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HFMA - IT and DSRIP Technology Enabled Healthcare - Paul Contino
1. Focus on Technology: IT and DSRIP
Technology Enabling Healthcare
Paul Contino
Corporate Chief Technology Officer
NYC Health & Hospitals Corporation
Metropolitan New York Chapter HFMA Spring Academy 6/4/2015
2. Agenda
• Who We Are –
HHC and OneCity Health PPS
• DSRIP and Delivery System Reform
• Technology Enabled Healthcare
• Q&A
3. • Largest municipal healthcare organization in the U.S.
• $6.7 billion integrated healthcare delivery system
• Serving 1.4 million New Yorkers every year, including
475,000 uninsured
Facilities:
• 11 acute care hospitals
• 4 skilled nursing facilities
• 6 large diagnostic and treatment centers,
• Health and Home Care (in-home services)
• More than 80 community health clinics
• 420,000 member health plan (MetroPlus)
4.
5. Delivery System Reform Incentive
Payment Program (DSRIP)
As part of New York’s Medicaid
Redesign Team (MRT) Waiver
Amendment, DSRIP’s purpose is to
fundamentally restructure the health
care delivery system by reinvesting in
the Medicaid program, with the primary
goal of stabilizing the safety-net system
and reducing avoidable hospital use by
25% over 5 years.
Transition care delivery from a
volume to value base system
6. Delivery System Reform
better care, smarter spending, and healthier people
Current
Managing Illness
Evolving
Managing Wellness
Episode of Care
Fragmented Care
Hospital at center of
delivery system
Incentives for Volume
Fee-For-Service
Payment Systems
Population health and a system
of care for chronic illnesses
Coordinated Care
Pro-active primary care, well integrated with
specialty services. Hospitals care for
increasingly ill population
Incentives for Quality and Outcomes that are
evidence-based, measurable and improve health
and the quality of life
Value-based purchasing
Accountable Care Organizations
Medical Homes
Bundled payments / Risk contracts
Quality/cost transparency
7. DSRIP Programs Across the Country
Alaska
Hawaii
Michigan
California
Nevada
Oregon
Arizona
Utah
Idaho
Montana
Wyoming
Colorado
New Mexico
Nebraska
MaineVermont
New York
North Carolina
Georgia
South
Carolina
Florida
Alabama
Mississippi
Louisiana
Texas
Pennsylvania
Wisconsin
MinnesotaNorth Dakota
Ohio
West
Virginia
South Dakota
Arkansas
Missouri
Iowa
Illinois Indiana
Tennessee
Kentucky
Delaware
New Jersey
Connecticut
Massachusetts
New Hampshire
Virginia
Maryland
Rhode Island
District of Columbia
Kansas
Oklahoma
Washington
DSRIP
Implemented (6)
$6.67 B
five years
$0.06 B
three years
$11.40 B
five years
$6.42 B
five years
$0.63 B
five years
$0.58 B
three years
In development (3)
9. NYC’s largest Performing Provider
System (PPS).
It is sponsored by the NYC Health and
Hospitals Corporation (HHC).
Approximately 400 local and city-wide
community-based organizations and
healthcare providers form the PPS.
Represents a broad range of services
across the continuum of care
10. Community partners include:
• Behavioral health providers
• Certified home health agencies
• Diagnostic and treatment centers
• Long term care providers
• Health centers and FQHCs
• Health homes
• Other Hospitals & Health systems
• Skilled nursing facilities
• Substance abuse treatment programs
• Support service providers
11. DSRIP Projects
1 Create an Integrated Delivery System
2 Health Home At Risk Intervention Program
3 ED Care Triage for At Risk Populations
4 Reduce 30 day Readmissions for Chronic Health Conditions
5 Integration of Primary Care and Behavioral Health Services
6 Evidence Based Strategies for Disease Management in High Risk/Affected
Populations (Adults Only)
7 Expansion of Asthma Home Based Self Management Program
8 Integration of Palliative Care into the PCMH Model
9 Strengthen Mental Health and Substance Abuse Infrastructure across Systems
10 Increase early access to, and retention in, HIV care
11 Implementation of Patient Activation Activities to Engage, Educate and
Integrate the uninsured and low/non utilizing Medicaid populations into
Community Based Care
12. Key Technology Supporting DSRIP
Electronic Health Records (EHR)
Care Coordination Management System
Health Information Exchange (HIE)
Clinical Record Locator Service (CRLS) & Master
Data Management (MDM)
Performance Management & Analytics
Contact Center
Telehealth & Remote Patient Monitoring
13. Electronic Health Records (EHR)
Eligible Partners must have a MU2 Certified EHRs
Some partners will not have EHRs and/or do not
qualify for MU (community-based organizations,
nursing homes, home health, behavioral health, etc.)
Primary care practices must meet 2014 NCQA Level
3 PCMH standards by Year 3.
EMR connectivity to RHIO (HIE)
14. Care Coordination Mgmt System
Integrated delivery network must perform care
coordination functions that are not typically
supported by today’s EHR systems.
Must be able to track patients across partners with
centralized registries, support individualized care
plans, referral tracking and portals for providers and
patient engagement.
Support multi-disciplinary care teams
Will extend beyond participants with
EHRs such as Behavioral health and
non-clinical participants in the
community (housing, social services,
etc)
15. Health Information Exchange
Partners will be required to have connectivity to HIE
and support the SHIN-NY
DIRECT Secure Messaging (HISP)
Event Notification (ADT Alerts)
Partner connectivity from EMR or CCMS to HIE
Private HIE
HIE
16. Clinical Record Locator Service
(CRLS) & Master Data Management
(MDM)
Matching of patient records from multiple partners to
create a unique PPS-wide patient identifier
Establishes Patient Identity and allows linkage of
data across multiple sources (EMR, CCMS, MCO,
NYS Claims, RHIO)
Provider Master registry
17. Performance Management & Analytics
Expansion of HHC Business Intelligence Capabilities
Gather, load, normalize, validate and store patient-
level data from multiple HHC and external sources
(clinical and claims data)
Quality Measures & Performance Management
Use for Population Health Management
PPS & Partner dashboards
Advanced analytic capabilities
Care Gaps / Disease Patterns
Predictive Modeling
Risk Stratification
19. Contact Center
A standardized patient services solution
Supporting current and planned DSRIP services,
including expanded patient navigation, scheduling and
referrals, appointment reminders
Leverage full capabilities and services of our partners
Improve patient satisfaction and experience
20. Telehealth &
Remote Patient Monitoring
Remote examination and treatment using audio and
video conferencing (eVisits)
home monitoring and mobile devices allow providers
to intervene quickly with high-risk patients.
21. Putting It All Together
EDW
A
B
C
Partners
Clinical Provider
EMR
Healthix
Interboro
BronxRHIO
Qualified Entities
Regional Health
Information
Organizations
SHIN-NY
ADT HL7
HealthShare
PPS
Health Information
Aggregation
ADT HL7
ADT HL7
Claims Feeds
NYS, MCO
CCMS
Composite Health Record
Provider Registry
Clinical Viewer
Clinical Message Delivery
Terminology
Consent Manager
MDM
Initiate
CRLS – Clinical Record
Locator Service
Patient and Provider
Identity Management
ADT
EMPI
Global PPS
HIM / Identity
Governance
Business Intelligence
Patient
Match Reports
ADT HL7
Performance Metrics /
Analytics
CCDA (Care Plan to EMR)
Standardized Medical Record data elements for MDF Reporting
Clinical and Claims Based Dashboards for Population Health
EMPI Medical Record Data
ADT HL7
EMPI
HHC EMR
QCPR / EPIC
Risk Stratification
22. Improving Care Delivery Efficiency
Emerging technologies
capable of connecting patients
with physicians, hospitals, and
other care providers include
wearable sensors for collecting
information about a patient’s
physiological condition, activity,
behaviors, and environment.
As data is collected, these
devices transmit information,
ultimately making it available to
care provider organizations.
25. Questions?
Paul Brian Contino
Corporate Chief Technology Officer
Enterprise Information Technology Services
NYC Health and Hospitals Corporation (HHC)
55 Water Street,
New York, NY 10041
Tel: 646-458-3888
Cell: 917-279-4760
paul.contino@nychhc.org
Editor's Notes
The New York City Health and Hospitals Corporation (HHC) is a $6.7 billion integrated healthcare delivery system with its own 420,000 member health plan, MetroPlus, and is the largest municipal healthcare organization in the country.
HHC is committed to making exemplary healthcare accessible to all New Yorkers, and will be playing a crucial role in delivery system transformation over the next five years through its leading role in DSRIP, the Delivery System Reform Incentive Payment program. Through DSRIP, NYS DOH has allocated $6.42 Billion Medicaid dollars to fundamentally restructure the health care delivery system to transition care delivery from a largely inpatient-focused system to a community-facing system that addresses both medical needs and social determinants of health.
DSRIP is a 5-year, performance payment-based program with primary goal of reducing avoidable hospital use by 25% over 5 years. At the end of program life, the aim is for the newly-transformed system to be sustainable.
HHC has formally partnered with hundreds of New York City provider and service organizations in order to achieve DSRIP transformation goals. This partnership is referred to by NYS DOH as a Performing Provider System (PPS), and the PPS led by HHC is called OneCity Health. HHC created a Central Services Organization (CSO) as a wholly-owned subsidiary of HHC, referred to as OneCity Health Services. The subsidiary's function is to provide operational, program, IT and other support to all OneCityHealth PPS partners and the OneCity Health governing bodies.
If you are not familiar with the HHC brand – you are likely to recognize many of our well known city hospitals such as Bellevue, Kings County, Elmhurst and Jacobi
Through DSRIP, NYS DOH has allocated $6.42 Billion Medicaid dollars to fundamentally restructure the health care delivery system to transition care delivery from a largely inpatient-focused system to a community-facing system that addresses both medical needs and social determinants of health
HHC is taking a leadership role in the Delivery System Reform Incentive Payment (DSRIP) process. We have applied to the state as a single, city-wide Performing Provider System (PPS) consisting of all our healthcare facilities, including our nursing homes, community health centers, home health agency and our insurance plan, MetroPlus. The HHC-led PPS, OneCity Health, has approximately 400 community based partners across the city whose work will be guided by the results of comprehensive community health assessments of the areas we serve. In response to those health appraisals, we will launch new initiatives to proactively meet the primary care needs of higher-risk patients, reduce 30-day readmissions, better address chronic health conditions, and enhance mental health and substance abuse programs. OneCity Health closely aligns and expands on HHC’s previous population health work and takes it to a next level of magnitude.
HHC is taking a leadership role in the Delivery System Reform Incentive Payment (DSRIP) process. We have applied to the state as a single, city-wide Performing Provider System (PPS) consisting of all our healthcare facilities, including our nursing homes, community health centers, home health agency and our insurance plan, MetroPlus. The HHC-led PPS, OneCity Health, has approximately 400 community based partners across the city whose work will be guided by the results of comprehensive community health assessments of the areas we serve. In response to those health appraisals, we will launch new initiatives to proactively meet the primary care needs of higher-risk patients, reduce 30-day readmissions, better address chronic health conditions, and enhance mental health and substance abuse programs. OneCity Health closely aligns and expands on HHC’s previous population health work and takes it to a next level of magnitude.