PROJECT ADVISORY COMMITTEE (PAC) MEETING OF THE SUFFOLK PPS Tuesday, December 22, 2015 10:00am-11:00am Hosted by the Office of Population Health at Stony

PROJECT ADVISORY COMMITTEE (PAC)MEETING OF THE SUFFOLK PPS

Tuesday, December 22, 2015

10:00am-11:00am

Hosted by the Office of Population Health at Stony Brook Medicine

www.suffolkcare.org

http://www.suffolkcare.org/

SCC COALITION PARTNER CONTRACTING PROCESS/ON-BOARDING PROGRAM LAUNCH

3

As the Suffolk Care Collaborative moves from the planning

phase to project implementation, we would like to take this

opportunity to provide an overview of the SCC Contracting

Process and Onboarding Program.

The completion of the contracting process and onboarding

program is an important first step in officially participating in

the SCC PPS.

1. Summary of our Network of Partners

2. Discuss our methodology & what you can expect

3. Introduce the SCC Coalition Partner Participation Agreement

4. Describe the SCC On-boarding Program Parts 1-4

5. Highlight the SCC On-boarding program webpage

6. Review the Funds Flow Model for Performance Payment

7. Frequently Asked Questions (FAQ)

8. Question & Answers

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PAC MEETING OBJECTIVES

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Primary Care Practitioner Non-PCP

Practitioner

Hospital

Clinics

Health Homes

Mental HealthSubstance Abuse

Nursing Home

Pharmacy

Hospice

CBO & DDs

All Others

Approximately 5,800 partners canvassing over 500 organizations

Enrolled to date

SCC PARTNER NETWORK COMPOSITION

HUB MODEL DIAGRAM

NYS Department of Health

Stony Brook Clinical Network IPA, LLC d/b/a the SUFFOLK CARE COLLABORATIVE

CHS

SCC Coalition Partner

Organizations

NSLIJ


Organizations

SBUH


Organizations

DSRIP Waiver Administrators

Suffolk PPS Lead (Stony Brook University Hospital)

HUB Networks

SCC Coalition Partners

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• Wave one of contracting focuses on:o On-boarding Safety net providers o “Hot Spot” geographic areas servicing a large volume of Medicaid lives o Our prioritization strategy primarily Includes PCPs, Hospitals, SNFs,

Mental Health & Substance Abuse Practitioners etc.o Timeline: Spans the first & second quarter of 2016 (January – June) o Additional contracting opportunities exist across our DSRIP Programs

under “vendor contracting opportunities” that are tied to DSRIP project work

• Organized & Personalized Approach:o One PPS, Three “HUBs” – One Consistent Approacho No direct/mass-mailings of applications and materialso We’ll be scheduling meetings to discuss the SCC Coalition Partner

Participation Agreement, Detailed Funds Flow Model, and Orientation to the SCC DSRIP program

o We’ve streamlined execution of contracts by “Contract Entity”7

CONTRACTINGOUR METHODOLOGY & WHAT YOU CAN EXPECT

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SCC COALITION PARTNER ON-BOARDING TEAMS

“HUB” Name Title

Stony Brook University Hospital “HUB”

Joseph Lamantia Chief of Operations for Population Health

Linda Efferen, MD Medical Director

Kevin Bozza Director, Network Development & Performance

Alyssa Scully Director, Project Management Office

Lucas Magnani Provider Engagement Liaison

North Shore LIJ Health Care System “HUB”

Sandy Balwan, MD Medical Director, DSRIP

Ariel Hayes Director, DSRIP Operations

Kiki Nwokoye Director, Business Development

Eleanor Wardwell Director, Provider Network

Catholic Health Services of Long Island “HUB”

Robert Ginsberg System Director, Strategy and Business Development

Jessica Wyman Associate Director, DSRIP

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SCC ON-BOARDING PROGRAM FOLDER

Our SCC On-boarding Program Folder will include all pertinent materials for you to complete, to name a few:• Enrollment Checklist• Coalition Partner Participation

Agreement• RHIO Participation Agreement• Education Attestation

o 1-2 Page DSRIP Project Clinical Summaries & Education Materials

o Reference Materials Hosted on SCC website

• Four parts to the SCC On-boarding Program:o Part 1: SCC Coalition Partner Participation Agreemento Part 2: SCC On-boarding Program Required Documents o Part 3: SCC Current State Assessment Survey o Part 4: Educational Materials for DSRIP Program Participation

• Features:o Designed to properly enroll our Partners into the DSRIP Programo Defines roles and responsibilities for participation i.e. “Engaged” vs.

“Knowledgeable” o Provides an orientation to DSRIP & the SCCo Establishes payment procedures “Triggers for Funds Flow” based on

the achievement of performance factors tied directly to DSRIP projects

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DESCRIBING THE SCC ON-BOARDING PROGRAM PARTS 1-4

• Part 1: Complete and return the SCC Coalition Partner Participation Agreement o Body of the agreement

documenting the terms and conditions of the relationship between SCC and the Coalition Partner

o The agreement includes seven exhibits that provide details regarding participation requirements

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DESCRIBING THE SCC ON-BOARDING PROGRAM PART 1 OF 4

The SCC Coalition Partner Participation Agreement is comprised of the following parts:

• Body of the Agreement (pages 1 through 10). The body of the Participation Agreement sets forth the key terms and conditions that define the role of the coalition partners in SCC, including their participation in the SCC 11 DSRIP projects, DSRIP funds flow, and data sharing.

• Exhibit A – List of DSRIP Projects List of DSRIP projects.

• Exhibit B – Project Participation Eligibility Requirements identifies which coalition partners are required to participate in which DSRIP projects. There are two types of participation, defined below: • “Engaged Participant” must participate in the applicable DSRIP project and fulfill project

requirements as outlined in the SCC Coalition Partner Participation Manual to receive performance funds flow payment.

• “Knowledgeable Participant” must be informed of the DSRIP projects and requirements

Example: NYS DOH Provider Types of “Primary Care Practitioner” will follow the following criteria: • “Engaged” participation in projects: 2ai, 3ai, 3bi, 3ci, 3dii, 4bii• “Knowledgeable” participation in projects: 2biv, 2bvii, 2bix, 2di, 4aii

INTRODUCING THE SCC COALITION PARTNER PARTICIPATION AGREEMENT

• Exhibit C – Business Associate Addendum is intended to enable the coalition partners to share protected health information with SCC in a manner that complies with HIPAA.

• Exhibit D – Data Exchange Application & Agreement (DEAA) Confidentiality Provisions Sets forth certain provisions that the NYS Department of Health (DOH) requires the coalition partners to agree to in order for them to receive Medicaid Confidential Data/ Protected Health Information that originates with DOH.

• Exhibit E – Performance Payment Distribution Plan Will set forth performance factors which you are required to achieve to qualify for Performance Payment funds flow.

• Exhibit F - New York State Department of Health Standard Clauses for Managed Care Provider/ IPA Contracts Since SCC is an independent practice association (IPA), SCC is required by the Department of Health to include certain standard clauses prepared by the DOH regarding an IPA’s contracting with managed care organizations. These standard clauses are reproduced verbatim in Exhibit E. We are prohibited by the DOH from revising these standard clauses.

• Exhibit G – General Terms and Conditions Addendum sets forth certain legal terms and conditions that are applicable to SCC and the coalition partners.

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INTRODUCING THE SCC COALITION PARTNER PARTICIPATION AGREEMENT

The SCC Coalition Partner Participation Manual is designed into four parts:

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INTRODUCING THE SCC COALITION PARTNER PARTICIPATION MANUAL

Engaged Partner: Domain 1 Project Engagement Reporting Requirements

• Each Domain 1 project requirement is defined along with the metric, SCC data source to be submitted to the SCC PMO, documentation to be provided to the NYS DOH upon requirement completion by SCC, timeframe project requirement must be submitted and a description of the document validation process from the IA.

Engaged Partner: Domain 1 Patient Engagement Reporting Requirements

• Based on your Provider Type you will be provided a Patient Engagement Reporting Requirement quarterly. The SCC PMO will provide a Quarterly Reporting timeline and a set of templates to be used.

Coalition Partner Performance Measures

• Based on your Provider Type you will be monitored and scored against a number of Outcome Measures. You will be engaged according to the SCC Performance Reporting & Improvement Plan.

SCC General Policies & Procedures

• All SCC Coalition Partners engaged will follow the general policies and procedures referenced in this section. These may include, but are not limited to the following, Data Sharing, Compliance/HIPAA, Data Privacy & Security, Quality Assurance & Improvement, Performance Payment & Funds Flow Oversight, Participation in Governance, etc.

Example of the SCC Coalition Partner Participation Manual:

Project Engagement Reporting Requirements

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EXAMPLES SCC COALITION PARTNER PARTICIPATION MANUAL

Metric ID: 2ai.5Engaged Provider Type: Primary Care Physician Project Requirement 5: Ensure that EHR systems used by participating safety net providers meet Meaningful Use and PCMH Level 3 standards and/or APCM by the end of Demonstration Year 3.Metric: PPS has achieved NCQA 2014 Level 3 PCMH standards and/or APCM.

Engaged Provider Requirements SCC Requirements to NYS DOH NYS DOH Validation Criteria to SCC

NCQA-certifiedand/or APC-approved Certification documentation.

List of participating physicians/practitionerscomprising name, license #, start/end date of contract, type of provider, full address, etc. The information must be provided in excel spreadsheet format.

The IA will review the data sources submitted to ensure that all practices meet NCQA 2014 Level 3 PCMH and/orAPCM standards

Data Source Due Date: prior to DY3 Q4

Example of the SCC Coalition Partner Participation Manual:

Patient Engagement Reporting Requirements

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Demonstration Year & Quarter* Reporting Period

SCC Coalition Partner Data Request Due Date* Quarterly Report Due

DY 1, Q3 10/1/15 – 12/31/15 January 15, 2016 January 31, 2016

DY 1, Q4 1/1/16 – 3/31/16 April 15, 2016 April 30, 2016

DY 2, Q1 4/1/16 – 6/30/16 July 15, 2016 July 31, 2016

DY 2, Q2 7/1/16 – 9/30/16 October 14, 2016 October 31, 2016


DY 2, Q4 1/1/17- 3/31/17 April 14, 2017 April 30, 2017

DY 3, Q1 4/1/17 – 6/30/17 July 14, 2017 July 31, 2017

DY 3, Q2 7/1/17 – 9/30/17 October 13, 2017 October 31, 2017


DY 3, Q4 1/1/18 – 3/31/18 April 13, 2018 April 30, 2018

Continues through March 31, 2020, Reference SCC Coalition Partner Participation Manual for full schedule

Examples of the SCC Coalition Partner Participation Manual:

Coalition Partner Performance Measurement Program

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Coalition Partner Performance Measurement Program includes the following requirements:

1. Adhering to the measures and specifications outlined within NYS DOH DSRIP Measure Specification & Reporting Manual (Example below for PCP)

2. Participation in SCC Performance Improvement & Reporting Plan

3. Participation in Medical Record Abstraction

4. Fulfillment of Technical Requirements for Interoperability & Data Ingestion

Measure Name

Provider Type

Data Source

Projects Associated

with Measure

Numerator Description

Denominator Description

Performance Goal HPF Statewide

measure

Children’s Access to

Primary Care – 25 months

to 6 years

PCP HEDIS 2015 2.a.i, 2.b.ix

Number of children who had a visit with

a primary care provider during the

measurement period

Number of children ages 25

months to 6 years as of June 30 of

the measurement year

98.4% No Yes

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

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

• Part 2: SCC On-boarding Program Required Documents o SCC Coalition Partner Attestation (New Coalition Partners Only)o SCC Partner Enrollment Checklisto RHIO Qualifying Entity (QE) Participation Agreement o OMIG Certification of Compliance Program

- Applies to entities receiving $500,000 or more Medicaid funds in a consecutive 12-month period

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• Part 3: SCC Current State Assessment Survey o Distributed first week of November to SCC Partnerso Survey evaluates important information for your organization to meet

specific DSRIP participation requirements i.e. Demographic Information, Information Technology Infrastructure, Workforce, Training, Cultural Competency/Health Literacy, DSRIP Project Readiness

o Survey due December 31, 2015o Surveys not completed prior to contracting will be incorporated into

the on-boarding requirements

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• Part 4: Educational Materials for DSRIP Program Participation o Upon on-boarding, partners will be provided with additional

guidance and materials to help orient you to our programo In person as well as self-directed educational methods will be

used for orientation to our programo Topics covered include – DSRIP Project Requirements,

Performance Reporting, Compliance, HIPAA, Information Technology, RHIO, Meaningful Use, Cultural Competence and Health Literacy

o Complete and return SCC Education Attestation

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http://suffolkcare.org/forpartners/onboarding/

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WEBSITE TUTORIAL

http://suffolkcare.org/forpartners/onboarding/

Maximum DSRIP payments SCC can earn is shown below:

Award Component $ Based onPerformance

Subtotal (excl.High

Performance)$ Based on

High Performance Total

Net Project Valuation (NPV) $181,115,320

Equity Performance Program (EPP) $44,228,717

Equity Infrastructure Program (EIP) $58,971,622

Add’l High Performance Fund (State) $10,045,427

Net High Performance Fund $4,200,998

TOTALS $284,315,659 $284,315,659 $14,246,425 $298,562,084

DSRIP AWARD FOR THE SUFFOLK PPS

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© 2015 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.

DSRIP AWARD FOR THE SUFFOLK PPS CONTD.


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The maximum DSRIP payments a PPS can receive is determined by the following:

• Net Project Valuation and Equity Performance Program payments are based upon DSRIP performance

• The AVs are assigned to each of the PPS projects by DOH. The “earned” payment is then reported to the PPS at the Project level

• DSRIP payments issued to SCC will be based upon the achievement values (AVs) earned for reporting and performance during the applicable DSRIP period

• High Performance funds can be awarded based upon PPS performance for the 10 HP measures

• There may also be reductions if overall performance does not meet the State-wide performance benchmarks established by CMS

NYS DOH PPS VALUATION

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25

SCC QUARTERLY REPORTING AND PAYMENT SCHEDULE

PPS Quarterly Reporting and Payment Schedule (As of September 1, 2015)

DOMAIN 2-3

DSRIP Year DeliverableQuarterly Report #

PPS SubmissionDate

Final ApprovalDate

Measurement Year Payment Date

Payment #

DY 1 DSRIP Project Plan 12/22/2014 2/03/2015 4/23/2015(SCC RCVD 8/21/2015 DUE TO IGT)

1

DY 1 DSRIP Domain 1 ImplementationPlan

6/1/2015 9/29/2015 N/A

DY 1 PPS First Quarterly Report (4/1/15– 6/30/15) / Domain 1 (revised) & Project Implementation Plan

1 8/7/2015 10/7/2015 2

DY 1PPS Second Quarterly Report(7/1/15 – 9/30/15)

2 10/31/2015 12/30/2015

DY 1PPS Third Quarterly Report (10/1/15-12/31/15)

3 01/31/2016 03/31/2016MY 1

7/1/14-6/30/157/29/2016 3

DY 1 PPS Fourth Quarterly Report(1/1/16 – 3/31/16)

4 4/30/2016 6/29/2016

DY 2 PPS First Quarterly Report(4/1/16 – 6/30/16)

5 7/31/2016 9/29/2016 MY 17/1/14-6/30/15

1/29/2017 4

DY 2 PPS Second Quarterly Report(7/1/16 – 9/30/16)

6 10/31/2016 12/30/2016

DY 2 PPS Third Quarterly Report(10/1/16 – 12/31/16)

7 1/31/2017 4/1/2017 MY 27/1/15-6/30/16

7/29/2017 5


8 4/30/2017 6/29/2017DSR

IP Y

EA

R 2

DSR

IP Y

EA

R 1

DOMAIN 1

1/29/2016

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SCC QUARTERLY REPORTING AND PAYMENT SCHEDULE CONTD.

PPS Quarterly Reporting and Payment Schedule (As of September 1, 2015)

DOMAIN 2-3

DSRIP Year DeliverableQuarterly Report #

PPS SubmissionDate

Final ApprovalDate

Measurement Year

Payment Date

Payment #


9 7/31/2017 9/29/2017 MY 27/1/15-6/30/16

6


10 10/31/2017 12/30/2017


11 1/31/2018 4/1/2018 MY 37/1/16-6/30/17

7/29/2018 7


12 4/30/2018 6/29/2018


13 7/31/2018 9/29/2018 MY 37/1/16-6/30/17

8


14 10/31/2018 12/30/2018


15 1/31/2019 4/1/2019 MY 47/1/17-6/30/18

9


16 4/30/2019 6/29/2019


17 7/31/2019 9/29/2019 MY 47/1/17-6/30/18

10


18 10/31/2019 12/30/2019


19 1/31/2020 3/31/2020 11


20 4/30/2020 6/29/2020DS

RIP

YE

AR

5D

SR

IP Y

EA

R 3

DS

RIP

YE

AR

4

DOMAIN 1

1/29/2019

7/29/2019

1/29/2020

7/29/2020

1/29/2018

Group Overview Sessions• Introduce the KPMG team to SCC;• Set expectations about our role in helping SCC design its funds flow

distribution plan; and• Introduce important DSRIP funds flow concepts for key stakeholders to

consider and communicate to their provider network

Collaborative Information Gathering

Data Request & Review• Initial funds flow approach• Key stakeholders• Governance model• Term sheets

Interview Sessions• DSRIP projects• Funds flow distribution• Treatment of provider

categories• Provider engagement &

feedback• Hub model intricacies• Execution challenges

FINANCE COMMITTEE MEMBERS, BOARD MEMBERS & OTHER KEY STAKEHOLDERSFirst Name Last Name Title/Position OrganizationJerry Hirsch Finance Committee/Board member NSLIJRichard Diem Finance Committee member NSLIJBob Detor Finance Committee member NSLIJTerry O'Brien Senior VP Strategy & Business Development CHSLIJim Sinkoff Finance Committee/Board HRHBrenda Farrell Board member BrookhavenMary Zagajeski Board member Dominican SistersMichael Stoltz Board member Assoc. for Mental Health & WellnessKaren Boorshtein Board member Long Island Behavioral AllianceGary Bie CFO Stony Brook University HospitalBernard Cooke Director of Finance Stony Brook University HospitalPaul Connor CEO Eastern Long Island HospitalBob Chaloner CEO Southampton HospitalKris Smith NSLIJ DSRIP Project Manager NSLIJ

Project / Provider Information3.1 PPS Project application NYS DOH website 6/29/20153.2 PPS Organizational application NYS DOH website 6/29/20153.3 PPS Organizational Structure (HUB, PPS Lead / CSO)3.4 PPS Community Needs Assessment NYS DOH website 6/29/20153.5 PPS Provider Partners (Name, provider type, Safety-net designation, HUB designation )3.6 PPS Vendor or contractor partners - List and role3.7 PPS HUB Structure Overview3.8 PPS HUB facilities (Name, provider type, safety-net designation, public hospital y/n)3.9 PPS Implementation Plan3.10 PPS Provider Participation matrix - include the provider type3.11 PPS Project impact / provider responsibility matrix / templates 3.12 PPS Operating agreement - DRAFT Version if initiated or guiding principles document J. Lamantia 6/29/2015

Contacts / Contact ListsSCC Engagement Sponsor J. Lamantia 6/29/2015SCC Funds Flow Project Team J. Lamantia 6/29/2015SCC Funds Flow Project Team Support / Resources SCC DSRIP Project Team Leads J. Lamantia 6/29/2015SCC Finance committee J. Lamantia 6/29/2015SCC Finance Committee Meeting Minutes J. Lamantia 6/29/2015KPMG Project Team

PROJECT LEADSProject First NameLast Name Title/Position Organization2.a.i Joe Lamantia COO, Population Health Stony Brook Medicine2.a.i Jim Murry CIO Stony Brook Medicine2.b.iv Steven Feldman, MD Director, Care Management Stony Brook Medicine2.b.vii Bob Heppenheimer Executive Director/Owner Hillaire Farm Skilled L/R Center2.b.vii Dianne Zambori Associate Executive Director fo Quality Intiatives North Shore LIJ2.b.ix Eric Niegelberg Associate Director of Operations EM/IM Stony Brook Medicine2.d.i Gwen O'Shea President/CEO Health and Welfare Council of LI3.a.i Kristie Golden Associate Director of Operations- Neuro Stony Brook Medicine3.b.i Margaret Duffy Associate Director of Nursing for Cardiac Surgery Stony Brook Medicine3.c.i Joshua Miller, MD Assistant Professor of Med, Endo, Diabetes Stony Brook Medicine3.d.ii Ellen Miller Associate Director of Operations Children Hospital Stony Brook Medicine3.d.ii Pati Susmita Chief, Divison of Primary Care Peds Stony Brook Medicine4.a.ii Kristie Golden Associate Director of Operations- Neuro Stony Brook Medicine4.b.ii Ernie Conforti Associate Director of Operations - Cancer Services Stony Brook Medicine

FUNDS FLOW MODEL APPROACH

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Category Selected Principles

Overarching Themes

■ SCC needs to design its funds flow distribution to account for movement towards value based payments■ Transparency of the funds flow mechanics is critical to develop trust across SCC

Hub Allocation / Expectations

■ Hubs are allowed to distribute funds within their Hub as they see fit, provided the Board confirms the methodology is compliant with DSRIP program requirements

■ Need to establish trust and consistent incentive models across Hubs – “Parity of Expectations”

Model Mechanics

■ Incorporate reconciliation, or “true-up” to help ensure payment is properly linked to the correct performance reporting period

■ Model requirements must be translated into Operating Agreements to set expectations and clearly define success

Performance ■ Payments will be contingent on, and proportionate to performance

Payment■ Net Project Valuation and Equity Performance Program amounts will be distributed by DOH according to the

performance of the PPS. Note: DOH is expected to issue additional guidance re: the Equity payments.■ 95% or greater of DSRIP funds will be distributed to Safety Net providers

PPS Lead PMO

■ PPS Lead costs are currently expected to be reimbursed at a rate up to 10% of the PPS valuation.

FUNDS FLOW MODEL GUIDING PRINCIPLES OVERVIEW


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Category Selected Principles

Reserve / Contingency (Withhold)■ PPS Level reserves / contingency defined by the PPS will be deducted from the

performance adjusted payment.

Budget Categories

The following budget categories are part of the State reporting requests:

■ Project Implementation & Administration■ Revenue Loss■ Provider Bonus Payments■ Cost for Services Not Covered■ Other

Hub Specific Funds Plan

■ The Hub specific funds plans are expected to be reviewed and approved by the PPS Board. These plans should be consistent across the PPS.

■ Hub level funds flow distribution, and reporting to the PPS, will be consistent with DSRIP requirements including those defined for Domain 1 reporting and funds flow compliance.

FUNDS FLOW MODEL GUIDING PRINCIPLES CONTD.


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FUNDS FLOW HUB LEVEL DISTRIBUTION

Payment(s) issued to the Suffolk Care Collaborative (SCC)

Net Project Valuation &Equity Performance

Program (EPP)

High PerformancePayment

Equity InfrastructureProgram (EIP)

Determine Hub Level DistributionSCC ReservesSCC Admin Costs

SB CHS NSLIJ

$

Hub Level Distribution to Provider



$ $

30



FUNDS FLOW PROVIDER LEVEL DISTRIBUTION

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Hub Level Distribution From SCC

Provider Level Distribution Per SCC Funds Plan

l Provider valuation based upon the provider type Distribution Factor

l Provider agreements based on performance factors by Provider Type

l Performance is assessed per responsibilities outlined in provider agreements

Distribution of Approved Payment to Providers

Safety Net? 95%

PPS Provider

Payments Reported To DOH

Non Safety Net? 5%

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Provider Type Distribution Factor

PCP Performance Attribution less Duplicates

Non-PCP Performance Attribution less Duplicates

Hospital Medicaid and Medicaid Managed Care Adjusted Discharges

Nursing Home Medicaid and Medicaid Managed Care Days

Clinics (Article 28 and FQHC) Performance Attribution less Duplicates

Clinics (Other) Medicaid and Medicaid Managed Care Visits

Substance Abuse Performance Attribution less Duplicates

Mental Health Performance Attribution less Duplicates

FUNDS FLOW DISTRIBUTION FACTORS BY PROVIDER TYPE

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# Performance Factor Description Frequency of

paymentEngagement • Sign-on Commitment

• Submission of Required SCC On-boarding documentation Agreement to ongoing: • Good citizenship • Timely and complete quarterly Domain 1 patient engagement reporting • Data sharing • Participation in Population-wide-prevention programs (D4)

• Knowledgeable in all 11 DSRIP programs

Recurring

2 PCMH Certification

• Receipt of NCQA 2014 Level 3 PCMH Certification • Stage 2 Meaningful Use certification from CMS

One-time

3 Technical On-boarding

• Work with SCC’s Information technology team to achieve technical data integration and system interoperability between the Partner’s source system and the Suffolk PPS Population Health Platform.

One-time

4 Clinical Improvement Programs (Domain 3)

• Meet requirements of Primary & Behavioral Health Integrated Care Program One-time• Meet requirements of Cardiovascular Health Wellness & Self-Management

Program One-time

• Meet requirements of Diabetes Wellness & Self-Management Program • Engagement in Promoting Asthma Self-Management Program

5 Domain 2 & 3 Outcome Measures

• The Performance Reporting and Improvement Plan establishes a planned, systematic, organization-wide approach to performance reporting, performance measurement, analysis and improvement for the healthcare services provided.

Recurring

FUNDS FLOW FOR PERFORMANCE PAYMENT DISTRIBUTION EXAMPLE FOR PRIMARY CARE PHYSICIANS

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FUNDS FLOW FOR PERFORMANCE PAYMENT DISTRIBUTION EXAMPLE FOR PRIMARY CARE SKILLED NURSING FACILITIES

# Performance Factor Description Frequency of payment

1 Engagement Payment • Sign-on Commitment • Submission of Required SCC On-boarding documentation

Agreement to ongoing: • Good citizenship • Timely and complete quarterly Domain 1 patient engagement

reporting • Data sharing • Participation in Population-wide-prevention programs (D4)


Recurring

2 Technical On-boarding Work with SCC’s Information technology team to achieve technical data integration and system interoperability between the Partner’s source system and the Suffolk PPS Population Health Platform.

One-time

3 System Transformation Programs (Domain 2)

Meet requirements of INTERACT Program. One-time

4 Domain 2 & 3 Clinical Outcome Measures

The Performance Reporting and Improvement Plan establishes a planned, systematic, organization-wide approach to performance reporting, performance measurement, analysis and improvement for the healthcare services provided.

Recurring

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FUNDS FLOW FOR PERFORMANCE PAYMENT DISTRIBUTION EXAMPLE FOR HOSPITALS

# Performance Factor Description Frequency of

payment1 Engagement

Payment• Sign-on Commitment • Submission of Required SCC On-boarding documentation Agreement to

ongoing: • Good citizenship • Timely and complete quarterly Domain 1 patient engagement

reporting • Data sharing • Participation in Population-wide-prevention programs (D4)


Recurring

2 Technical On-boarding

Work with SCC’s Information technology team to achieve technical data integration and system interoperability between the Partner’s source system and the Suffolk PPS Population Health Platform.

One-time

3 System Transformation Programs (Domain 2)

Meet requirements of Transition of Care Program for Inpatient and Observation Units.

One-time

Participate in meeting requirements of Integrated Delivery System program

Meet requirements of INTERACT Program for Hospitals. 4 Domain 2 & 3

Clinical Outcome Measures

The Performance Reporting and Improvement Plan establishes a planned, systematic, organization-wide approach to performance reporting, performance measurement, analysis and improvement for the healthcare services provided.

Recurring

Q: We have a very large organization with several departments that will participate in DSRIP. Will we need to complete individual contracts for each department? Or will a single contract with the parent organization suffice?

A: A single contract agreement completed by the identified “contracting entity” or parent organization will cover all departments and providers that participate in DSRIP within that organization.

Q: Can coalition partners choose the DSRIP projects they would like to participate in?A: Coalition partners are required to participate in the DSRIP projects applicable to their provider type as referenced in

Exhibit B of the SCC Coalition Partner Participation Agreement.

Q: Will this contracting process need to be renewed annually?A: Formal contracting between the SCC and partner organizations will not need to be renewed annually. There is a five-year

term.

Q: What is the difference between being “Engaged” and “Knowledgeable” in a project as described in Exhibit B of the SCC Coalition Partner Participation Agreement?

A: As an Engaged Partner in a project, you are required to fulfill provider-type specific requirements outlined in the SCC Coalition Partner Participation Manual Parts 1, 2 and 3. Engaged Partners will be eligible to receive Performance Payments based on the fulfillment of the defined requirements. As a Knowledgeable Partner, you are only required to be informed and knowledgeable about that program, you do not have any provider-type specific requirements to qualify for Performance Payments. Knowledgeable Partners may be eligible to receive funds flow directly through a vendor contracting process established through the SCC.

Q: How do I know what HUB I’m in? A: Please contact Lucas Magnani, Provider Engagement Liaison via email at [email protected] with

the subject line: “Contracting.”

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FREQUENTLY ASKED QUESTIONS (FAQ)

mailto:[email protected]

Questions & Answers

Thank you!

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