DSRIP Meeting Agenda

PAGE 1

Date and Time 11/15/16, 10-11am Meeting Title NYP PPS IT/Data Governance Committee

Location Heart Center Room 4 Facilitator Steven Kaplan, Alvin Lin

Go to Meeting https://global.gotomeeting.com/join/654424661 Conference Line United States +1 (408) 650-3123

Access Code: 654-424-661

Invitees

Co-Chair: Alvin Lin (NYC DOHMH PCIP/REACH) Co-Chair: Gil Kuperman, Steven Kaplan, MD (NYP) Kate Nixon (VNSNY) Stuart Myer (VillageCare) Betty Cheng (CBWCHC) Greg Fortin (Isabella) Andres Pereira, MD Mitze Amoroso (ArchCare) Todd Rogow (Healthix)

Meeting Objectives Time

1. Welcome/Review Action Items from Previous Meeting 2. Leadership Change (Steven Kaplan) 3. Welcome New Membership/Committee Rotations Outcome (Steven Kaplan) 4. Allscripts Care Director Update (Nelson Mesa) 5. Review Draft of Milestone 4 – Plan for Engaging Attributed Members in QEs

(Nelson Mesa/Patricia Hernandez) 6. Review of Performance Metrics and MAPP Tool (Andrew Missel) 7. Planning for 2017 and Beyond (Alvin Lin) 8. Identify Next Steps

2 mins 2 mins 5 mins

10 mins 10 mins

20 mins 5 mins 2 mins

Action Items

Description Owner Start Date Due Date Status

Finalize governance committee rotation process L. Alexander, Co-

Chairs 8/16/2016 9/9/2016 Complete

Incorporate feedback on IT milestone #4 into the strategy document P. Hernandez 8/16/2016 11/15/2016 Complete

Submit final IT milestone #2 and #3 to NYS L. Alexander 8/16/2016 10/31/2016 Complete Schedule performance metrics overview presentation for November meeting L. Alexander 8/16/2016 9/9/2016 Complete

Share ACD/Healthix e-mail updates with the Committee between the August and November meetings, as appropriate

IT team 8/16/2016 11/15/2016 Complete

DSRIP Meeting Agenda

PAGE 1

Date and Time 11/15/16, 10-11am

Meeting Title NYP PPS IT/Data Governance Committee

Location Heart Center Room 4 Facilitator Steven Kaplan, Alvin Lin

Go to Meeting https://global.gotomeeting.com/join/654424661

Conference Line United States +1 (408) 650-3123 Access Code: 654-424-661

Invitees

Co-Chair: Alvin Lin (NYC DOHMH PCIP/REACH) Co-Chair: Steven Kaplan, MD (NYP)

Kate Nixon (VNSNY) Claudia Beck (NYP)

Stephen Lam (CBWCHC) Nelson Mesa (NYP)

Andres Pereira, MD Mitze Amoroso (ArchCare)

Lauren Alexander (NYP) Patricia Hernandez (NYP)

Andrew Missel (NYP) Todd Rogow (Healthix)

Meeting Objectives Time

1. Welcome/Review Action Items from Previous Meeting 2. Leadership Change (Steven Kaplan) 3. Welcome New Membership/Committee Rotations Outcome (Steven Kaplan) 4. Allscripts Care Director Update (Nelson Mesa) 5. Review Draft of Milestone 4 – Plan for Engaging Attributed Members in QEs

(Nelson Mesa/Patricia Hernandez) 6. Review of Performance Metrics and MAPP Tool (Andrew Missel) 7. Planning for 2017 and Beyond (Alvin Lin) 8. Identify Next Steps

2 mins 2 mins 5 mins

10 mins 10 mins

20 mins 5 mins 2 mins

Action Items

Description Owner Start Date Due Date Status

Submit Plan for Engaging Attributed Members in QEs to Executive Committee for ratification

L. Alexander, G. Kuperman

11/15/2016 12/19/2016 Not started

Share meeting materials with Committee members

L. Alexander 11/15/2016 12/23/2016 Not started

Look into whether there are differences in Healthix consent based on race/ethnicity

T. Rogow 11/15/2016 1/17/2016 In progress

Look into whether there are State requirements to connect to an EHR by a certain date and by provider type

A. Missel 11/15/2016 1/17/2016 Complete

Domain 1 IT Systems and Processes

1

Milestone 4 Develop a specific plan for engaging attributed members in Qualifying Entities Background NYP PPS Network The NewYork-Presbyterian Hospital (NYPH), Performing Provider System (NYP PPS) includes the five Manhattan-based NYPH campuses and related community-based clinics, federally qualified health centers, community-based clinics, federally qualified health centers, community based physicians, nursing homes, home care providers, behavioral health providers, as well as social services and community-based organizations (e.g. supportive housing, transportation, meal programs). Qualified Entity NYPH PPS established a partnership with Healthix, a New York City-based Qualified Entity (QE) and the largest public health information in the nation, to deliver real-time, patient data, at the point-of-care, to NYP Collaborator organizations. NYPS PPS Community Needs Assessment Highlights Based on the preliminary Community Needs Assessment attribution maps, NYPH serves Medicaid beneficiaries throughout Manhattan, Bronx, Brooklyn, and Queens. The Columbia University Medical Center campus serves a geographically well-defined community in Northern Manhattan and the Southwest Bronx. Weill Cornell Medical Center (WCMC) and Lower Manhattan Hospitals (LMH) serve geographically broader communities throughout these four boroughs. Each serves a local Manhattan community geographically close to the hospital (Upper East Side and East Harlem for WCMC; below 14th street for LMH). In addition, WCMC draws patients from throughout Western Queens and the Bronx, and LMH draws patients from Brooklyn.

• Columbia University Medical Center Campus There are a total of 870,000 people who live in the Columbia University Medical Center campus region. This region includes the communities of the Washington Heights, Inwood, Harlem, and portions of the Southwest Bronx. Sixty-one percent of the CUMC region is of Hispanic descent, and 31% are African American. Forty percent of the total population in the CUMC region is foreign born. Spanish is the predominant language spoken in these communities (55%); however, 35% of the population report English as their primary language.

• Weill Cornell Medical Center Campus

There are a total of 524,000 people who live in the Weill Cornell Medical Center campus region. This region includes the communities of the Upper East Side of Manhattan, East Harlem, and Northwest Queens. Twenty-five percent of the WCMC region is of Hispanic descent, with an additional 11% African American and 11% Asian/Pacific Islander. English is the predominant language spoken in these communities; however, 22% of the population report Spanish as their primary language.

• Lower Manhattan

Based on the most recent U.S. Census Bureau data available, there are a total of 336,000 people who live in the Lower Manhattan region. Twenty-five percent of the Lower Manhattan region is of Asian descent, with the vast majority (75%) of Chinese origin. In addition, 30% of the total population in the Lower Manhattan region is foreign born.

Domain 1 IT Systems and Processes

2

Plan for Engaging Attributed Members in Qualifying Entities

1. NYP PPS IT/Data Governance Committee will review current Healthix (Qualified Entity) consent process, including pitfalls experienced by clinical and operational staff in the current model.

2. NYP PPS Cultural Competency, Clinical/Operations, and IT/Data Governance Committees will work with Community Health department to ensure that cultural competency and health literacy principles are incorporated into the new RHIO consent process, particularly in NYPH PPS linguistically isolated patient communities.

3. NYP PPS Cultural Competency, Clinical/Operations, and IT/Data Governance Committees will

develop a staged plan for outreach to NYP Collaborators to communicate Healthix (Qualified Entity) consent processes, assist with implementation (as needed), and track/report member engagement.

4. NYP PPS Director of Interoperability Informatics will be responsible for engaging Healthix

(Qualified Entity) to work with NYP Collaborators to finalize plan, including getting feedback from Collaborators on operational feasibility and cultural appropriateness. NYP has hired a Manager for Team-based Care to carry out these activities.

5. NYP PPS Cultural Competency, Clinical/Operations, and IT/Data Governance Committees will

present the Plan for Engaging Attributed Members in Qualifying Entities to the Executive Committee for ratification.

The following are other examples of how the NYP PPS will engage collaborators and attributed members in Qualifying Entities:

• Engaging Patients in their Preferred/Primary Languages o Ensure providers, care managers, care coordinators, or other care team

members that are implementing Qualified Entity consents at their organizations, speak the patient’s primary language.

o If providers/care team members do not speak a patient’s primary language, the organization will utilize interpreter services, both in-person or via phone.

o The NYPH PPS can assist with the identification of these kinds of services.

• Availability of Forms in Patient’s Primary/Preferred Language o NewYork-Presbyterian Hospital will make use of the Healthix consent forms;

currently translated into 19 different languages Complete listing of languages and their respective forms can be found here:

http://healthix.org/who-we-serve/healthix-participant-organizations/compliance/consent-forms/

Domain 1 IT Systems and Processes

3

• Provider/Care Team Training o Providers and care team members will be trained to communicate/explain the

benefits of sharing data with the qualified entity (Healthix). o NewYork-Presbyterian PPS will extend the Quality Interactions Resource

Center (QI-RC) to providers/care team members involved in the consenting process. The QI-RC is a reference tool designed to help providers improve their cultural competency awareness and communication skills.

o Resource information is available and organized according the following categories: Foundations in cultural competency Difficult cross-cultural situations Common clinical issues Major world religions Ethnic origin references Language and interpretation

• The PPS will use its IT Data Governance Committee to share best practices about how to

address the language and cultural barriers to achieving engagement in qualified entities. Results from Preliminary Engagement of Healthcare Providers and CBOs The NYP PPS worked with two collaborators, Charles B. Wang Community Health Center and Village Care in order to identify strategies for engaging attributed members in Qualifying Entities. Both Charles B. Wang Community Health Center (CBW CHC) and Village Care represent a large number of culturally and linguistically isolated patient communities. Village Care mostly serves patients who speak Spanish, Cantonese, Mandarin, and Urdu, while CBW CHC has about 90% of clients who are from Asian descent, specifically Chinese and Korean. At a meeting of the IT Data Governance Committee in mid-2016, these two organizations shared their approaches for obtaining patient consent in a linguistically and culturally appropriate manner. The presentations and the ensuing discussions helped the other organizations identify approaches that could be implemented in their care settings. Contact Information Gil J. Kuperman, MD, PhD Director, Interoperability Informatics NewYork-Presbyterian Hospital Adjust Professor of Biomedical Informatics, Columbia University 212.585.6847 gkuperman@nyp.org

IT/Data Governance Committee Meeting

11/15/2016

1

Proposed Agenda Items Welcome/Review Action Items from Previous Meeting

Leadership Change (Steven Kaplan)

Welcome New Membership/Committee Rotations Outcome (Steven Kaplan)

Allscripts Care Director Update (Nelson Mesa)

Review Draft of Milestone 4 – Plan for Engaging Attributed Members in QEs (Nelson Mesa/Patricia Hernandez)

Review of Performance Metrics and MAPP Tool (Andrew Missel)

Planning for 2017 and Beyond (Alvin Lin)

Identify Next Steps

2

Allscripts Care Director Implementation Update

3

NYP PPS IT Infrastructure Plan

4

Overview

The NYP Information Technology Infrastructure Project supports the development of an Integrated Delivery System for Medicaid patients in the NYP PPS service area

Information Technology Goal Component

– Equip community health workers with the technology to connect patients to the clinical services and local community resources

– Extend Allscripts Care Director to five NYP PPS DSRIP projects and Center for Community Health Navigation Program

Allscripts Care Director

– A web-based solution that coordinates outpatient care across health care settings

DSRIP Projects and PPS Collaborators

5

DSRIP Projects

• IDS • Adult Ambulatory ICU • Peds Ambulatory ICU • ED Care Triage • Transitions of Care • BH Primary Care • BH Crisis Stabilization • HIV • Palliative Care • Tobacco Cessation

CCHN Programs

• Win for Diabetes • Win for Asthma • Adult Ambulatory ICU • Peds Ambulatory ICU • Transitions of Care • BH Crisis • HIV

PPS Collaborators

• ACMH • Argus • ASCNYC • CLOTH • DWDC • Fort George • NMIC • NMPP • Coalition Mexicana • LHNH • Hamilton Madison House • Village Care • WHCP

PPS Integrated Delivery System

ACD Implementation Project Workstreams Legal

– Execute DSRIP Service Agreement Amendments with NYP Collaborators

Administrative

– Management of system access requirements

– Procurement, configuration, and distribution of tablets

Development

– Creation of new ACD templates

e.g. Intake assessments, 3 month note, follow up notes, etc.

Go-live – ACD application, clinical workflow, and authorization to release PHI training

– Go-live support

6

ACD Intake Assessment

7

Intake Sections • Patient Information • Caregiver Information • Household Information • PCP & Insurance

Information • Medications • Alternative Medications

or Therapies • Pharmacy • Social Determinants • Referrals

ACD Implementation Status

8

4 3 98 7 13 3 5

11 6 4 1

7

1624

31

44 4752

6369

73 74

0102030405060708090

100

ACD Implementation Timeline

Total Users (NYP +CBO) Running Total

Complete

Scheduled TBD

Complete

Complete

Complete

Complete

Complete

Complete

Complete

Milestone #4 – Engaging Attrbibuted Members in QEs

9

Overview of DSRIP Performance Metrics

Introduction of Andrew Missel, MPH Manager, DSRIP Strategy & Project Management

Role and responsibilities 1. Manage aspects of DSRIP planning and project integration 2. Grow project management skills and tools within the PPS 3. Help inform community and population health strategy

Background – Community health programming development – Ambulatory care management/care coordination – Healthcare safety and culture training

Interests – Camping/backpacking, rugby, anything DIY, consumer products design

11

PPS Lead Partner Required to Report on Four Domains of DSRIP Measures

Domain 1 – Infrastructure Development for Project Success (Process) – Ex) PPS has a standard clinical protocol for Ambulatory ICU services

Domain 2 – System Transformation (Process) – Ex) Adult Access to Preventive or Ambulatory Care

Domain 3 – Clinical Outcome Improvements (Outcomes) – Ex) Medical Assistance with Smoking and Tobacco Use Cessation

Domain 4 – Population-Focused Improvements (Outcomes) – Ex) Percentage of cigarette smoking among adults

12

Illustration of How a Measure Population is Derived from the Total PPS Attributed Population

13

Visual of DSRIP Annual Performance Targets

14

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Most Recent MY Result (LCL)

PPS 5 Yr Performance Goal (UCL)

AIT (Annual Improvement Target) (10% Reduction in Gap)

High Performance Fund Eligible (20%+ Reduction in Gap or Exceeds Performance Goal)

Current PPS Performance

PPS Data Sources for Tracking Performance Measures

15

Data Source Access Limitations New York State Medicaid Analytics Performance Portal (MAPP)

• Claims data in summary format • Trends analyses • Geographic analyses • Access to patient- and provider-

level data

• Data are old (1+ year) • Cannot export data • Patient-level data not exportable • Provider-level data not always

available by organization Salient Interactive Miner (SIM) • 10+ years of Claims data in raw,

deidentified format • Data updated every 2 weeks • Some (not all) P4P metrics are

reprdocued within the tool

• Data are deidentified • Trends analyses are challenging • Challenging to attribute patients to

individual providers • Claims data are not always

representative of actual activity due to billing challenges

• Steep learning curve to use tool Raw New York State Medicaid Claims Data

Currently working on security protocols w/ NYS to accept raw claims data • Data will be identifiable

• Need to develop competencies in Medicaid claims data analysis

• Data not immediately matched to NYP MRNs

• Claims data are not always representative of actual activity due to billing challenges

NYP Electronic Health Record (EHR) and Administrative Data (e.g. “Amalga,” Tableau, etc.)

Currently working on reproducing high-priority NYS metrics on internal data – will need clinical input on prioritization and proxy definitions • Access through normal TRAC data

request fulfillment processes • Data are up-to-date

• Only NYP data, does not include other providers’ dataExtended build period means dashboard not available until after Jan. 1, 2017

A Closer Look at the New York State Medicaid Analytics Performance Portal (MAPP)

Claims data in summary format

Trends analyses

Geographic analyses

Access to patient- and provider-level data

16

Shift from Pay-for-Reporting to Pay-for-Performance

17

Note: As part of a December 2015 waiver amendment request to the federal Centers for Medicare and Medicaid Services, New York is seeking to slightly modify these percentages. Source: New York State Department of Health, Attachment I—NY DSRIP Program Funding and Mechanics Protocol, April 2014.

15%

45% 65%

85%

20%

25%

15%

15%

15%

80% 60%

40% 20%

DSRIP Year 1 DSRIP Year 2 DSRIP Year 3 DSRIP Year 4 DSRIP Year 5

Project progress milestones Pay-for-reporting Pay-for-performance

We are here

Current Steps to Provide the PPS with Actionable Data

1. Users trained in all four data mining tools

2. Dedicated team building interactive performance measures dashboard

3. Project teams accountable to specific performance measures

4. PPS and project-level governance discussions on: – Spread and use of IT tools – Resources for statistical analysis of data

18

Appendix: How Performance Goals & Improvement Targets are Set

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Planning for 2017 and

Beyond

20