Creating and Managing a New Coalition Across the Health Care Continuum

NewYorkStatePublicHealthAssociationAnnualMeetingApril27,2017

Today’s Objectives

Howtoidentifyandgeneratebuy-infromdisparatepartners

Howtocreateandsustaincommunitiesofpractice

Howtocreateandsustainstructurestosupportprogramimplementationacross

alargesystem

Topics Covered

WhatisDSRIP?

BPHCanditsGovernanceFramework

BuildingtheClinicalNetwork

CommunityEngagementStrategies

LessonsLearned

Delivery System Reform Incentive Payment4

§ DSRIPisamajorcollectiveefforttotransformNewYorkState’sMedicaidHealthcareDeliverySystemfromafragmentedsystem,overlyfocusedoninpatientcare,toanintegratedandcommunity-basedsystemfocusedonprovidingcareinorclosetothehome.

§ NYSranked50th forpotentiallyavoidablehospitaluseandcostofcare§ 25PerformingProviderSystems(PPSs)wereestablishedinNYStoconductthistransformation

§ Upto$6.42billionallocatedtothisprogramwithpayoutstothePPSbaseduponachievingpredefinedresultsinsystemtransformation,clinical management andpopulation-based health

• Volume-based• Patient-based• Episodic• AcuteCare• SicknessCare

FROM TO

• Value-based• Population-based• Continuous• PreventiveCare• Wellnesspromotion

DSRIP Goals§ Reduce unnecessaryhospitaluse(inpatientandED)by25%over5years§ CreateanIntegratedDeliverySystem(IDS)§ AchievePCMHRecognitionforparticipatingprovidersandexpandaccesstoprimarycare

§ Supportintegration ofBehavioralHealthandPrimaryCare,anddevelopCareManagementandCareCoordinationcapacity

§ PromoteInformationexchangeanddataintegrationtosupport“rightlevelofcareatrighttime”(EHR/RHIO)

§ ShiftthepaymentsystemfromVolume-BasedtoValue-Based

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Key Program Components§ DSRIPprojectsselectedfromamenuofstate-definedinterventionsanddesignedaroundneedsofthecommunity

§ Integrationofcommunity-basedorganizationstoaddressthesocialdeterminantsofhealth

§ Trainingandstrategicre-deploymenttosupportavibrantworkforce operatingthroughoutthecontinuumofcare

§ Connectivity toimprovetransitionsofcareacross thePPSandfacilitatepopulationhealthapproaches

§ Ensuresuccessfulchangestothedeliverysystemaresustainable

§ Deliverpatient-focusedcareandempoweringself-management

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BPHC: A Bronx Tale7

KeyTakeaways:§ 59%ofBronxresidentsenrolledinMedicaid§ TheBronxistheleasthealthycountyinNewYork

Statewithhighratesofpreventablechronicdisease.• TheBronxhasthehighestrateofpotentially

preventableinpatientMedicaidadmissionsofallfiveboroughs.

• In2012,thePQI*rateinfortheBronxwas31%lower,comparedto2%lowerforallofNYC,thanallofNYS.

§ Thecostsincurredformedicalcareareextremelyhighandactasabarriertoeffectiveuseofpreventionanddiseasemanagementservices

TheCommunityNeedsAssessment(CNA)conductedbytheNewYorkAcademyofMedicineinOctober2014highlightedtheneedforinnovationsinhealthcareandimprovedcollaborationbetweenclinicalandcommunityresources.

*PQI:PreventiveQualityIndicator,toidentifyqualityofambulatorycare,suchaspreventablehospitalization

Bronx Health Disparities Snapshot: Social Determinants of Health

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LanguageandCulture:50%+of1.5milpopulationspeakalanguageotherthanEnglishathome.

Transportation:Bronxresidentshavelongcommutesandhigherratesofdisruptiontobus/subwayservice.

Environment:Poorairqualityandotherenvironmentalpollutantsfromindustrialactivityandwastecenters.

Income:~30%ofBronxhouseholdsliveinpoverty,andBronxresidentsexperiencethegreatestunemployment(~10%)whencomparedtootherNYCboroughs.

FoodInsecurity:~22%ofBronxresidentslackadequateaccesstofood.Unhealthyfoodismoreaccessiblethanfreshfruitsandvegetables.

Education:Fewerthan20%ofBronxresidents[have]completedadegreebeyondhighschool.

Housing:Overathirdofthepopulationhasinadequatehousing,andnearly40%ofhouseholdspay50%+oftheirincomeonrent.BronxresidentsreporthigherratesofunsafehousingthanotherNYCboroughs.

HealthcareAccess:2,080Bronxresidentsperprimarycaredoctor,2xthestateaverage.~16%ofBronxresidentsareuninsured.

Preventable Illness in the BronxCardiovascularDisease:Heartdiseaseisthetopcauseofmortalityandthesecondleadingcauseofprematuredeathintheborough,aftercancer.

Diabetes:Therateofhospitalizationforshort-termdiabetescomplicationsamongMedicaidbeneficiariesisalmost50%higherintheBronxthaninthecityandstateoverall(151/100,000vs.105/100,000and110/100,000,respectively).

Asthma/COPD:Youngadultasthmaandrespiratoryhospitalizationsareconcentratedinthesouthernpartoftheborough,extendingacrossbothsidesoftheGrandConcourse.

MentalHealth:IntheBronx,7.1%ofallpeoplereportexperiencingseriouspsychologicaldistress,comparedto5.5%inNYCoverall.ApproximatelyhalfofCNArespondentsreportedthatthementalhealthservicesarenotveryavailableintheircommunity.

SubstanceAbuse:Substanceabusewasthesecondmostcommonlycitedhealthconcernbysurveyrespondents(47.2%).

HIV/AIDS:FourneighborhoodsintheBronxhavehigherHIV/AIDSprevalenceratesthanthecityasawhole:HighBridge/Morrisania,Crotona/Tremont,Fordham/BronxPark,andHuntsPoint/MottHaven.

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ESTABLISHING THE BPHC PERFORMING PROVIDER SYSTEM

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BPHC Profile

TheBronxisreadyforDSRIP:§ LeasthealthycountyinNYS§ PooresturbancountyintheUS§ <70%adultshaveattainedahighschooldiplomaorequivalent

§ OverhalfofresidentsspeakalanguageotherthanEnglishathome

Bronx PartnersforHealthyCommunitiesPPS

SBH HealthSystem(lead)• 150yearsofservingtheBronx• Over70%Medicaidpatients

Memberorganizations240organizations,1,000+sites~70,000employees

PatientPopulation• 170Kattributedforvaluation• 370Kattributedforperformance*

*AsofJuly1016

BPHC’s Charge

HomeCareAgencies CommunityBased

Organizations

Hospitals

FQHCs

HealthHomes

BehavioralHealthFacilities

LongTermCareFacilities

IPAsandIndependentProviders

Transform240siloed providerandcommunitybasedbehavioralhealthandsocialserviceorganizationsinto oneIntegratedDeliverySystem

BPHC Engagement & Funds Flow Strategy

August2015

Fundingfor:

- ContractswithselectorgswithexpertiseidentifyingbestpracticestosupportDSRIPprojectimplementation

October2015

Fundingfor:

- DSRIPProjectManagersforBPHCpartnerorganizations.- PCMHtechnicalsupportandcoachingservices- Workforcerecruitmentandtrainingprograms.

February2016

FundingtolargePCandBHProvidersfor:

- Team-basedcare- Carecoordination- Inter-connectivity- Populationhealth

May2016

FundingtoIndependentprovidersfor:

- PCMH- Carecoordination- Populationhealth

Fundingtohospitalsfor:

- EDTriageandCareTransitions

Fall2016/Winter2017

Fundingfor:

- CBO/CBHcapacitybuilding- Inter-connectivityviaRHIO&CCMS- HealthLiteracyandcommunityengagement- InnovativeapproachestoadvanceDSRIPgoals- Depression/substanceabusescreening,PCconnection

Summer/Fall2017

Fundingtopost-acutecareservicesandsupportivehousingprovidersfor:

- Inter-connectivityandinformationexchangeviaRHIO- InnovativeapproachesforadvancingDSRIPgoals

Wave1:InvestinginPPSExpertise

Wave2:ImplementingFoundationalRequirements

Wave3:PCMHandProjectSupport

Wave4:PCMHandProjectSupport

Wave5:CBO/CBHSupport

Wave6:Post-acuteand

HousingSupport

ExecutiveCommittee• OversightofoverallDSRIPProgramimplementation• Satisfactionofkeymetricstorealizeincentivespayments• DevelopmentofProgramvisionandimplementationof“rulesoftheroad”• RepresentativeofthePPS(thoughsomepartnersmaynothaveadirectrepresentative)• Involvementofexecutiveswithabilitytocommittheirorganizationstodecisionsandprovideleadership• OversightofPPSfinancialmanagement

Finance&Sustainability Quality&Care

Innovation

InformationTechnology

Workforce

MakerecommendationsondistributionofProjectPartnerImplementationFundsand

CommunityGoodPool(approvedbyExecCommitteeandSBH)

CreateandupdateITprocessesandprotocolsapplicabletoallPartners

DevelopandimplementacomprehensiveworkforcedevelopmentstrategyCreateandupdateclinical

processesandprotocolsapplicabletoallPartners

Subcommittees

BPHC Governance Structure

BPHCCentralServicesOrganization

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BPHC Governance Structure (Cont’d)15

Finance&Sustainability

CentralServicesOrganization(CSO)Staffsupportsthegoverningcommittees(PAC)

CommitteereflectthediversityofBPHC’smemberorganizations• 75committeeandsubcommitteeseats• 150+workgroupseats

ExecutiveCommitteeIncludesclinicalandnon-clinicalstakeholdersrepresenting:• Primarycareandbehavioralhealthprovidersinhospitals,FQHCsandIPAs;

• CBO(BronxWorks),MCO(HealthFirst),Workforce(1199),andtheBronxRHIO

• CBOshaveseatsonallcommittees,subcommitteesandworkgroups

Valuetransparencyandcollaboration• Planningandimplementationworkgroups• Frequentandtargetedcommunications• Monthlycommitteemeetings• Meetingswithsubcommitteeco-chairs

StructureandGuidingPrinciples

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HealthHomeWorkgroup

7ClinicalWorkgroups

WorkforceInformationTechnology

Quality&Care

Innovations

ExecutiveCommittee

Subcommittees

NominatingCommittee

CulturalResponsivenessWorkgroup

3WorkforceWorkgroups

BehavioralHealthSteeringCommittee

Collaborativewith14BHAgencies

PharmacyWorkgroup

BPHC Governance Structure (Cont’d)

Other:PhysicianIPA,Payer,Pharmacy,CareMgmt,NYCDOHMH,BPHCCSO

ParticipatingDisciplines ParticipatingOrganizations

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*IncludesExecutiveCommittee,NominatingCommitteeandfourSub-committees:Finance&Sustainability,Workforce,ITandQuality&CareInnovation**n=72totalcommitteemembersasofJanuary2017

MakeupofGovernanceCommittees*

Other: RN,Pharmacist,CareManagement/ManagedCare

n=72**n=72**

BehavioralHealth7%

CEO/ED/Sr.Admin36%

Finance11%

FrontLine7%

HR

8%

IT/QA

10%

Physician15%

Other6%

CommunityBehavioralHealth7%CBO

8% HomeCare

11%

Hospital21%

LaborUnion7%Long-Term

Care7%

Non-HospitalPrimaryCare

26%

RHIO

3% Other10%

BPHC’s Central Services Organization (CSO)17

ClinicalSupport• Clinicaloperationplans• Targetpopulationidentification• Protocolcompliance• Performancemonitoring

Patient&ProviderEngagement• Caremanagementsupport• Patientregistriessupport• Providerengagement

Workforce,Staffing& Training• Workforcedevelopment• Recruiting/deployment• Training

InformationTechnology• ITinfrastructurestrategy• HIT,HIE,andtelehealth• Centraldatamanagement

Data&Analytics• Populationhealthmanagement• Data/trendreporting• Partnerperformancefeedback

Financial/ProgramManagement• Fiscalagent/fundsdistribution• Contracting• Compliance• SustainabilityandVBPplanning

OperationalFunctionalities

BUILDING THE CLINICAL NETWORK

EstablishingaPrimaryCareNetworkCreatingaCommunityPracticeUnifyingProgramImplementationAcrossBPHCEmbeddingLocalResourcesofAccountability

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Establishing a Unified Primary Care Network

OneStandardofCare

§ EngageallPCPsinPCMHRecognitionProgram

§ SupportPCPengagementwithconsultanttoprovidetechnicalassistancewithapplicationandtransformationprocesses

§ Establishstandardizedtoolsformeasuringbaseline,operationalgapsandprojectplanning

§ QuarterlymeetingswithpracticeleadershipregardinghurdlesandachievementstowardPCMHjourney

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§ AchievePCMH2014Level3byMarch2018§ Variedsettings,preparation&experience§ Commitmentto889practicesites§ PCMHPCPsrecognizedbyNCQA:503

Challenges

BestPracticesFundingforPCMHCoaches§ CSOrecruitedpoolofcoaches§ Practicesselectedcoachesfromthepool

FundingStartupforPCMHInfrastructure§ CareTeamandCareCoordination§ Regularmeetingstoexchangelearnings

andbestpractices

Unifying Program Implementation Across BPHCQuality&CareInnovation

Subcommittee(QCIS)

Improvement*WorkGroups

CSOClinical/OpsTeam

Weeklymeetings

DSRIPProgramDirectors(DPDs)

Site-specificImplementationTeams(SSITs)LargerOrganizations

Weeklymeetings

Bi-monthlymeetings

PCMHTAs Contractors

Monthlymeetings Weeklymeetings

*IWGevolvedfromPlanningWorkGroupstoTransitionalWorkGroups,ImplementationWorkGroups,andeventuallyinto ImprovementWorkGroups.

DSRIP Program Directors (DPDs)21

§ Embeddedliaisonsandimplementationfacilitatorsatthesevenlargestprimarycareorganizationpartners.

§ Playthemanagement,coordinationandliaisonrolebetweentheSite-SpecificImplementationTeams(SSIT)andtheCSO.

§ SupportandadvocateforthepartnerorganizationsineverypossiblewaytoenablethemtoaccomplishtheirDSRIPgoalsandobjectives

§ ServeasthevoicebackattheirorganizationsandhelpaccomplishBPHC’sDSRIPrequirements– Coordinateandmonitortheprogressoftheclinicalprojects– Ensurethesuccessofprojectimplementation,monitoring,reporting,communicationandcoordination

§ Responsibleforsubmittingawiderangeofreportsrepresentingtheimplementationandperformanceprogressonbehalfofthepartnerorganizationstheyrepresent

Quality & Care Innovation Sub-Committee

§ Comprisedofmembersfromhospitals,FQHCs,IPAs,CBOsandPharmacies.

§ Chargedwithestablishingevidence-basedpracticeandqualitystandards,andmeasurements,overseeingclinicalcaremanagementprocesses,and,togetherwiththeExecutiveCommittee,holdingprovidersandthePPSaccountableforachievingtargetedmetricsandclinicaloutcomes.

§ QCISreportstotheExecutiveCommittee.

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PractitionerCommunicationandEducation

AdviseBPHC'sImplementationWorkGroups(IWGs)

Evidence-BasedPracticeGuidelines/ClinicalProcesses&Protocols.

MonitorPerformance

OverseeClinicalProjectImplementation.

CollaboratewithOtherSub-Committees.

SupportDevelopmentofCulturalCompetencyandHealthLiteracyStrategy

SYSTEMS SUPPORTING NETWORK COMMUNICATION AND INFORMATION SHARING

RegionalInformationSystemCareCoordinationandManagementSystemReferralManagementSystems

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BPHC Interoperability Framework24

BxRHIOHIE/VHR

HIE/VHR DataStorage CCMSData

BxRHIOBRAD&

Spectrum/IMATEHRData

Analytics

ClaimsData(SSP,DEAA)

LocalStorage

CentralizedAnalyticCapacity

GSIHealth

•Assessments•CarePlanning•CarePlanManagement•Reporting

RMS

Referralmanagementplatformwith

featuresincluding:

•Medicalandsocialservicecapabilities• Closed-looptracking• Securemessaging• Patientportal

VHR:VirtualhealthrecordHIE:HealthInformationExchangeCCMS:CareCoordinationManagementSystemRMS:ReferralManagementSystem

Care Coordination Management System

§ Supportsself-managementforhigher-riskpatients

§ Tracksassessmentsandcareplanning,mainlyforsocialdeterminantsofhealth

§ Identifiessocialserviceneeds§ Enhancescommunication andcollaborationbetweenproviders

§ Reducesduplication§ Providesgreaterinsightintotheneedsofpatientsastheynavigate throughthecaredeliverysystem

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AkeyelementinBPHC’sinteroperabilityandpopulationhealthmanagement(PHM)strategies.

GSIHealth:Assessments,CarePlanning,CarePlan

Management&Reporting

Hospitals

Community-BasedOrgs

PrimaryCare

Referral Management System26

DiagramadaptedfromEY:Hughes,S.andKramer,K.IntegratedMedicalManagement.Performance,Volume7,Issue2,May2015.

PopulationHealthManagement

IntegratedReferralManagement

PopulationhealthmanagementGoal:reducecostsbypreventingillness,improvingqualityoflifeandenhancinghealthoutcomesforthosesufferingfromchronicconditions.

IntegratedreferralmanagementGoal:optimizereferralprocesses,driveaccountabilityandminimizedisruptions.

Referralmanagementsystemwouldcomplete themissinglinkintheframeworkformanagingpatient’s

medicalandsocialneedsacrosstheIDS

CaseManagement

DiseaseManagement

UtilizationManagement

EXPANDING PARTICIPATION THROUGH COMMUNITY ENGAGEMENT STRATEGIES

EstablishingDesignatedResourcesRepresentationEngagementStrategyandPlan

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Reinforcing a Central Role for BPHC CBOs 28

§ Convenedover40CBOstoidentifycommonpainpointsandwishlistsforimprovingcaredeliveryacrossPPSorganizations:ü MeaningfulInvolvementinPlanningand

ImplementationActivitiesü ImproveCommunicationbetweenMember

Organizationsü ImproveinterconnectivityandAccesstoITSupportü ImproveAccesstoTrainingtoCBOFrontlineü RecognizeandBuildonCBOCompetenciesü EnhanceUnderstandingofArrayofAvailableServicesü OfferNetworkingOpportunitiesü AdvanceBHandCBOservices

BPHChas137uniquecommunity-basedorganizationsandeachplaysavitalrole.HowdoweensurethattheyeachhaveavoiceandplayaroleinhelpingBPHCmeettheTripleAimandbecomeaneffectiveintegratedcoalitionofserviceproviders?

ExecutiveCommitteeandSubcommittees

CommunityEngagementWorkGroup

HealthLiteracy

WorkGroup

Community Engagement Plan 29

IntegrationwithCommunity-BasedOrganizations(CBOs)inhealthcaredeliveryiscriticaltoourabilitytofullyaddressbehavioralandsocialdeterminantsofhealth

§ EstablishedaCommunityEngagementWorkGroup§ CommunityEngagementGroupislinkedtotheGovernance

– RepresentedontheWorkforceHealthLiteracyWorkGroup

– WorkforceSub-CommitteeCo-ChairsitsontheCommunityEngagementWorkGroup

§ CommunityEngagementWorkGroupdevelopedaStrategyandWorkPlanrecommendingfourtargetedprograms:1. Createdirectoryofserviceresourcestoimprove

coordinationbetweenBPHChealthcareprovidersandCBOs

2. ProvideaccesstokeytrainingprogramsforCBOfrontlinestaff

3. BuildonCBOoutreachandculturalcompetencies4. Facilitatecollaborationbetweencommunityproviders

TRANSLATING PLANS INTO ACTION

CommunityResourceDirectoryCommunityEngagementProgramsCommunityHealthLiteracyProgramTrainingProgramsCommunityBehavioralHealthInitiative

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BPHC Resource Directory

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110MemberOrganizationsalreadyrepresentedintheDirectory

• IdentifythevastarrayofprogramsandservicesprovidedthroughourPPSmembership

• Developinformationandtoolstobetternavigatecommunityresources

Boosting Health Literacy in the Community 32

§ FocusesonunderservedindividualsnotwellengagedinprimarycareandsupportiveHealthHomeServices.

§ CBOsemployedpeersandcommunityhealthworkerstoprovideeducationalsessionstolearnersinthecommunity(i.e.communitycenters,laundromats,churches,nailsalons,thestreet)on:§ SeekingandUsingHealthInsurance§ Navigatingthehealthcaresystem.

Curriculumdevelopmentandtrainingby:§ NYCHumanResourceAdministration’s

OfficeofHealthInsuranceAccess-SeekingandUsingHealthInsurance

§ MemorialSloanKetteringImmigrantHealthandCancerDisparitiesService-CareNavigation&HealthLiteracy

Communityeducatorstrained:44Educationsessionsheld:219Communitylearners:2,916

TheBronxHealthLink

RegionalAidforInterimNeeds BronxWorks

BronxCommunityHealthNetwork HealthPeople

MaryMitchellFamily&YouthCenter

ArchCare

Training & Developing the Community Workforce

ProgramsforsegmentsofBPHCworkforce:1. Leadersaschangeagentsforculturalresponsiveness2. Culturalaffirmingcareforfrontlinestaff3. Culturalcompetency&thesocialdeterminantsofhealthfor

practitioners

ProgramsbasedonPPScommunityneeds4. Train-the-trainerforCBOstoeducatecommunitymemberson

obtaininghealthinsurance&navigatinghealthcaresystem5. Patient-centeredcareforimmigrantseniorsaddressesbehavioral

&psychosocialissues

Raisingculturalcompetencyforthefrontline:6. Knowledge&skillsforrecovery-orientedcareforpeoplewith

behavioralhealthconditions7. Understandingculturalvaluesforhomehealthworkers8. Povertysimulationtoexperiencehowlivinginpovertyeffects

healthbehaviorsandtoinfluencepolicychanges

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§ BPHChasdeveloped29coursesdeliveredtomorethan1000trainees§ 27CBOshaveregisteredstafftoparticipateinthesecourses

TrainingProgramsinCulturalResponsiveness:DY2Q4– DY3

ProvidingCulturalResponsiveness Training

§ TheJewishBoard§ NYCHumanResource

Administration’sOffice

§ ImmigrantHealthandCancerDisparitiesService

§ Healthlink NY§ PeopleCare

§ NewYorkAssociationofPsychiatricRehabilitationServices

§ RegionalAidforInterimNeeds(R.A.I.N)

§ Selfhelp CommunityServices

CelebratingGraduatesNewYorkCityCouncilMemberRitchieTorresandOusmanLaast,OfficeofU.S.SenatorKirstenGillibrand,celebratingPeerLeaders&CHWstrainedbyHealthPeople(DiabetesSelf-Management)anda.i.r.bronx (AsthmaHome-Based

Self-Management)

Engaging Community Behavioral Health Providers§ BPHChas60+community-basedBehavioral

Healthmemberorganizationswith~60,000patients

§ TheCommunityBehavioralHealthLeadershipGroupwasestablishedtodevelopstrategiesforengagingthediverseCBHorganizationsinBPHCplanningactivitiesandoperations

§ 14CBHagenciesinvitedthroughanRFPtoleadandparticipateinplanningthe“CalltoAction”initiativein March2017.

§ Basefundingdistributedtosupportinformationexchange,monitoringandpatienttracking,aswellasprovideenhancefindingsformeetingspecificperformancetargets

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“CalltoAction”Kick-offbreakfastatMercyCollege,BronxCampus,onFriday,November4th.KeynoteSpeaker:AnnSullivan,Commissioner,OMHandGuestSpeaker:NYSSenatorGustavoRivera.

WHAT WE’VE LEARNED

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Engage Stakeholders

§ IncludestakeholdersintheGovernancestructureanddecisionmaking§ Workwithinaframeworktoachievespecificgoals§ Clear,timely,frequent,andtransparentcommunication§ IncorporateCollaborativeDesignprinciples§ Maintainflexibilitytochangecoursewhenneeded§ ProvidetimelyandrelevantTechnicalAssistanceandsupport§ Usedatatodriveengagement§ Focusondevelopinginfrastructureforsustainability

– PopulationHealthManagement– TraintheTrainer– DevelopdownstreamP4Pstrategies

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Build Legitimacy and Trust Transparency&Empowerment

§ Createaclear,collaborativestructure

§ Identify&fostercommunityleadership

§ Createopportunityforcommunityleadershiptoactivelyparticipate

§ Createopportunityforcommunitytolead

§ Requireaccountabilityforoutput,workproductsandperformanceoutcomes

SustainingtheCoalition

§ Distinguishbetweenparticipationandleading

§ Putyourdollarswhereyourintentis(thoughtfulandequitabledistribution)

§ Gobeyondbuy-inandcreateownership

§ Buildacommunityofpractice

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Create a Community of Practice

§ Adheretoasharedvisionandcommongoals§ Adoptselectedbestpractices,andClinicalOperationsPlans§ Implementstandardizedperformancemonitoringandreportingstrategies§ Establishasharedperformanceimprovementmethodology§ Issuecontinuouscommunicationstokeepparticipantsinformedandintheloop

§ Holdsocialeventsandinvitememberstocelebratemilestones§ Facetime!

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The ChallengesAnticipated

§ Aligninghospitals,community-basedFQHCandindependentpracticeproviders

§ Integratingphysicalandbehavioralhealthservices

§ Creatingacommongroundfor(competitive)vendors

§ Gettingthebuy-infornetwork-widesystemintegration

§ Aligningclinicalandnon-clinicalagendas

ChallengesUnforeseen

§ ContinuouslychangingroleoftheCSO

§ Limitedaccesstocurrentdataandanalytics

§ Bridgingthegapbetweeninstitutionalandcommunity-basedorganizations

§ ThinkingaboutfutureVBPwithpartnerswhoarestillbuildingtrustinaworldthat’sstillfeeforservice

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THANK YOU!

• IreneKaufmann,ikaufmann@sbhny.org• J.RobinMoon,jrmoon@sbhny.org• AmandaAscher,aascher@sbhny.org

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