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DOH Announces Medicaid Redesign Efforts Reach Milestone
ALBANY, N.Y. (June 1, 2018)
The New York State Department of Health today announced that through New York State Medicaid redesign efforts, providers are exceeding their goals, resulting in improved health care throughout the state. New York handily passed its first federal test of the Delivery System Reform Incentive Payment, or DSRIP, on four key statewide performance measures: statewide metrics performance, success of statewide projects, total Medicaid spending and Managed Care plan expenditures. As part of the program established in 2014, New York was required to submit a statewide report card to the Centers for Medicaid and Medicare Services (CMS) detailing performance.
"Medicaid redesign is improving health care and lives throughout New York State, while saving taxpayers millions of dollars each year," said New York State Department of Health Commissioner Dr. Howard A. Zucker. "Thanks to Governor Cuomo's leadership, we continue to exceed not only our own goals, but federal standards in making Medicaid more efficient and accountable."
Currently in its fourth year, DSRIP has 25 Performing Provider Systems (PPS) made up of hospitals, providers and community-based organizations, who collaborate to provide Medicaid members and the uninsured with higher quality, more coordinated care. Through community-level collaborations and a focus on system reform, the ultimate goal of these projects is to improve quality of care and achieve a 25 percent reduction in avoidable hospital use over the five years of the program.
Today's report shows that through DSRIP, New York State has exceeded performance goals on the majority of measures in place, related to the transformation of care. Statewide metrics show several areas of improvement including the following critical measures:
- Preventable hospital readmission
- Preventable emergency room visits
- Patient Connection to Consistent Source of Primary Care
- Access to timely appointments
Additional report highlights include:
- Statewide Medicaid spending for emergency department and inpatient spending came in under target from the previous year.
- New York State has far exceeded the 10 percent goal of Managed Care Organizations' (MCO) service dollars being contracted by Value Based Payment (VBP) arrangements instead of Fee for Service. (Under Value Based Payment, MCOs and providers agree that a portion of compensation is dependent on provider performance.)
- Majority of DSRIP performance and quality metrics were achieved.
"A passing grade on all four of the milestones proves that we are making monumental progress toward improving care for millions of New Yorkers," said New York State Medicaid Director Donna Frescatore. "While we are on a clear path to success, our work is far from over. In the months and years ahead, we will shift our focus toward improving performance metrics and health outcomes as we work to change the culture of health care."
New York must submit a statewide report card to CMS for each year remaining in the demonstration, which ends on March 31, 2020. Failure to meet any of the four milestones will result in a financial penalty of overall DSRIP dollars from the federal government.
The full report can be viewed
here
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Opioid Addiction Treatment in Primary Care Receives Statewide Recognition
In the fall of 2016, Bassett Healthcare Network, in collaboration with DSRIP's Leatherstocking Healthcare Partners Collaborative, launched an innovative program aimed at making evidence-based addiction treatment more readily accessible to people living in rural central New York by offering medication-assisted treatment (MAT) in the primary care setting. The program is now being held up as a model for other health systems around the state and has earned Bassett the Healthcare Association of New York State's 2018 Pinnacle Award for Quality and Patient Safety. The award recognizes organizations that are playing a leading role in promoting improvements in health care delivery in New York State.
Battling an Epidemic
According to the Centers for Disease Control and Prevention, on average, 115 Americans die every day from an opioid overdose.
Currently, Bassett's opioid addiction program is helping more than 200 patients from around central New York address their addiction through a combination of MAT, counseling and comprehensive primary care to address other health issues.
"Some counties in our project's service region had among the worst rates of overdose for prescription opioid and heroin use in the state in 2015," explains James Anderson, PhD, a clinical psychologist with Bassett and medical director for behavioral health and integrated services. "However, in order to receive MAT, they often had to travel over 60 miles one-way. We had to figure out a way of helping the population we serve that is struggling with addiction. By weaving treatment into our primary care services and conceptualizing it as management of a chronic health condition, it fits within the purview of whole-person primary care to which our primary care clinicians are accustomed.
"Primary care visits within Bassett Healthcare Network are also covered by private insurance and Medicaid, making addiction treatment in this setting accessible to more patients regardless of income."
The network now has 27 primary care practitioners, both physicians and advanced practice clinicians, who have obtained Drug Addiction Treatment (DATA) waivers or "x" licenses, in order to be able to prescribe buprenorphine for treatment of opioid addiction. Bassett's goal is to have 90 percent of the network's primary care clinics offering addiction treatment as part of comprehensive primary care within the next three years.
MAT in Norwich
Dr. Jennifer O'Reilly, a primary care physician and medical director in Bassett's Norwich health center, is working with family nurse practitioner Pam Gilbert to help addicted patients. They currently have 58 patients in treatment. "The work has been incredibly rewarding," says O'Reilly. "We are able to offer prenatal care in conjunction with MAT to our pregnant patients. We have a number of patients who have been able to find stable housing, successfully start a job, and regain custody of their children since starting treatment. We have been able to address multiple chronic illnesses, including hepatitis C, that otherwise would have gone untreated. We are also providing contraceptive care, preventative screenings, and mental health care for these marginalized patients. The patients have been so grateful for help, and having them receive their treatment in primary care has normalized their condition and helped them to feel less persecuted and judged for their mental health and substance use issues."
An important factor in the program's success has been a partnership with the University of Massachusetts (UMass) to provide training, consultation and support through the first year. Clinicians, nurses and office staff from health centers around Bassett's eight-county service region met weekly in a virtual video conference with two family medicine physicians from UMass who have significant experience in using buprenorphine to manage opioid addiction, as well as a clinical psychologist with experience in providing integrated behavioral health care. These sessions served to help answer specific questions about an individual patient and allowed the group to learn from each other about how to best deliver this component of care. In conjunction with DSRIP, Bassett is currently exploring a second year of collaboration with UMass.
In addition to the collaboration with UMass, the network hired an addiction medicine psychiatrist (Dr. Roxanne Lewin), who helps initiate treatment for many of the patients and then transitions them back to primary care once they are more stable. Lewin also acts as an ongoing resource to support primary care providers within their clinics, as they care for patients struggling with addiction.
MAT Piloted in Cobleskill
Dr. Joseph Sellers, regional medical director and a primary care practitioner in Bassett's Cobleskill clinic where the MAT program was first piloted, says, "We've been doing this a year and a half now; we've matured quite a bit. Initially, we worried about people's substance abuse and now that's evolved to the patient's recovery phase and helping with transportation; education and job development."
Between the Middleburgh, Schoharie and Cobleskill health centers, Bassett's Schoharie County clinics are helping 48 patients through addiction treatment and recovery. Sandra Falco is the nurse manager for the Cobleskill health center.
"This is so much better than before when we had to refer them to community resources, which were very thin and patients might not follow through," explains Falco. "In the primary care setting, there's no stigma. Our addicted patients are here for treatment of a chronic illness and they're grateful to have help managing other medical conditions as part of their overall health. It's exciting to be able to effect such positive change on our patients' lives."
Sellers agrees and notes, "We've had people who've gotten their lives back together; I've had a patient graduate from college, get a job and move on with his life. It is tremendously rewarding."
Bassett was honored with the Pinnacle Award at HANYS' 50th annual membership conference June 28. This is the third year in a row Bassett Medical Center has earned HANYS' prestigious Pinnacle Award for Quality and Safety. The previous awards were for initiatives related to improving outcomes for diabetic patients and patients on dialysis.
HANYS encourages other hospitals to garner ideas and identify best practices for quality and safety improvement from published award submissions. More information is available at www.hanys.org.
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LCHP Sponsors Poverty Simulation
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The Springbrook Gymnasium openly waits for its participants.
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About 65 people experienced the virtual realities of poverty in a unique poverty simulation conducted on March 28 by LCHP in the gym at Springbrook.
The Community Action Poverty Simulation (CAPS) was designed to help people better understand the realities of poverty. Participants included staff members of LCHP partner organizations, various human service agencies, and student volunteers from the SUNY Delhi School of Nursing.
"This program helps people understand the complexities and frustrations of living in poverty day to day," said Bonita Gibb, of the Mohawk Valley Population Health Improvement Program (MVPHIP), who assisted in facilitating the simulation. "With greater awareness of its impact, we can more effectively address poverty issues in our area."
Using a simulation kit, participants role-played the lives of low-income families. Some were TANF (Temporary Assistance for Needy Families) recipients, some were disabled, and others were senior citizens on Social Security. During the course of four 20-minute "weeks," they had the stressful task of providing for basic necessities and shelter on a limited budget. They interacted with human service agencies, grocers, pawnbrokers, bill collectors, job interviewers, police officers and others.
The simulation is designed to sensitize those who frequently deal with low income families and to create a broader awareness of poverty. "According to the 2017 Poverty Report from the New York State Community Action Organization, almost 15% of residents of our PPS are living at or below the poverty level. This does not include those who have incomes just above the poverty level, who also struggle to meet basic needs," said Cindy Levene, LCHP Partner Engagement Manager. "This is the everyday reality of thousands of individuals in our five county area. Hopefully, participating in the simulation will give us all a better understanding of that reality."
LCHP is anxious to share the
poverty simulation experience with other groups and organizations in the PPS. For more information, please contact Cindy Levene at 607-322-5154, or email her at lucinda.levene@bassett.org.
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| Participants wait to meet the rest of their "families" to begin the simulation. |
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Partners and nursing students for Delhi College interacting during a "work week".
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2018 Living Healthier Expo a HUGE Success!
The Otsego County Department of Health hosted the 2018 Living Healthier Expo at the Foothills Performing Arts Center in Oneonta on April 6 and 7. Sponsored in part by LCHP, the Expo brought together area resources and experts to provide the community with the knowledge to live healthier, live better and live longer.
Coinciding with National Public Health Week, topics included rabies awareness, Lyme disease, chronic disease management and prevention, as well as mental health awareness and resources for chronic pain control and substance abuse. Several LCHP partners participated as vendors and presenters.
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Catskill Area Hospice and Palliative Care
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Family Planning of South Central New York
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LEAF |
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SUNY Cobleskill Tobacco Cessation
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Bassett Healthcare Community Navigation
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Senator Seward with Dr. R. Brown, Matt Johnson, Otsego County DOH, and Julie Dostal, LEAF
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| Friends of Recovery of Delaware and Otsego |
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The Neighborhood Center |
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HCR
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Progressive Primary Care Solutions, Inc.
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Please Welcome our NEW PARTNERS!!
LCHP Welcomes:
A & D Transport Services, Inc.
Al Rubin, President
83 Lower River Street
Oneonta, NY. 13820
(607) 433-1726
Oneonta City School District
Joseph Yelich, Superintendent of Schools
31 Center St.
Oneonta, NY 13820
(607) 433-8200
Schoharie County Department of Health
Earl VanWormer III, Chairman
Amy E. Gildemeister, Ph.D. Director of Public Health
P.O. Box 667
284 Main Street.
Schoharie, NY 12157
(518) 295-8365
Email: amy.gildemeister@co.schoharie.ny.us
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Check Out Performance Hub Activity
Now the latest work occurring in the LCHP Performance Hubs can be reviewed on our website.
Learn more by clicking this direct link:
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Workforce Update:
Thank you to LCHP Partners who participated in the Demonstration Year 3 Compensation and Benefits Survey! Click this link for a narrative summary of the results:
You can direct questions regarding the DY3 survey results direct to Wendy Kiuber, LCHP Workforce Lead:
wendy.kiuber@bassett.org
Reminder for Upcoming Workforce Reporting:
Reporting on both the partners' spending as well as their actual staff impact continues to be required every DYQ2 and DYQ4. Partners should keep in mind all associated activities with the DSRIP clinical projects as well as those subsequent projects that may be associated with driving associated performance measures. Data is entered into the HWapps platform and is next due to be reported for period 4/1/18-9/30/18.
In order to sustain the required reporting, LCHP, in conjunction with Health Workforce New York, conducted workforce reporting training in early 2018. The recorded training can be accessed by clicking on the following link:
Please direct questions regarding reporting or to access the training direct to
cpayne@hwapps.org
Thank you!
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68 Practices Achieve Patient Centered Medical Home 2014 Level 3 Recognition
Congratulations to the many primary care practices who achieved PCMH 2014 Level 3 Recognition, the highest level of recognition by NCQA (National Committee for Quality Assurance). The PCMH recognition program is the
most widely adopted Patient-Centered Medical Home evaluation program in the country. More than 12,000 practices (with more than 60,000 clinicians) are recognized by NCQA. Additionally, more than 100 payers support NCQA recognition through financial incentives or coaching.
Practices who transform their practices and earn recognition through NCQA have made a commitment to quality improvement within their practices. They take a patient-centered approach to care which results in patients who are happier and healthier.
100% of the LCHP partners submitting for PCMH recognition achieved Level 3 recognition
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Bassett Medical Center
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50 practices including 27 Primary Care, 3 Pediatric and 20 School Based Health Centers
Community Memorial Hospital
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4 practices
Bassett Oneida Health Center
- 1 practice
Oneida Healthcare
- 4 practices
Regional Primary Care Network
- 1 Federally Qualified Health Center
Little Falls Hospital
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2 practices
AO Fox
- 6 practices including 5 primary care and 1 pediatric practice
Congratulations to our partner organizations and their teams for this achievement!
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First Hub Assembly Meeting at the Otesaga
LCHP sponsored its first Hub Assembly meeting on March 16 at the Otesaga in Cooperstown. Over 100 LCHP partners and key stake holders in LCHP projects gathered to hear presentations ranging from a look at the MCO perspective on Value Based Payment by Tony Vitagliano, Vice-President of Provider Network Management and Operations for Excellus, to a "data dive" by Director of Network Operations and Analytics, Brett Wilhelm.
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| Tony Vitagliano, Vice-President of Provider Network Management and Operations for Excellus |
Asked about the significance of the event, Wilhelm said, "The maiden gathering of our Performance Hub Assembly brought together the five county-based Hubs to share our progress made since the Hub Kickoff meetings in June of last year. The meeting was a celebration of nearly a year of planning, discussion, collaboration, trend-seeking and data-driven patient interventions. For many attendees, this was the first glimpse into the work happening at the five county PPS-level, bringing a sense of greater accomplishment and impact than is visible at the Steering Committee or Workgroup level. The feedback from partners was very positive, particularly when related to the progress reports from our Performance Champions, who have been leading their county's efforts since November. We hope to bring even more Hub data to reflect Measurement Year 4 patient outcomes to the next Assembly meeting in September."
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| Performance Hub Champions shared the progress their workgroups are making as they "drill down" on specific performance measures in their respective counties. |
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| Sarah Nies, Schoharie County CCSI/SPOA Program Coordinator, and Dr. James Anderson, LCHP Medical Director, discussed their use of a focus group in Schoharie County to refine an intervention. |
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DID YOU KNOW?
LCHP's contract with HWapps/ Health WorkForce NY assists
our partners with advertising jobs. By visiting the LCHP homepage Career Center, partners will have the option to post new jobs and review submitted resumes. Users can view openings by accessing the job board and will have the option to upload their resumes separately or apply to a specific job posting. New users can learn more about the LCHP region by visiting the recruitment page.
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HUD Public Housing is Going Smoke Free on July 30, 2018!
Now is a good time to help patients and clients quit!
The U.S. Department of Housing and Urban Development (HUD) has taken steps to protect people from harmful secondhand cigarette smoke. The ruling that will restrict smoking in public housing requires public housing agencies (PHAs) to adopt a smoke-free policy by July 30, 2018. The policy will directly impact residents in our communities. It will disallow the use of "prohibited tobacco products" in all indoor areas including individual living units, common areas, administrative office buildings, and outdoor areas within 25 feet of those areas. Implementation of this rule presents a unique opportunity for healthcare and behavioral health providers to support to PHAs, housing owners, and housing agents to assist tenants who want to quit smoking.
The role your organization can play in supporting this transition could include:
- Providing tobacco cessation counseling and referral, such as referral to the NYS Smokers' Quitline at 1-866-NY-QUITS;
- Providing/prescribing medication to make it easier to quit. Medicaid covers it!;
- Sharing your experience and lessons learned regarding your smoke free policy;
- Providing sample signage, toolkits, and informational flyers/brochures; and
Talking further with your patients and clients about which treatment may be right for them.
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LCHP Partners Conduct Training Sessions
O'Connor Hospital and Catholic Charities Provide Community NARCAN Training
A life-saving law took effect in April
, 2006, making it legal in New York State for non-medical persons to administer Naloxone to another individual to prevent an opioid/heroin overdose from becoming fatal. All registered opioid overdose programs are furnished Naloxone (NARCAN) by the NYSDOH. It is a prescription medicine that reverses an overdose by blocking heroin (or other opioids) in the brain for 30 to 90 minutes.
On April 3, O'Connor Hospital hosted three NARCAN trainings for staff and community members. 43 people attended the trainings which were facilitated by Joseph Filippone of Catholic Charities' Project Safe Point. Participants learned how NARCAN creates a barrier on the brain's nerve receptors to overturn an overdose, how to recognize the signs of an overdose, and how and when to administer NARCAN to someone having an overdose.
Oliver Bourgeois, the Delaware County Hub Project Manager commented, "As an LCHP representative I was very impressed with the initiative taken by our Delaware County partners to put together the April 3rd Narcan training event at O'Connor Hospital. Educational trainings like this involving community members and staff alongside one another help start conversations and create connections to address the Opioid Epidemic our rural communities are facing. The training was very well presented by Project Safe Point and the group discussion was meaningful. I am confident it gave attendees the tools and knowledge to save a life - what is more meaningful than that?"
For further information about the use of Naloxone, click here
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New York State Department of Health Announces Results of Medicaid
Redesign Efforts to Improve Patient Care Statewide, Yielding Measurable
Reductions in Avoidable Hospital Use
ALBANY, N.Y. (June 19, 2018)
- The New York State Department of Health today announced that through the Medicaid Accelerated eXchange or ("MAX") Series, avoidable hospital use for the state's most vulnerable patients has been significantly reduced. Since its launch in 2015, the MAX Series has been an integral part of the Department's strategy toward successfully achieving Delivery System Reform Incentive Payment (DSRIP) goals.
The objective of the MAX Series is to empower hospital and community partners in their care redesign efforts, increase patient and workforce satisfaction and reduce avoidable hospitalizations. More than 900 professionals from 68 hospitals and 11 community-based practices from around the State have participated in the MAX series to date, and early results among teams are showing an 18 percent reduction in hospital readmissions and an 8 percent reduction in hospitalizations overall.
"Under the leadership of Governor Cuomo, our Medicaid redesign efforts are constantly increasing the efficiency of the healthcare system, resulting in improved outcomes and cost savings for New Yorkers," said New York State Health Department Commissioner Dr. Howard A. Zucker. "The Max Series is yet another example of our use of innovative techniques to use data and multi-disciplinary cooperation to transform healthcare delivery in New York State."
The MAX Series places front-line healthcare and community based professionals from throughout the state at the helm of change and provides them with the tools to restructure processes in a manner that is sensitive to local needs. Collectively, Action Teams, which consist of clinicians, administrators, healthcare workers and community-based professionals, have worked to identify the highest need patients, develop innovative solutions to provide better care, and to rapidly implement, test, and measure improvements for positive change.
"For years, we have known that a relatively small number of patients frequently visit hospital emergency rooms or are admitted to the hospital-sometimes many times a week or month - at a significant cost to the Medicaid program," said New York State Medicaid Director Donna Frescatore. "The MAX Series empowers local Action Teams to ask the patient why. Many times, the answer may be that the patient needs help with housing, making or getting to doctor's appointments, or help taking their medications. By focusing on the patient and thinking in a different way, the MAX Series has not only reduced hospital admissions and readmissions, it's made a difference in the lives of these patients."
Jodi Ramano, Director of Mental Health Services at Elmhurst Hospital said, "Usually when you think about performance improvement we think about big projects. What MAX brought to the picture is that small changes in processes can make huge differences and I think that's the beauty of the program."
Cara Pace, Chief Operating Office of PEOPLe, Inc. said, "MAX focuses on what the individual needs, not trying to make the individual fit into a process but having a process be available and ready for different types of scenarios."
Dr. Faizon Arshad, Emergency Department Physician at Vassar Brothers Medical Center said, "MAX helps to really connect the dots and to understand our patients in a broader sense - what specific challenges they have on a daily basis and how as a community we can really band together and provide leadership as an organization to steward our patients to higher quality care and overall improved outcomes, as well as improved quality of life."
Currently in its fourth year, DSRIP has 25 Performing Provider Systems (PPS) made up of hospitals, providers, and community-based organizations, who collaborate to provide Medicaid members and the uninsured with higher quality, more coordinated care. Through community-level collaborations and a focus on system reform, the ultimate goal of these projects is to improve quality of care and achieve a 25 percent reduction in avoidable hospital use over the five years of the program. More information on the DSRIP program can be found here:
www.health.ny.gov/DSRIP
Contact: New York State Department of Health
518-474-7354, Ext. 1
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Workforce: LCHP Lead Partner Offers Students a Look at Healthcare Occupations
The Scrubs Club program piloted last fall, where high-school students visit Bassett Medical Center to learn about careers in health care, has concluded for the school year. Approximately 70 high-school students from five schools (Cooperstown, Oneonta, Laurens, Milford and Edmeston) came to the hospital once a month during the year to investigate the variety of career possibilities and to find out if they might be interested in pursuing a health care career after graduation. In the end-of-year presentations by the students, some noted they were surprised to find out that some of the career possibilities, other than being a doctor or nurse, included work in finance, billing, human resources, carpentry and maintenance, security services and information technology.
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| Photo (l. to r.) Scrubs Club participants Morgan Jipson, Olivia O'Donnell and Angelica Goodhue. |
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The students worked closely with hospital employees in a variety of departments, participated in virtual tours and were a part of discussion groups. They actively participated in medical procedure simulations, such as placing and removing a nasogastric tube on a mannequin. They also enjoyed a visit to the hospital helipad and an opportunity to meet with flight paramedics.
"One of the major things Scrubs Club has helped me with is my plan for my future," says Olivia O'Donnell, a tenth grade student at Oneonta High School. "Before coming to Scrubs Club, I was sure I wanted to be a physical therapist. After learning about the different careers and colleges, I have now decided I am interested in endocrinology or pediatric endocrinology. Even though we did not specifically talk about endocrinology, Scrubs Club inspired me to go home and research more health care careers. I am so grateful to have been a part of this amazing club and all the opportunities it has provided me."
Another Oneonta sophomore, Angelica Goodhue, mentioned that her favorite part of Scrubs Club was going to the helipad, seeing the helicopter land and meeting the flight paramedics. "I met one of the flight paramedics who went to SUNY Cobleskill," says Goodhue. "This is the college I want to go to, and because of that day and their presentation, I now know that I want to become a paramedic. I have always known I wanted a future in health care, but I never knew just how many jobs and positions are actually available. I feel like [the program] will help so many other students like it helped me. Because of this program...I have contacted SUNY Cobleskill about their paramedic program."
Ghafar Kurdieh, RN, Bassett nurse educator, one of many Scrubs Club instructors, says, "My take-away from this experience was how much I enjoyed working with the high schoolers. Modifying the material I teach to nurses so that it is understandable for high-school students helped me become a better educator. To see their excitement and energy gives me hope for the next generation."
When a new school year begins in the fall, another Scrubs Club program will kick off at Bassett Medical Center, welcoming more students from participating schools. To learn more about Scrubs Club, call (607) 547-4598. To see a powerpoint description of the program, click HERE.
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