health. Use ADO Connects technology and quality improvement initiatives to standardize and improve the delivery of care for high blood pressure, high cholesterol, diabetes, and asthma Community efforts to promote smoke-free air policies; reduce sodium in the food supply; encourage healthy eating habits, regular exercise, and medication adherence Increase use of effective care practices through innovations such as team-based care, patient-centered medical homes, and interventions to promote adherence to treatment Support team-based care that improves care coordination by utilizing nurses, nurse practitioners, physician assistants, pharmacists, dietitians, and community health workers to promote medication adherence and patient navigation to free and low-cost drug programs. Improve access to care through team-based delivery, open scheduling, expanded hours, transportation assistance, and asynchronous contact (e.g., phone visits, secure email access, online patient portals). Ensure that patient education and self-management are delivered in a culturally and linguistically appropriate manner through patient educators, navigators, coaches, and linkages to community resources Enter into incentive payment distribution contract with PPS providers that incentivize improvements in clinical quality measures

Characters used:39554.3)Domain 4 (Population-wide Strategy Implementation) Applicants must select at least one project from this domain, but can submit up to 2 projects from Domain 4 for scoring purposes. Project #1- Sub-list A-DI.S.(REQUIRED) Must choose 1 from sub list A, B, C, or D-->4.A.IIIStrengthen Mental Health and Substance Abuse Infrastructure across Systems20

Project #2- Sub-list A-DI.S.(NOT REQUIRED) Can choose 1 from sub list A, B, C, or D-->4.B.IIIncrease Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings (Note: This project targets chronic diseases that are not included in domain 3.b., such as cancer)17

Provide reasoning regarding why your emerging Performing Provider System has selected the projects listed above from Domain 4 (Restricted to 4000 characters)Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level below.At the center of it all will be the use of our proprietary technology called ADO Connects. Once the technology is widely used across the PPS, all the clinical data will finally be in one single location and we will be able to use our proprietary technology to create one single and complete health record per PPS member for the benefit of the PPS as a whole.The true measure of success is in having the PPS, the Care Navigators, the Providers, the Payers and the State Medicaid Program acting in unison to achieve goal of uncompromised compliance and enhanced reimbursement and bonuses payments to providers.It is therefore a normal extension of ADO to jointly develop protocols with the PPS members and code the workflows into the software program to strengthen Mental Health and Substance Abuse Infrastructure across PPS Systems. For example, the protocol may call for a behavioral health patient upon discharge from a hospital for detoxification must be discharged to a rehabilitation facility which in turn must release the patient to a Primary Care Provider for scheduled follow up and random urine test for the presence of illegal drug(s) or alcohol. ADO Connect will have the capabilities to recognize when the protocol is not followed so that the ADO staff can intervene and bridge the gap. Furthermore, ADO can facilitate access to the health record of the patient so the behavioral health care provider is fully aware that the required medical follow up took place upon discharge and the full set of results must be made available. The payers have a role to play as well as the State Medicaid Program. The Payers should compensate the compliant providers with an enhanced fee and allow for the PPS to enter into Incentive Payment Contract to reward the compliant providers with enhanced bonus payment. Furthermore, the State Medicaid Program should take steps to put immediate and targeted partial holds on the Benefit Cards of non-compliant patients. With the widespread use of ADO Connect among the PPS members, we will know exactly when and where the patient is seeking services in real time; the Care Navigators and all the providers in the PPS can intervene and direct the patient to the next step in their mandated care in order to reactivate their Benefits Card as they become complaint.

The above approach can be used very effectively to Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings. The technology is simply the enabler for easy identification, intervention and control. PPS proposes to develop programs and engage the patients, providers, payers, State Medicaid Program and other stakeholders in a number of ways in order to ensure success with a single goal: High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings.ADO will conduct in wide-ranging activities such as: targeted educational campaigns; community fairs, healthy eating habits workshops; regular group exercise sessions where the Medicaid patients live, play or receive care; medication adherence incentive programs; effective care practices through innovations such as team-based care, patient-centered medical homes, and interventions to promote adherence to treatment; ensure that patient education and self-management are delivered in a culturally and linguistically appropriate manner through patient educators, navigators, coaches, and linkages to community resources

Characters used:3856Project Description

4.4)Provide a brief executive summary of your emerging Performing Provider System's vision and goals and how your emerging Performing Provider System hopes to sustain these achievements beyond the DSRIP program timeframe. (Restricted to 3000 characters)

Our vision is to have any and all current Medicaid providers participate in the PPS as they have been delivering care to the population for a long time. Our goal is to transform the participating organizations, groups, and provider practices (one member at a time) using proven methodologies, which have resulted in delivering better care at lower cost. At the center of it all will be the use of our unique technology called ADO Connects.

Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level below. Hence, we will avoid unnecessary hospitalization, and get rid of all other forms of waste or abuse currently embedded in the current system.

ADO will provide access to an EHR system to all providers of the PPS who wish to use it at no charge to the participants.

The other major tenor of the ADO System is its support staff. ADO proposes to create a PPS certification program that every member must go through over the first 6 months of participating in the PPS. Once the PPS Certified status has been obtained, it must be maintained in order to continue receiving the added incentives. Every two years, the PPS provider has to go through a re-certification process. The certification is based on

1. The acquisition of the ADO EHR or the working HL7 bridge to another system that carries PPS meaningful use data2. The training of the provider and staff on the effective use of the EHR 3. The ability of provider and staff to pass a simple test on their knowledge about the EHR 4. PCMH accreditation5. Ability to effectively contribute to data aggregation in the ADO cloud6. Maintaining a single record on each PPS member7. Maintaining a single portal for all PPS members8. Commit to work in collaboration with the ADO Connects Operations Center to reduce cost of delivering care to Medicaid recipients and reducing hospitalizations by 25% over 5 years

The ADO staff will train and coach providers every step of the way and make sure they become PPS certified and remain certified. Throughout the two-year certification process, PPS providers will continue to receive score cards and suggestions on steps to take to improve their scores. Hence, it will never be a surprise when a provider loses its PPS certified status as such provider would been given ample opportunities to intervene and correct any and all potentials issues preventing their recertification. This will ensure success and longevity of the program well beyond the first 5 years.

Characters used:27824.5)Why does your emerging Performing Provider System, as a whole, feel uniquely qualified to participate in DSRIP and serve the area you have proposed? (Restricted to 3000 characters)ADO proposes to set up the infrastructure for patient care, quality assurance, and provider productivity with technology that is easy to use for care participants, including the hospitals. This is our proprietary ADO Connects technology. Being that we are looking into the current healthcare delivery systems for Medicaid recipients with the eyes of an outsider and we are not hospital owned or affiliated, we have absolutely no biases of any forms. Through the Stakeholders engagement exercise as well as the Community Needs Assessment, we are truly open to learning (as opposed to verifying our assumptions) the needs of both groups. Then and only then will we start to work on solutions to the identified issues as guided by the DSRIP program requirements.Furthermore, upon analyzing data for the last 5 years of the Medicaid program in NYS, we are confident that our predictive analysis tool will unveil many areas for improvement all of our participants should eagerly adopt. More importantly, these models will serve as the solid foundation for our actions in effecting practice transformation. ADO Connects all care providers in the echo system and allows them to communicate effectively. The solution is designed to put a solid foundation for the PPS system to be built upon. The technology solution will be:o Limited to PPS needs. This is NOT a certified EHR platform for meaningful use purposeso Distributed to all PPS participants who do not have their own EHR in place or who prefer to use the new system for any reasono Connected to all Hospitals in the Systemo Can be used as a standalone or integrated technology platform o Offered to all community based organization in the PPSo Offered to any and all other providers, entities, and organizations that may potentially interact with the Medicaid patients covered under the PPS contract.With this solid foundation in place, coupled with our staff and the Operations Center, ADO is in a unique position to effect lasting change that will deliver on the promise of delivering better care, accessible care, at lower possible cost.

Furthermore, because we are all inclusive at the beginning, there are no providers left behind. However, every PPS provider will have to make the decision to go through the Organization/Group/Practice Transformation Process and emerge as a PPS compliant entity. It will be up to the entity to commit and remain a PPS member. Through our PPS certification program every PPS member will always be performing at the top of their ability as they have to recertify every two year.

It is clear that our system along with the experience of all Medicaid providers will work not only in Nassau and Suffolk Counties, but anywhere a commitment is made to effect serious changes through the DSRIP program.

Characters used:28034.6)What specific challenges does your emerging Performing Provider System foresee that could hinder the implementation of its DSRIP Project Plan? (Restricted to 3000 characters)Small offices with few Medicaid providers did not adopt EHR technology; for the most part they welcomed the AIU grant of $21,250 per provider and failed to move forward with the program. To them EHR usage equates to a loss of revenue. The lack of capital to effectively make the transition as it requires not only the acquisition of the EHR software, it also requires training, support personnel and long term relationships with third party consulting companies that specialize in the transformation of practices. The consulting companies keep the providers compliant with the many changes affecting their practices on a daily basis.Based on the current data set made available by NYS about the Medicaid EHR Incentives program, we notice the following:HOSPITAL PAYMENTS: a total of 304 hospital payments have been made. 162 were made in in the first year of the program (2011), 114 in the second year (2012) and 28 in 2013. One can summarize this as 53.29% of the payments in year 1, 37.50% of the payments in year 2 and 9.21% of the payments in year 3. PROVIDER PAYMENTS: A provider being a Physician, Physician Assistant, Nurse Practitioner, or Certified Nurse Midwife. A total of 10,832 have been made of which 7,829 were made in the first year of the program, 2,872 in the second year, and 131 in the third year. One can summarize this as 72.28% of the payments in year 1, 26.51% of the payments in year 2, and 1.21% of the payments in year 3.DENTIST PAYMENTS: A total of 1,038 have been made of which 986 were made in the first year of the program, 50 in the second year, and 2 in the third year. One can summarize this as 95% of the payments in year 1, 4.82% of the payments in year 2, and 0.2 % of the payments in year 3.

* Data set up to March 2014 Long Term Care LTC facilities: mostly did not qualify for EHR Incentives Nursing Homes NH are not interested in EHR Incentives because most of their doctors are contracted providers and want the incentives for their own office Mental Health Care Providers MH are for the most part not medical doctors, therefore do not qualify for EHR Incentives Community based organizations and social services organizations, which are at the core of caring for the Medicaid recipients were not part of the EHR adoption conversation at all as they are not considered care providers.

1. How are we going to have any form of EFFECTIVE PPS with member organizations seamlessly sharing data and working in collaboration with each other without the basic tool called EHR? 2. That is the big elephant in the room that no one is talking about while everyone is trying to take advantage of this funding opportunity to expand their influence and at the same time spend $8 billion of Federal government funds without necessarily showing the results for it.3. We need to build a solid foundation in order to see the short and long term advantages of the DSRIP program.

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NYS DOH DSRIP_Project Design Grant Application Page 2Project Desrciption

NYS DOH DSRIP_Project Design Grant Application Page 2Project Desrciption

NYS DOH DSRIP_Project Design Grant Application Section 4Project Program Overview/Description

https://www.health.ny.gov/health_care/medicaid/redesign/docs/dsrip_project_toolkit.pdf

Section 5_CNA_StakeholdersCommunity Needs Assessment

Examples of items to include in the descriptions can be found in the instructions.

Description - Each box is restricted to 5000 characters.

~ Keep in mind, the description box will expand as you type ~

Description5.1)Planning and OrganizingIn order to plan and organize the community needs assessment our Performing Provider System will include the following steps.

1. Find a process to improve: It is clearly understood that the current means of community needs assessment is not up to par. We would address this issue to ensure that the new and improved process is more efficient and effective in terms of continuous quality improvement in providing healthcare. An opportunity exists to improve the committee needs assessment process beginning with providers, and ending with patients. This effort should improve the effectiveness and cause the data collection to become more resourceful for the improvement in quality of care for patients. 2. Organize a Plan: First we will begin by identifying the staff integral to the process and invite them to join the team. Having the staff be present in the decision making part of the process will allow for the PPS to function at a capacity paying attention to fine details. Stakeholders will be identified as well, however they will be appointed to lead the team. Although the project will be a daunting task, a facilitator will be appointed in order to keep the project on track therefore our goals and/or deadlines will be met. The team will be assembled and comprised or team members, team leader(s), recorder(s), and a team facilitator. Ground rules will be established to ensure there is a mutual understanding amongst the team members. A grant chart will be reviewed to familiarize the team with the financial responsibility for this project. The team leader(s) will circulate agendas throughout the project and at monthly team meetings. Last but certainly not least; the recorder will document minutes at each formal proceeding.3. Clarify current knowledge: In order to tackle community needs assessment we must understand and gather information for the current process. Understanding what staff is involved, whom the current vendors are, the equipment being used, and the materials in place, will allow for our PPS to address the improvements necessary with a better understanding of what is already being done. A flow chart will be used to visually examine the relationship and sequence of the current steps and create a common understanding amongst team members of the process flow. With this method, redundancy can and will be eliminated from the process. We are sure to find unnecessary complexities and steps that are no longer efficient; once identified they will be removed. 4. Understand the source of variation: In essence our goal is to trim the fat off the current system being that it is unnecessary and should be removed. This allows us to more accurately compare and identify the extent to which the process differs from the norm. In turn, we will be able to identify the parts of the process that are in or out of our control. For those parts that are within our control a new and improved process will be implemented. As for the parts of the process that are out of our control, a process to positively influence the external parties of the process will also be implemented. 5. Select the improvement method: After reviewing all the possible alternative methods to remediate the current system, we will choose the best alternative for the improvement and effectiveness of the committee needs assessment process.6. Plan the improvement of the process and collect data: This part of the process will be used to determine how out PPS will implement a process to see through the improvements needed. Data will be collected in order to track our progress throughout the project in order to ensure a positive outcome, and to reach our goal/deadline. 7. Do the improvement: Our PPS will now be ready to take action in implementing the new and improved process. Here we will make the change and measure the effectiveness of said change. 8. Check the results: Monthly formal proceedings will take place in order to gather all team members and examine the collected data to determine if the improvements achieved the desired results.9. Act to improve the process: Along the way we may find that the anticipated step in the plan can be replaced by a better approach, therefore we will take the necessary steps to keep an open mind and adjust the obstacles we may face in order to hold on to the gains and progress we have made thus far.

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Description5.2)Needs Assessment MethodologyThe communities that our PPS would target are Nassau County and Suffolk County of Long Island, NY. In order to begin, we would accurately define the two target counties, in addition to defining the current health of those communities. Nassau County, for instance, is a sub urban county on Long Island, NY. The 2010 census calculates that the current number of residents was near 1.4 million people. Within Nassau County there are two cities, three towns, 64 incorporated villages, and over 100 unincorporated areas. For the purpose of this needs assessment the three towns will pose as the identified subareas of the county, which form a cluster of zip codes. We would then go into further detail and identify the demographics, size and trends, and socioeconomic indicators consistent within the county. AN identical procedure will be conducted for Suffolk County as well.The purpose of attaining the needs assessment is to determine the unmet needs of the community. Our main targets would be 1) access to essential health Care and 2) to enhance personal health behavior. The methodology involved with this project would require us to:1. Establish a community advisory.2. Obtain primary, secondary, quantitative, and qualitative data to analyze 3. Develop a report of our findings

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Description5.3)Data CollectionIn order to maximize the benefits of the data collection for the needs assessment we will divide the community into focus groups by; age group, location, and the number of participants. We will conduct the survey in three ways. The use of a recruitment method will encourage participants to take part in a written survey. Participants will be compensated for their travel expenses and volunteered time. Necessary language interpreters will be provided for each location. Individuals with expertise in the health and healthcare needs of the community will conduct over the phone informational interviews. Language interpreters will also be provided using this method. We will also conduct a needs assessment survey electronically. This will allow us to reach out to a larger focus group and obtain the necessary information for the needs assessment. If English is not the participants primary language we will provide directions for them to follow in order to complete the survey in a written format or over the phone, where interpreters will be available to assist. The collected qualitative information obtained from the focus groups and informational interviews will be analyzed by identifying and coding themes across groups and individual interviews. This data will be organized into major topic areas related to health status, access to care, special population needs, unmet needs of the community, and health care priorities. Our goal is to make the information gaps in the community as minuet as possible.

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Description5.4)ReportingThere are endless ways to interpret and utilize the data that will be collected for the communitys needs assessment. We plan to report the data in the following fashion:1. Describe the needs of the community: After the surveys are completed and the data is collected, this will give us a clear picture as to what the community actually needs.

2. Describe the differences between designated subareas: The areas of focus that we will be comparing between areas are:a. Health Status:i. Birth outcomes: birth rates, adolescent birth rates, low birth weight, and infant mortality rate.ii. Self-reported health status: fair or poor health, health conditionsiii. Communicable diseases: Hepatitis B, Lyme disease, Staphtococcal infection, chlamydia, HIV/AIDS etc.iv. Health Concerns: Here we will determine the top two main health concerns of the community.

b. Access to care: Health insurance status, emergency room utilization among the uninsured, prescription drug coverage, economic barriers, utilization of preventative services, pre-natal carec. Use of health Screenings: dental visits, recommended screenings; blood pressure, colonoscopy, pap smear test, mammogram, rectal exam for prostate cancer, etc.d. Health Behavior: nutrition, exercise, tobacco use, alcohol consumptione. Social capital and neighborhoodf. Health needs of the special populations.

Characters used:1367Stakeholder Engagement5.5)As an emerging Performing Provider System, please explain the process on how you plan to engage the key stakeholders to develop your DSRIP Project Plan? (Restricted to 3000 characters)

(Key stakeholders should not be a part of the emerging Performing Provider System) - See instructions for examples of key stakeholders

The current major providers of care to the Medicaid population will be invited to participate and provide input to the creation of the ADO PPS. The engagement process will take a two-prong approach: first to recognize the providers importance and experience in providing care to the said population and second to expose them to the ADO philosophy, technology, and care management approach to delivering quality care at the lowest possible cost. Each provider type will be engaged at different levels and challenged until consensus if not agreement is reached on philosophy, technology, and care management approach that will benefit the PPS as a whole so we can deliver on the promise of reducing hospitalization, helping the safety-net providers thrive, and deliver quality care at the lowest possible cost while keeping the doors open. The ADO PPS will strive to engage stakeholders in the following areas:

1. Hospitals: on the surface, they seems to have the most to lose (25% of admissions) we need to show them how the PPS can help them find/increase sources of revenue in the new paradigm:a. Public Hospitalsb. Voluntary Hospitalsc. Critical Access Hospitalsd. Sole Community Providerse. Etc

2. FQHCs3. Article 164. Article 285. Article 316. Associations such as:a. Mental Health Association of Nassau/Sufflok/NYCb. Family and Children's Association: Home and community based servicesc. Long Island Council on Alcoholism and Drug Dependenced. Circulo de la Hispanidade. Etc

7. Community Based Organizations8. Group Homes such as FREE9. Skilled Nursing Facilities10. Long Term Care Facilities11. Palliative Care Facilities12. Department of Social Services (Nassau and Suffolk)13. Certified Health Home Agencies such as VNS, LIJ Home Care, etc..14. Adult Daycare Program15. Private Practices (all current small and large safety net providers on the DSRIP website)16. Healthix HIE17. And others

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NYS DOH DSRIP_Project Design Grant Application Section 5Community Needs Assessment

Section 6_Vendor

List of Vendors6.1)Applicant must list contact information of any vendor they plan to contract with to assist in their DSRIP planning efforts. **The state maintains the right to approve any vendor used in the DSRIP program.**

1Organization NameHITS CONSULTING GROUP LLC2Organization NameIT ACCELAddressCityStateZip CodeAddressCityStateZip CodeOrganization Address243 5TH AVENUE, SUITE 404NEW YORKNY10016Organization Address30 BROAD STREETNEWYORKNY10004Contact PersonHENRY L. DENISContact PersonCHARLIE MILLERContact Phone Number2129790330Extension:Contact Phone Number2125642200Extension:Contact [email protected] [email protected]

Describe the vendor's qualifications and how they will be assisting the applicant in their planning efforts? (Restricted to 1000 characters)HITS Consulting Group LLC is a consulting firm specialized in practice transformation from paper to electronic health record. They have been in operations in NYS for the last 5 years and have helped major organization achieve success with the transition to EHR technology through their various solutions ranging from unique technology integration solutions, Cloud computing, PCMH, Meaningful Use, business consulting, ACO preparedness, and more. HITS Consulting Group LLC has worked with various Regional Extensions Centers in the area among which the NJ HITEC REC and came out as top contractor from 2010 to 2014.HITS CG is ADOs contractor for integration of records on multiple platforms to achieve a single patient record.Their revolutionary technology will be a key component to meet our goal of having one health record per patient for the entire PPS. Hence, managing data on a system wide basis can be achieved and performance outcome attained and monitored in real time. Describe the vendor's qualifications and how they will be assisting the applicant in their planning efforts? (Restricted to 1000 characters)IT Accel is a 10 year old IT recruiting and consulting company located in the heart of the financial district of NYC with a mission to want to bring their experience and depth of knowledge to solving complex human resources issues and challenges created by an ever-changing technological and business landscape. Because they know information technology so well -- how it works, how it changes, and which employees have the best tools for the job -- they are uniquely qualified for, and focused on, handling all of your business's technological staffing needs. And because of the value they place on longstanding relationships with satisfied clients, you can rest assured that they will continue to handle those issues day after day, year after year.IT Accel has the technologist the PPS will need in order to fulfill its IT goal and integrate disparate data sets for consolidated reporting and meet our goal ONE BODY ONE HEALTH Record.

Characters used:982Characters used:9373Organization NamePierre-Louis & Associates, LLC4Organization NameAddressCityStateZip CodeAddressCityStateZip CodeOrganization Address8817 Bells Mill RoadPotomacMD20854Organization AddressContact PersonHOLDEN PIERRE-LOUISContact PersonContact Phone Number3012665533Extension:Contact Phone NumberExtension:Contact [email protected] Email

Describe the vendor's qualifications and how they will be assisting the applicant in their planning efforts? (Restricted to 1000 characters)Pierre-Louis & Associates (P&L), LLC is a Business Intelligence (BI) Services & Solutions company. Since 2006, P&L has enabled 2 Federal Agencies, as well as large (Single Location5+ providers) & multi-location healthcare providers to define, measure and monitor their KPIs (Key Performance Indicators). Weve enabled our clients to develop (Descriptive => Diagnostic => Predictive => Prescriptive) analytics. As a result, our clients became more efficient and more effective at analyzing / visualizing their data in order to make critical strategic and operational decisions. The deliverables are usually in the form of Dashboards, Analytical (What-if), and Reporting tools.Describe the vendor's qualifications and how they will be assisting the applicant in their planning efforts? (Restricted to 1000 characters)

Characters used:680Characters used:05Organization Name6Organization NameAddressCityStateZip CodeAddressCityStateZip CodeOrganization AddressOrganization AddressContact PersonContact PersonContact Phone NumberExtension:Contact Phone NumberExtension:Contact EmailContact Email

Describe the vendor's qualifications and how they will be assisting the applicant in their planning efforts? (Restricted to 1000 characters)Describe the vendor's qualifications and how they will be assisting the applicant in their planning efforts? (Restricted to 1000 characters)

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7Organization Name8Organization NameAddressCityStateZip CodeAddressCityStateZip CodeOrganization AddressOrganization AddressContact PersonContact PersonContact Phone NumberExtension:Contact Phone NumberExtension:Contact EmailContact Email

Describe the vendor's qualifications and how they will be assisting the applicant in their planning efforts? (Restr