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
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
SCC Coalition Partner
Organizations
SBUH
SCC Coalition Partner
Organizations
DSRIP Waiver Administrators
Suffolk PPS Lead (Stony Brook University Hospital)
HUB Networks
SCC Coalition Partners
• 6
• 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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EXAMPLES SCC COALITION PARTNER PARTICIPATION MANUAL
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, Q3 10/1/16 – 12/31/16 January 13, 2017 January 31, 2017
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, Q3 10/1/17 – 12/31/17 January 12, 2018 January 31, 2018
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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EXAMPLES SCC COALITION PARTNER PARTICIPATION MANUAL
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
• 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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DESCRIBING THE SCC ON-BOARDING PROGRAM PART 2 OF 4
• 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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DESCRIBING THE SCC ON-BOARDING PROGRAM PART 3 OF 4
• 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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DESCRIBING THE SCC ON-BOARDING PROGRAM PART 4 OF 4
http://suffolkcare.org/forpartners/onboarding/
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WEBSITE TUTORIAL
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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DSRIP AWARD FOR THE SUFFOLK PPS CONTD.
© 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.
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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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© 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.
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
DY 2 PPS Fourth Quarterly Report(1/1/17 – 3/31/17)
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 #
DY 3 PPS First Quarterly Report(4/1/17 – 6/30/17)
9 7/31/2017 9/29/2017 MY 27/1/15-6/30/16
6
DY 3 PPS Second Quarterly Report(7/1/17 – 9/30/17)
10 10/31/2017 12/30/2017
DY 3 PPS Third Quarterly Report(10/1/17 – 12/31/17)
11 1/31/2018 4/1/2018 MY 37/1/16-6/30/17
7/29/2018 7
DY 3 PPS Fourth Quarterly Report(1/1/18 – 3/31/18)
12 4/30/2018 6/29/2018
DY 4 PPS First Quarterly Report(4/1/18 – 6/30/18)
13 7/31/2018 9/29/2018 MY 37/1/16-6/30/17
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DY 4 PPS Second Quarterly Report(7/1/18 – 9/30/18)
14 10/31/2018 12/30/2018
DY 4 PPS Third Quarterly Report(10/1/18 – 12/31/18)
15 1/31/2019 4/1/2019 MY 47/1/17-6/30/18
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DY 4 PPS Fourth Quarterly Report(1/1/19 – 3/31/19)
16 4/30/2019 6/29/2019
DY 5 PPS First Quarterly Report(4/1/19 – 6/30/19)
17 7/31/2019 9/29/2019 MY 47/1/17-6/30/18
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DY 5 PPS Second Quarterly Report(7/1/19 – 9/30/19)
18 10/31/2019 12/30/2019
DY 5 PPS Third Quarterly Report(10/1/19 – 12/31/19)
19 1/31/2020 3/31/2020 11
DY 5 PPS Fourth Quarterly Report(1/1/20 – 3/31/20)
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
27
© 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.
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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28
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
Hub Level Distribution to Provider
Hub Level Distribution to Provider
$ $
30
© 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.
© 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.
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)
• Knowledgeable in all 11 DSRIP programs
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)
• Knowledgeable in all 11 DSRIP programs
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)
Questions & Answers
Thank you!
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