HFMA - IT and DSRIP Technology Enabled Healthcare - Paul Contino
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Metropolitan New York Chapter HFMA Spring Academy 6/4/2015 Focus On Technology IT and DSRIP Technology Enabled Healthcare - Paul Contino
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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)
- 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
- 18. Risk Stratification Source: The Advisory Board Company: How to Prioritize Population Health Interventions
- 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.
- 23. Bending the Cost Curve
- 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.