PAC Meeting, December 5, 2019

NQP Highlights SDH, VBP and DSRIP 2.0 at Year-end PAC Meeting in December

NQP held its final PAC meeting of 2019 on December 5, with a lively agenda and an enthusiastic audience. The focus was on some of our favorite healthcare acronyms: SDH, VBP and DSRIP 2.0.

Martine Hackett, PhD, MPH, Associate Professor in the School of Health Sciences and Human Services at Hofstra University, spoke eloquently about Social Determinants of Health and their impact on healthcare delivery. She discussed the NYS agreed-upon domains of SDH: Health and Healthcare, Education, Neighborhood and Environment, Social Family and Community, and Economic Stability. She then went further in arguing that social risk factors and mining for social needs that fall within the SDH construct that must be addressed in order to make real progress in addressing health within a community. She defined Social Risk factors as the adverse social conditions associated with poor health. She suggested that screening patients for unmet needs, talking to patients about those findings, and connecting them to community services to address those needs will go far in addressing the most basic and daily needs. “A person may have many social risk factors but fewer immediate social needs, which is why patient-centered care and engaging individuals in conversations about their unmet social needs are crucial to identifying which need is the most pressing for a patient in each moment”, Dr Hackett said. Lastly, advocating for program and policy changes to meet these needs is incumbent upon our industry and society in general to begin to address health disparities.

Dr. Andrew Cleek, from the NYU McSilver Institute for Poverty Policy and Research, used his presentation to simplify for the audience how VBP is defined and what it means to downstream providers. He explained that according to CMS, “value-based programs reward health care providers with incentive payments for the quality of care they provide. These programs are part of our larger quality strategy to reform how health care is delivered and paid for. Value-based programs also support our three-part aim: (1) Better care for individuals, (2) Better health for populations, (3) Lower cost”. He described the payment models and its basic elements of fee-for- service, shared risk, and capitation. Each has upsides and downsides in terms of risk sharing in order to gain the best financial position. Savings can be achieved through key metrics, which he warned that all organizations should become comfortable knowing, using and communicating. To put organizations in the best position to achieve VBP success, they must develop a flexible, adaptable, and interconnected infrastructure. That infrastructure needs to include ongoing IT support and development, a solid financial structure and data reporting capability, quality improvement support and development, a Human Resources culture and process that is performance driven, and access to and understanding of data and analytics, including a comprehensive common data set in a standard format, that is simple enough to be actionable— yet making sure it is complaint with HIPPA and 42CFR. CBO’s and Behavioral Health organizations can be well positioned to take advantage of VBP arrangements to make a positive impact on community health.

Tom Early, Executive Director of NQP, was the final speaker who discussed several DSRIP milestones and achievements after four plus largely successful years. Measurement Year 5 (MY5) ended in June 2019, and with it the tracking of pay for performance metrics. We are currently in Demonstration Year 5 (DY5), which ends in March 2020. Great statewide success included a 21% reduction in PPA (potentially Preventable Admissions). He then pointed to just a few examples of the overall success that NQP and its partners has achieved: Over 2,000 providers contracted to participate in DSRIP initiatives across Nassau & Eastern Queens; two activities highlighted in UHF Promising Practices publication (Crisis Stabilization: Preventing Unnecessary Behavioral Health Hospitalizations and Integration: Embedding Nutrition Assistance Within Healthcare Settings); and over 35,000 “units” of Workforce Training (i.e., 35,000 instances of people trained, some of which could have been filled by a person more than once). He gave credit to the partners and people within our PPS whose efforts helped us achieve so much.

Tom then addressed what was on everyone’s mind: where will DSRIP be after March 2020? He reviewed what we know of the NYS Two Phased Waiver Amendment Proposal submission to the federal government on November 27. The proposal requests an additional $8 billion. The waiver negotiation would continue between now and March 31—which the DOH hopes will lead to a positive outcome. The proposed Phase One would begin on April 1, 2020 and last for one year, with the PPS structure still in place to work on continuing the fine work on projects that have proven successful. The proposed Phase Two would include a transition from the PPS structure to a VMO (Value Management Organization), which would consist of representatives from Providers, MCO’s, local health departments, Social Determinants of Health Networks (Lead applicants to be CBOs or IPAs), and Medicaid members. Proposed new Funding Pools will be developed. This new entity would be responsible for implementing the five Promising Practice focus areas, as identified by the United Hospital Fund: Transforming / Integrating BH, Care Coordination / Care Management / Care Transitions, Addressing Social Needs / Community Partnerships / Cross Sector Collaboration, the Opioid Crisis, and High Utilizers of Care. Additional high priority areas include Children’s Health, Reducing Maternal Mortality, and Long Term Care. No one knows what the final agreement will look like, but the proposal presents an encouraging development in continuing this successful program.

Click here for: December 2019 PAC slide decks

NQP PAC Meeting Highlights DSRIP Success Stories

Those in health care know that there are many acronyms that we toss around quite often. While DSRIP technically stands for Delivery System Reform Incentive Payment Program, on Friday March 22 it stood for Dramatic Stories Recounting Initiatives for People. In what many described as one of the best PAC Meetings they had attended, NQP and several of our partners described key initiatives that resulted in more efficient and effective delivery of healthcare and better lives for members of their communities.
Dr. Gilbert Burgos, NQP’s new Executive Director, kicked off the event by providing an overview of the remaining DSRIP timeline, for which the final submission is due in April of 2020. Budgets have been adjusted accordingly for a wind-down. Rumors persist that DSRIP may be extended due to the positive results that have been achieved statewide, but nothing has been finalized yet. Our major accomplishment involves facilitating over 2,000 providers to participate in DSRIP initiatives across Nassau and eastern Queens. They contributed to improving the care we deliver to our community by improving year over year many of the quality metrics we track and participating in many innovative activities, some of which were highlighted at the meeting.

DSRIP Success Stories from the Field. The first part of the day consisted of local success stories on the utilization of DSRIP funding. Below are brief summaries of the presentations.
a. Behavioral Health Crisis Programs at Northwell Health (Lindsay Hall, Assistant Director, Health Solutions, Northwell Health). Lindsay described Crisis Stabilization Centers at both Zucker Hillside Hospital and Cohen Children’s Hospital Behavioral Health Urgent Care. Both centers have been able to achieve an over 90% avoidance of a hospital visit. Northwell has also partnered with Transitional Health Services of NY (TSINY) to create an innovative program to help avoid ED visits for patients of

Creedmoor Psychiatric Center, a high utilizer of services. She reported 99% of calls were de-escalated without an ED visit.

b. College Partnerships with NQP (Dawn Nolan, Director, Center for Workforce Development, Nassau Community College). Nassau Community College and NQP have partnered to create workforce pipelines, training and assistance with curriculum development. Dawn said the Community Health Worker Program, which is working towards developing into a career pathway certificate program and Associates Degree, as well as a Health Career Reception and on campus training programs are several of the initiatives we have worked on together.

c. Behavioral Health Primary Care Integration (Mary Emerton, LCSW, DSRIP Project Manager, Behavioral Health, CHS). Mary described several models Catholic Health Services has used in both Primary Care and Behavioral Health settings. Several practices and behavioral health settings are operationally integrated, and 40 utilize behavioral health screening tools. Critical focus for the next year are integrating additional practices, developing tele-psychiatry services, and ensuring financial stability.

d. MAX ED: St John’s Episcopal Hospital experience (Natalie Schwartz, MD, Chief Population Health Officer, SJEH). Dr. Schwartz discussed St John’s Episcopal Hospital’s success with ED Navigators and the ED Max Programs. She described improved process flows and interventions that resulted in a significant reduction in ED visits among high utilizers. Interventions included referrals for transportation and financial counseling, connection to PCP’s, CHW’s and other resources, improved health literacy education, and prescription pick-up.

e. LIFQHC: Transitions of Care (Julie Harnisher, Vice President, Population Health, LIFQHC). Julie discussed the pilot project to provide better transitions of care and to ensure their credo of “No Patient Left Behind”. They hired a TOC team of 6 (5 Advocates who work as navigators and a supervisor) and integrated with Home Care Management to ensure patients get connected to a PCP. Results thus far have been encouraging.

f. Use of Peers to Engage Health Home Residents (Jeremy Merrill, Director of Care Management, New Horizons Counseling Center) Jeremy’s organization began using Peers in an Adult Home setting with two active clinics. He told a heartening story of one such interaction in which the Peer model was successful, reducing ED visits from 27 per month to 3 per month by having a Peer shadow a client to ensure he was following medical protocols.

g. Community Health Workers in Elmont (Pat Boyle, Executive Director, Gateway Youth Outreach). Pat told a story of a real community hero for his youth services agency that serves over 800 children in the community. Their CHW is a Creole and English speaker who has a unique ability to connect with members of the local

Haitian community. He has developed tremendous trust among his constituents and continues work tirelessly to connect PCP’s with local schools for screenings and care.

Value Based Payments Roundtable: How will VBP impact local providers? John Javis, NQP’s Director of Behavioral Health, later moderated a panel discussion which asked the question: What Impact will Value Based Payment have (if any) on local organizations? The panelists were:

a. Svetlana Kats (Director, Intergovernmental & External Relations Behavioral Network Services – Public Sector/NYS United Healthcare Community Plan) b. Joseph Lamantia (Executive Director, Northwell Health Solutions, Vice President, Population Health Management ) c. Bob Detor (Chief Executive Officer, Advanced Health Network IPA) d. Greta Guarton (Executive Director, Long Island Coalition for the Homeless) e. David Nemiroff (President/CEO Long Island FQHC, Inc.)

Hospital systems like Northwell and primary care providers like the LIFQHC are already engaged in VBP contracting, and are learning how to better manage their risk. To what extent behavioral health providers and Tier 1 CBO’s will be engaged in Value Based contracts in the future is less clear.
The panelists were in universal agreement that the optimal results would be achieved if various partners (MCO, Hospital, Primary Care Physician, Behavioral Health provider and Tier 1 CBO) could work together in a networked fashion to quickly identify and respond to the patient’s urgent needs. It was also acknowledged that a focus on behavioral health and the social determinants of health would, in fact, improve overall health outcomes and lower the total cost of care.

The slide deck from the meeting appears below. Enjoy!