Transforming Medicaid Delivery on Staten Island: A Case Study · SDOH and Public Health Data Defines Targeted Clinical and Social Programs •Innovative program development on Staten

Transforming Medicaid Delivery on Staten Island: A Case Study

Session # 39, March 6, 2018

Joseph Conte, PhD, CPHQ, Executive Director, Staten Island Performing Provider System (SI- PPS)

Raj Lakhanpal, MD, FRCS, FACEP, Chief Executive Officer, SpectraMedix

Joseph Conte, PhD, CPHQ

Has no real or apparent conflicts of interest to report.

Presenter

Raj Lakhanpal, MD, FRCS, FACEP

Has no real or apparent conflicts of interest to report.

Presenter

Learning Objectives

• Identify the information technology and performance reporting capabilities needed

to support Delivery System Reform Inventive Payment (DSRIP) projects and goals

• Analyze the key challenges DSRIP Performing Provider Systems (PPS) face

implementing their projects

• Define DSRIP data sources, including Department of Health, provider partner,

public data sources and other outside sources

• Perform a deep dive into DSRIP initiatives to manage and reduce emergency

department visits and preventable readmissions

• Determine how successful strategies, processes and lessons learned from New

York DSRIP can be applied across Medicaid Reform Initiatives in all states

5© SpectraMedix, 2009-2017. The contents of this presentation are confidential and cannot be copied without prior written permission from SpectraMedix.

1) SI PPS and New York State DSRIP

2) Current Results

3) IT and performance reporting capabilities needed for DSRIP

4) Use cases

5) Importance of social determinants of health

6) Takeaways

Agenda


Case Study:Staten Island Performing Provider System

Delivery System Reform Incentive Program (DSRIP)

Year 3

Key Goals

• 90% of managed care payments be value-based

• Integrate physical and behavioral health

• Incentivize Medicaid providers to create integrated, high-performing system

• Reduce avoidable hospital use by 25%

Entities 25 Performing Provider Systems

Project

Domains

• System Transformation

• Clinical Improvement

• Population-wide Projects

Payments Measure based performance with transition from P4R to P4P

Staten Island Performing Provider System

We are a limited liability corporation

formed by Richmond University Medical

Center and Staten Island University

Hospital to implement Project

Management Function.

– PMO staff recruited solely for

program execution

Goal: Improve the quality and transform

the healthcare delivery system of Staten

Island

Breadth:

– 4 out of 10 Staten Island residents

affected by DSRIP

• Strategic analytics requires Advanced data integration warehousing

and visualization

• Multiple sources create complexity- DOH/MCO claims, clinical

datasets, external sources, EMRs, Care planning

• Successful solution demands integration of multiple data sources,

capability of projecting clinical and business risk & implementing

solutions in real time

Turning Data Into Business Intelligence

Impact of Peer / Substance Use Disorder (SUD) Initiatives on Performance

147.39

100.8384.56 73.14

0

20

40

60

80

100

120

140

160

Baseline MY1 Result MY2 Result MY3 Result toDate

Potentially Preventable ED Visits (BH Population)Preventable ED Visits per 100 Medicaid members

Salient NYS Medicaid Enterprise System, DSRIP Performance Module as of 5/31/17

Potentially Preventable ED Visits (BH Population)

24.96%

21.97%

51.94%

50.72%

0% 10% 20% 30% 40% 50% 60%

MY3 Result to Date

MY2 Result

MY2 vs. MY3 Improvement in SUD MeasuresSalient NYS Medicaid Enterprise System, DSRIP

Performance Module as of 5/31/17

Initiation of AOD* Treatment Engagement of AOD* Treatment

*Alcohol and other drug


Current Progress- Improving Outcomes

14.00 14.05

12.45

DY1 DY2 DY3Q1-Q2

2.A.III: Health Home at Risk Intervention30-day ER Rate (Per 100 Members)

6.44

3.53 4.24

DY1 DY2 DY3Q1-Q2

2.B.VII: Implementing the INTERACT Project (Inpatient Transfer Avoidance Program for SNF)30-day ER Rate (Per 100 Members)

14.37 14.11

12.76

DY1 DY2 DY3Q1-Q2

3.A.IV: Development of Withdrawal Management 30-day ER Rate (Per 100 Members) Improvement in 30-day ER Utilization Rate

• 2.A.III: Health Home at Risk12% reduction from Apr, 2015 – Sep, 2017

• 2.B.VII: Interact Project52% reduction from Apr, 2015 – Sep, 2017

• 3.A.IV: Withdrawal Management13% reduction from Apr, 2015 – Sep, 2017

SIPPS Strategy: Technology Supporting Performance and Program Developments

• SI PPS moved very quickly to populate an EDW with “live” partner data

• SpectraMedix (“SM”) harmonized data from diverse sources, created MPI

• PMO uses analytics to inform strategic direction, gauge P4P risk and develop action plans

• Hot spotting, geo-mapping and population health data visualization are critical tools

• SM measurement platform and portal are in use by key partners

• Salient tools and MAPP exports are integrated into EDW to enhance analysis

• Critically important to bring in outside data sources


Improving Population Health

Source Data

Labs Amb.WA-IIS PharmDSHS CustomEMR HIE Claims

Enterprise Data Warehouse

Measures Calculation and Reporting

Performance Improvement & Visualization

Predictive Modeling and Simulation

DSRIP Platform Building Blocks


Direct Data Feed from Partners

Lead Providers

Clinical Data

Other Partners

Clinical/Billing Data

Care Management Partners (GSI)

Actively Engaged

roster

Public Data

Uninsured population

Planning Dept. Data

ACS Data: Education & Housing

Status

NYC FITNESS-

GRAM

DOH Data SourcesMedicaid

Member Roster v3

IPA File

Claims Data

v1

CPA File

Medicaid Data Warehouse /

SIM

Other Feeds

Patient Activation Measures (PAM)

Overdose Death data

Local RHIO

Data Sources

Naloxone Data

(Hospitals, FDNY, NYPD)

MCO’s

EMS Calls Data

1 2

3 4

Data Sources


Custom


Provides daily and near

real-time updates

Applies rules to normalize

data

Aggregates data from disparate sources

Payer CAHPS Pharm EMR Labs Ambulatory HIE Claims

SpectraMedix EMPI

Map to DOH sources

Data Management/ Aggregation

SpectraMedix ETL Overview

EMR/

RHIO

All Payer

Claims

Database

Provider

Directory

Extract

Agent

Extract Reject /

Failures

New Business Rules

Input to Analytics

Data Quality

Checks & Data

Standardization

Rejects

Transformation

RulesSpectraMedix

CDR

Rejects

Source feeds

ClientQuality

Analyst

Provider

Attribution

• Configurable Email Alerts

• Success/Failure Reports

• Other Standard Reports

• Interactive Dashboards

Source Data Quality Assessment

EMPI: Unifying Patient Records

• Increased matching accuracy for two systems data from 83% to >98%

• Deterministic matching

• Built-in safeguards to prevent false positive matching

• Combines matching accuracy with computing efficiency for in-line

execution

• Different patient identifiers used at different institutions or programs

• Multiple identifiers assigned to a single person at one institution

• Lack of standards for including patient identifiers in data feeds

SpectraMedix

Enterprise

Master Patient

Index Solution

Patient Data

Integration

Challenges


Data Aggregation to Actionable Insights and VBP

SpectraMedix DSRIP Platform

eMeasures360 Framework

eureQa360

Enterprise Data Warehouse/EMPI

Regulatory Electronic Data

Submission

Structured data sources format

• Adjudicated claims• Partner 837 I/P• Clinical QRDA / C-CDA

RHIOs

• Healthix• Hixny• Rochester RHIO

Non standard format

• Custom DSRIP Data Spec Files

• Interfaces

Disease Registries

DSRIP

Pop Health Analytics

CMS Programs

Commercial Payer

Programs

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=imgres&cd=&cad=rja&uact=8&ved=0ahUKEwiBy-qG9uDJAhUBWz4KHRgCB_MQjRwICTAA&url=http://www.iconarchive.com/show/leaf-mimes-icons-by-untergunter/text-xml-icon.html&psig=AFQjCNEV431suB5zHXKcL0hh02E_j1J2yw&ust=1450373926817689

The Impact of Top 1000 High Risk Patients (HRP)

Staten Island PPS Risk profile algorithm identified the top 1000 High Risk

Patients (HRP) from 82,906 Staten Island PPS Medicaid Enrollees

>25%

2.a: IntegratedDelivery

(Health Home or HHR)

17%

2.b: Care Coordination(2.b.iv, 2.b.vii,

2.b.viii)

31%

3.a: Behavioral Health

(3.a.i, 3.a.iv)

>50%

Took PAM survey as of 04-07-2017

Percentage of Top 1000 High Risk Patients

(HRP) engaged in DSRIP projects

… and 40% of preventable readmissions

100% HRP had one or more Chronic

conditions

That population drives 23% of preventable

ED Visits (PPV) of Staten Island PPS Medicaid enrollees

Avg. PPV /HRP: 4.55Min PPV /HRP: 4 Max PPV /HRP: 140

Avg. PPR/HRP: 0.28Min PPR /HRP: 1 Max PPR /HRP: 5

1.2% of Staten Island PPS Medicaid Enrollees

are defined as High Risk Patients (HRP)

Diabetes12%

Schizophrenia7%

Other Mental Health

2%

Depression1%

Other47%

Asthma, Hypertension,

CVD31%


Measure Gaps by Partner - Summary


Analytics engine identifies gaps in care

Member Utilization

*Dashboards created using synthetic data

Gaps in Care Dashboards

Hospital Programs

• HIQR eCQM

• MU eCQM

• TJC eCQM

Ambulatory Programs

• Medicaid Reform

• MIPS

• CIN (Clinically Integrated Network)

• ACO

• Medicare Advantage

• Commercial P4P Programs

• PCMH

• CPC+


Electronic Interfaces

Data Sources

Inpatient Custom Programs Outpatient Custom

Programs

Continuous Performance Improvement for all Payers

CustomPayer CAHPS Pharm EMR Labs Ambulatory HIE Claims

HEDIS

When Outcomes are the Barometer of Success Can we Afford to Neglect SDOH?

Using Health & SDOH Data to Implement DSRIP Programs

MAPP Dashboard

Performance Management Dashboard

Stra

tegi

c P

lan

nin

g

Perf

orm

ance

Im

pro

vem

ent

Pop

ula

tio

n

Hea

lth

M

anag

emen

t

Population-based Registry 2.0Healthcare Hotspotting

Population Health

Management

Tool:Population-basedPatient Registry

Ver. 1.0

Use Case:Diabetes w/chronic

Comorbid Conditions

Population: Attributed Members with at least one of

the chronic comorbid

conditions:

Diabetes, BH, COPD and CHF

1 Key Statistics

3Patient Demographics

4Hospital Utilization Trend

2

Utilization by Population

Population Health View

0%

0%

Use Case: Diabetes Management

Improving Diabetes Management

PPS gathers and evaluates baseline

data for this population

Population Health Improvement Program

(PHIP) target Small Practices

City Harvest Program w PHIP to give a

“Healthy Food Prescription” &

nutrition/cooking classes

Fund Stanford Model – Chronic Disease

Self-Management Program and Diabetes

Self-Management Program

Expansion to other healthcare providers

and community groups

Overlaying data to target key hot spots and develop programs

Use Case: Asthma Analytics and Program Development

Improving Asthma Management

PPS gathers and evaluates

baseline data for this population

Incorporated Asthma as a VBP

component of our PHIP Program

Introduced Asthma Home Visits by

CBO Partner for at risk patients

Utilize School Health data to

hotspot lost days and monitor

progress

PPS shares analysis with clinical

partners to improve follow-up and

outcomes for asthma patients

Data Period: Oct, 14 – Oct, 16

Geomapping: Substance Abuse & Nation of Origin Overlay

Use Case: Substance Abuse Epidemic

Staten Island

Overdose Deaths in

NYC

Heroin

Opioids

SI PPS EMS Super Utilizer

Analyzer

Where are the calls originated?

What are the 911 Calls about?

Staten Island EMS Super Utilizers Analysis

Rank Chief Complaint # of Calls %Total

1 Alcohol Intox / ETOH 1261 10%

2 Psychiatric / Behavior 748 6%

3 Abdominal Pain 700 6%

4 Dyspnea-SOB 654 5%

5 Chest Pain 470 4%

6 Weakness 392 3%

7 Fall 303 2%

8 Seizure 229 2%

9 Asthma Symptoms 217 2%

10 Trauma Injury 174 1%

Subtotal 42%

Top 10 Chief Complaints Top 10 Locations

56

69

79

87

88

124

146

201

207

404

10 HOWARD CT

(T)Lakeside Manor Home - 797…

(T)NYCHA - STAPLETON

(T)Project Hospitality Outreach - 25…

(T)BAY STREET/VICTORY BLVD

(T)Family Support Staten Island-262…

(T)NYCHA - RICHMOND TERRACE

(T)NYCHA - SOUTH BEACH

(T)South Beach Psychiatric Center - 777…

(T)FERRY TERMINAL

#Calls

Data Period: 2014Q1-2016Q3Data Sources: RUMC and SIUH EMS tracking systems

SDOH and Public Health Data Defines Targeted Clinical and Social Programs

• Innovative program development on Staten Island includes multi-disciplinary pilots

• Identification of health disparities driven by continuous data mining community

needs assessment and public health data

• CBO and partner engagement critical for engaging underserved populations

affected by social determinants of health

• Use of claims and comprehensive data sources enhances PPS analytics

• Data drives DSRIP projects, Population Health Improvement Projects and informs

Cultural Competency and Health Literacy strategy

• DSRIP Year 2 data suggests outcome improvements

Use of Data to Inform Program Development Recruitment of Partners

Diversity and Inclusion (D&I) SI PPS Partner

Survey

Identify CCHL Site

Champions Gap Analysis

• Plans, policies, procedures

• D&I initiatives• Staff development

and training

Assessing outcome gaps includes identifying role of Language Access, Health Literacy, Cultural Competence, Healthcare Equality

• Monthly meetings• Develop programs,

share best practice• Report all

information to site leadership

• Organizational capacity

• Training: status, ability and needs

• Service improvement

90% partners identified Health Literacy as area for

improvement

65% partners seek LGBT and Disability sensitivity training

85% partners identified need for Medical Interpreter

Training

50% partners without language access

Contracted vendor for interpreting and translating needs; supplying sites with Video Remote Interpreting Equipment

Contracted 2 Medical Interpreter training vendors specializing in hospital and community interpreting

Contracted with CBO- Pride Center of Staten island to provide PPS-Wide LGBT Healthcare Equality training

Contracting with CBO PCCS to deliver sensitivity training for working with persons with developmental disabilities

Developing Health Literacy provider and community training

Findings: Action:


DY1 (4/2015-11/2015) vs. DY2 (4/2016-11/2016)

Potentially Preventable ER and Readmission Results

Key Takeaways

• DATA is the OXYGEN that enables delivery system reform

– Aggregation and governance of data is key

– Data from outside sources is essential

– Data needs to be turned into Business Intelligence

• Technology enables program developments and performance improvement

• Hot spotting, geo-mapping and population health data visualization are critical tools

• SDoH and public health data drives targeted clinical/social programs

• Ultimate goal is to transition to Value-Based Care

– Efforts should lead providers to implement other commercial and VBP programs

Questions

Raj Lakhanpal, MD, FACEP

Chief Executive Officer,

SpectraMedix

Tel: 609-336-7733 Ext. 301

Cell: 609-865-3244

[email protected]

Joseph Conte, PhD(c), CPHQ

Executive Director

Staten Island Performing Provider

System (SI PPS)

Tel: 917-830-1145

[email protected]

Documents

Transforming Medicaid Delivery on Staten Island: A Case Study · SDOH and Public Health Data Defines Targeted Clinical and Social Programs •Innovative program development on Staten