New York State is in the process of undergoing an unprecedented transformation of its healthcare system through the implementation of the $6 billion Delivery System Reform Incentive Payment (DSRIP) program. Why? New York must not only reduce the vast cost of care, but it must also assure that individuals’ care is optimized through better collaboration. DSRIP will require comprehensive networks of providers to work together in Performing Provider Systems (PPSs), delivering population-based healthcare to Medicaid beneficiaries and uninsured New Yorkers. Through this process, the State intends to transform New York’s healthcare safety net, improve healthcare quality, and increase sustainability through payment reform. Success in the DSRIP program will require innovative strategies in communication, patient care, data analytics, and many other areas. Technology must therefore be foundational to a solid PPS platform. This panel of leading PPS participants and tech solutions providers will examine the vital role that healthcare technologies will play in DSRIP implementation, and the potential for DSRIP to accelerate the introduction of new, innovative technologies into New York’s healthcare delivery system. • Jordanna Davis - Principal, Sachs Policy Group • Stan Berkow - Co-Founder & CEO, Sense Health • David Cohen, MD, MSc - Executive Vice President, Clinical Affairs & Affiliations; Chair, Department of Population Health, Maimonides Medical Center • Lori Evans Bernstein - President, GSI Health • Stephen Rosenthal - President & Chief Operating Officer, CMO, The Care Management Company of Montefiore Medical Center New York eHealth Collaborative Digital Health Conference November 17, 2014

1. New York State’s DSRIP Program: A Key Moment for Healthcare Technology & Improving Care for All New Yorkers
Jordanna Davis, Sachs Policy Group

2. 2
SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on data from FY 2010 MSIS and CMS-64 reports.
Total Medicaid Spending Per Beneficiary

5. 5
SOURCE: “The State of New York’s Medicaid Program,” Jason Helgerson. July 15, 2014

6. DSRIP Goals
• Safety net transformation at the system and
state level.
• Accountability for reducing avoidable hospital
use and improvements in population health
measures at the system and state level.
• Sustainability of delivery system transformation
through managed care payment reform.
6

7. “Emerging” PPSs
AW Medical Lutheran Medical Center HealthAlliance Hudson Valley
Mount Sinai Hospitals Group NY Hospital Med Center Queens Erie County Medical Center Corp
NYC Health and Hospitals Corp Stony Brook University Hospital Catholic Medical Partners
Maimonides Medical Center Long Island Jewish Medical
Center
Ellis Hospital
St. Barnabas Hospital Catholic Health Services of LI Albany Medical Center Hospital
SUNY Downstate Medical Center Nassau University Medical Center CNY PPS
Bronx‐Lebanon Hospital Center Finger Lakes PPS United Health Services Hospitals
The Jamaica Hospital Montefiore Medical Center Adirondack Health Institute
New York Presbyterian Hospital Westchester Medical Center Mary Imogene Bassett Hospital
RUMC & SIUH Refuah Health Center Samaritan Medical Center
7

8. Choosing from the DSRIP Menu
Care Coordination/ Transitional Care • Ambulatory ICUs • Development of co-located primary care services in the ED • ED care triage for at-risk populations • Care transitions intervention model to reduce 30-day readmissions for chronic health conditions • Care transitions intervention for skilled nursing facility residents • Transitional supportive housing services • Implementing the INTERACT project (inpatient transfer avoidance program for SNF) • Hospital-home care collaboration solutions • Implementation of observational programs in hospitals Connecting Settings • Development of community- based health navigation services • Expand usage of telemedicine in underserved areas to provide access to otherwise scarce services Special Populations* • Implementation of patient and community activation activities for the uninsured and low/non- utilizing Medicaid populations
Required
Mental Health and Substance Abuse
• Promote mental, emotional, and behavioral well-being in communities
• Prevent substance abuse and other mental emotional behavioral disorders
• Strengthen mental health and substance abuse infrastructure across systems
Chronic Disease Prevention
• Promote tobacco cessation, especially among low SES population and those with poor mental health.
• Increase access to high quality chronic disease preventive care and management in both clinical and community settings
HIV and STD Prevention
• Decrease HIV morbidity
• Increase early access to and retention in HIV care
• Decrease STD morbidity
• Decrease HIV and STD disparities
Women, Infants, and Children
• Reduce premature births
Integrated Delivery Systems • Create integrated delivery systems that are focused on evidence based medicine and population health management • Increase certification of PCPs within PCMH certification or Advanced Primary Care Models • Health home at- risk intervention program • Create a medical village using existing hospital infrastructure • Create a medical village or alternative housing using existing nursing home
Behavioral
• Integration of primary care services and behavioral health
• Behavioral health community crisis stabilization services
• Implementing evidence based medication adherence program in community based sites for behavioral medication compliance.
• Development of withdrawal management capabilities within communities
• Behavioral interventions paradigm in nursing homes
Cardiovascular Health
• Evidence based strategies for disease management in high risk/affected populations (adults only)
• Implementation of evidence-based strategies in the community to address chronic disease, primary and secondary prevention projects (adults only)
Diabetes Care
• Evidence-based strategies for disease management in high risk/affected populations (adults only)
• Implementation of evidence-based strategies in the community to address chronic disease, primary and secondary prevention projects (adults only)
Asthma
• Development of evidence-based medication adherence management programs in community settings- asthma medication
• Expansion of asthma home-based self-management program
• Evidence based medicine guidelines for asthma management
HIV
• Comprehensive strategy to decrease HIV/AIDS transmission to reduce avoidable hospitalizations- development of a Center of Excellence for management of HIV/AIDS
Perinatal
• Increase support programs for maternal and child health, including high risk pregnancies (e.g., Nurse-Family Partnership)
Palliative Care
• IHI Conversation Ready model
• Integration of palliative care into medical homes
• Integration of palliative care into nursing homes
Renal
• Specialized medical home for chronic renal failure
Behavioral
• Integration of primary care services and behavioral health
• Behavioral health community crisis stabilization services
• Implementing evidence based medication adherence program in community based sites for behavioral medication compliance.
• Development of withdrawal management capabilities within communities
• Behavioral interventions paradigm in nursing homes
Optional
Up to three more of any of the above BLUE choices, for a maximum of five BLUE choices. * The special populations project can only be chosen as the 11th project.
Up to two more of any of the above GREEN choices, for a maximum of four GREEN choices.
Up to one more of the above PURPLE choices.
Choose ONE from each of the five buckets below.
Choose as many additional as desired, but only options chosen according to the below guidelines count towards project valuation.
System Transformation
Clinical Improvement
Population-Wide
8

9. DD
Nursing
Home
SMI/SUD
All Others
Residential
(Waiver and
IID)
Day/Vocational
Care
Management
(MSC or CAH)
Article 16
Clinic
Other OPWDD
Waiver Services
Nursing Home
Care
Manager*
Intermediate or
Intensive
Residential Care**
OMH/OASAS
Outpatient
Treatment†
Freestanding
Psychologist/
Psychiatrist
Specialty
Medical or BH
Inpatient/ED
Health
Home
members
PCP (if meeting
utilization
standard)
Other Primary
Care Provider
or Outpatient
Clinic
Emergency
Department
Inpatient
*Health Home, TCM, ACT, or HCBS waiver care
management provider for children.
**RTF, RRSY, rehabilitative services for residents of
a Community Residence, etc.
†Outpatient clinic, CDT, PROS, day treatment,
MMTP, or outpatient rehabilitation. Attribution

10. PPS REGION
PPS
DEVELOPMENTAL DISABILITIES
LONG TERM CARE
BEHAVIORAL HEALTH
OTHER
OUTSIDE LOYALTY
GRAND TOTAL
NYC
AW MEDICAL
155
3003
13157
421323
437,638
MOUNT SINAI HOSPITALS GROUP
1,817
8,970
35,287
307,930
354,004
NEW YORK CITY HEALTH AND HOSPITALS
3,676
4,294
35,013
262,965
305,948
MAIMONIDES MEDICAL CENTER
821
2,865
14,800
276,119
294,605
ST. BARNABAS HOSPITAL
494
5,305
20,346
229,967
256,112
SUNY DOWNSTATE MEDICAL CENTER
169
2,138
8,386
166,166
176,859
BRONX-LEBANON HOSPITAL CENTER
11
2,849
7,354
72,264
82,478
THE JAMAICA HOSPITAL
6
816
5,903
72,566
79,291
THE NEW YORK PRESBYTERIAN HOSPITAL
38
542
4,514
69,380
74,474
RUMC & STATEN ISLAND UNIVERSITY HOSP
84
3,243
5,023
57,566
65,916
LUTHERAN MEDICAL CENTER
191
773
2,919
52,745
56,628
THE NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS
3,315
1,062
30,992
35,369
LONG ISLAND
STONY BROOK UNIVERSITY HOSPITAL
206
6,516
9,474
53,449
141,697
211,342
LONG ISLAND JEWISH MEDICAL CENTER
97
1,897
4,503
120,986
127,483
CATHOLIC HEALTH SERVICES OF LONG ISLAND
52
2,756
3,068
57,634
63,510
NASSAU UNIVERSITY MEDICAL CENTER
111
4,966
4,906
51,095
61,078
FINGER LAKES
FINGER LAKES PPS
2,201
7,584
24,036
172,806
50,359
256,986
MID-HUDSON
MONTEFIORE MEDICAL CENTER
429
6,549
14,217
80,353
101,548
WESTCHESTER MEDICAL CENTER
1,308
1,822
8,169
74,896
86,195
REFUAH HEALTH CENTER
100
141
927
29,575
30,743
HEALTH ALLIANCE OF THE HUDSON VALLEY
509
2
8
22
541
WESTERN NY
ERIE COUNTY MEDICAL CENTER CORPORATION
267
4,216
15,223
132,274
151,908
CATHOLIC MEDICAL PARTNERS
159
1,799
5,808
42,533
50,229
CAPITAL REGION
ELLIS HOSPITAL
1,289
2,632
11,902
72,601
5,103
93,527
ALBANY MEDICAL CENTER HOSPITAL
1,250
1,665
4,337
36,667
6,861
50,780
CENTRAL NY
CNY DSRIP PPS
340
3,951
11,500
70,676
56,825
143,292
SOUTHERN TIER
UNITED HEALTH SERVICES HOSPITALS
832
2,348
6,067
48,772
26,475
84,494
NORTH COUNTRY
ADIRONDACK HEALTH INSTITUTE
681
2,226
5,852
46,425
18,015
73,199
MOHAWK VALLEY
MARY IMOGENE BASSETT HOSPITAL
12
734
2,019
30,375
2,727
35,867
TUG HILL SEAWAY
SAMARITAN MEDICAL CENTER
456
767
2,917
20,785
5,071
30,050
GRAND TOTAL
17,761
90,684
288,751
3,161,907
313,133
3,872,236

11. Sample Valuation
11
Project
Project Index
Scores
Valuation
Benchmark
Project
PMPM
Project Plan
Application
Score
# of Attributed
Medicaid
Beneficiaries
# of DSRIP
Months
Maximum Project
Valuation
Project 1: 2.a.i 0.93 $4.88 $4.53 0.80 50,000 60 $10,872,000
Project 2: 2.a.ii 0.62 $4.88 $3.02 0.80 50,000 60 $7,248,000
Project 3: 2.b.vii 0.68 $4.88 $3.32 0.80 50,000 60 $7,968,000
Project 4: 2.c.i 0.62 $4.88 $3.02 0.80 50,000 60 $7,248,000
Project 5: 3.a.i 0.65 $4.88 $3.17 0.80 50,000 60 $7,608,000
Project 6: 3.b.ii 0.43 $4.88 $2.10 0.80 50,000 60 $5,040,000
Project 7: 3.c.i 0.50 $4.88 $2.44 0.80 50,000 60 $5,856,000
Project 8: 3.d.iii 0.52 $4.88 $2.54 0.80 50,000 60 $6,096,000
Project 9: 4.a.i 0.33 $4.88 $1.61 0.80 50,000 60 $3,864,000
Project 10: 4.b.ii 0.38 $4.88 $1.37 0.80 50,000 60 $3,288,000
Maximum Application Value $65,088,000

12. DSRIP Tentative Timeline
Date Milestone
December 22nd DSRIP Project Plan application due
March 2015 PPSs receive DSRIP award grants
April 2015 Performance Period Begins (DY1)
January 2016 DY2 Begins
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13. Contact
13
email: jdavis@sachspolicy.com
phone: 212.827.0660