Mid-Point Assessment Action Plans: PPS Progress through DY3, Q1. October 2017
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1 Mid-Point Assessment Action Plans: PPS Progress through DY3, Q1 October 2017
2 2 Contents Mid-Point Assessment Recommendation Review Changes to PPS Reporting PPS Progress on Mid-Point Assessment Action Plans Next Steps
3 Mid-Point Assessment Review 3
4 4 Mid-Point Assessment Recommendation Themes 22 of 25 PPS had recommendations as a result of the Mid-Point Assessment process. Total number of recommendations ranged from 1 (3 PPS) to 23 (1 PPS). Recommendations were organizational or project specific. The most common recommendation was the Standard Modification recommendation from PAOP. 14 of the 25 PPS received this recommendation. The PPS must develop a detailed plan for engaging partners across all projects with specific focus on Primary Care, Mental Health, Substance Used Disorder providers as well as Community Based Organizations (CBOs). The Plan must outline a detailed timeline for meaningful engagement. The Plan must also include a description of how the PPS will flow funds to partners so as to ensure success in DSRIP. The PPS must also submit a detailed report on how the PPS will ensure successful project implementation efforts with special focus on projects identified by the IA as being at risk. These reports will be reviewed and approved by the IA with feedback from the PAOP prior to April 1, 2017.
5 5 Mid-Point Assessment Action Plans PPS that received at least one recommendation as a result of the Mid-Point Assessment process were required to complete a Mid-Point Assessment Action Plan. Action Plans were due to the IA by March 10, Action Plans were available for PAOP and public comment on March 20, Final IA Approval of the Action Plans was completed by April 30, PPS were required to implement Action Plans by the conclusion of DY3, Q2 (September 30, 2017). PPS updates on progress towards implementing the Action Plans were provided as part of the DY3, Q1 PPS Quarterly Report in July 2017 and will provide final updates as part of the DY3, Q2 PPS Quarterly Report in October 2017.
6 Changes to PPS Reporting 6
7 7 Changes to PPS Reporting During the PAOP meetings in February 2017, PPS noted limitations of the current reporting tool, the PIT, for Funds Flow and Partner Engagement. In response to this feedback, the IA and DOH, created a new tool, the PIT-Replacement to support the reporting of Funds Flow and Partner Engagement. The PIT-Replacement tool provides PPS with more flexibility in identifying and reporting their partners in the category or categories that most accurately reflect how the partner has been engaged by the PPS. The PIT-Replacement also allows PPS to report their 2 nd Tier Funds Flow distributions. The Hospital and Case Management/Health Home categories were broken out in to multiple categories to allow for more discrete reporting of Funds Flow. Additional clarification was also provided on the reporting of Funds Flow to the CBO Partner Type Category. This category should represent only the Tier 1 CBOs that have received funds from the PPS. Tier 2 and Tier 3 CBOs would be reflected under the appropriate partner category, such as Mental Health, Substance Abuse, Clinic, or Case Management.
8 PPS Progress on Action Plans 8
9 9 PPS Progress on Mid-Point Action Plans Funds Flow Through the DY3, Q1 PPS Quarterly Report, PPS have increased the amount of funding distributed to partners relative to the funding distributed at the time of the Mid-Point Assessment. Cumulative Funds Flow at MPA (DY2, Q2) Cumulative Funds Flow at DY3, Q1 Additional Funds Flow since MPA % Change in Funds Flow Total Funds Flow $414,267,236 $878,498,690 $464,231, % Non-Hospital / Non-PPS PMO Funds Flow $113,408,240 $275,487,064 $162,078, % For the categories highlighted in the Mid-Point Assessment, PPS Funds Flow distributions increased by over 100%. Partner Category Cumulative Funds Flow at MPA (DY2, Q2) Cumulative Funds Flow at DY3, Q1 Additional Funds Flow since MPA % Change in Funds Flow Practitioner Primary Care Provider (PCP) $14,659,935 $38,183,032 $23,523, % Mental Health $9,741,485 $27,535,016 $17,793, % Substance Abuse $4,319,963 $10,434,092 $6,114, % Community Based Organizations $11,993,454 $28,005,068 $16,011, %
10 10 PPS Progress on Mid-Point Action Plans Funds Flow As of MPA (DY2, Q2) As of DY3, Q1 Changes since MPA Funds Distributed % of Funds Distributed Funds Distributed % of Funds Distributed Funds Distributed % increase in Funds Disbursed Practitioner Primary Care Provider (PCP) $14,659, % $38,183, % $23,523, % Practitioner Non-Primary Care Provider (PCP) $2,654, % $5,023, % $2,368,557 89% Hospital $ , % $177,988, % $56,212,354 46% Hospital IP/ED^ $0 0.00% $69,180, % $69,180, % Hospital Ambulatory^ $0 0.00% $16,370, % $16,370, % Clinic $29,687, % $78,114, % $48,426, % Case Management / Health Home $5,973, % $14,947, % $8.973, % Case Management^ $0 0.00% $2,540, % $2,540, % Health Home^ $0 0.00% $1,677, % $1,677, % Mental Health $9,741, % $27,535, % $17,793, % Substance Abuse $4,319, % $10,434, % $6,114, % Nursing Home $5,476, % $13,810, % $8,333, % Pharmacy $305, % $1,079, % $773, % Hospice $739, % $2,762, % 2,022, % Community Based Organization $11,993, % $28,005, % $16,011, % All Other $23,297, % $37,994, % $14,696,335 63% Home Care^ $0 0.00% $1,447, % $1,447, % PPS PMO $179,083, % $339,472, % $160,389,252 90% Other* $4,558, % $13,381, % $8,823, % TOTAL All Categories $414,267,236 $878,498,690 $464,231, % * Other category includes Partner Type Categories for Uncategorized, Non-PPS Network, County Agency, CBO Tier 3. ^ Hospital IP/ED, Hospital Ambulatory, Case Management, Health Home, and Home Care categories are new following MPA.
11 11 PPS Progress on Mid-Point Action Plans Standard Modification Funds Flow For the 14 PPS that received the Standard Modification recommendation from PAOP, the overall funding distribution and Non-Hospital/Non-PPS PMO distributions have increased since the Mid- Point Assessment. Cumulative Funds Flow at MPA (DY2, Q2) Cumulative Funds Flow at DY3, Q1 Additional Funds Flow since MPA % Change in Funds Flow Total Funds Flow $264,754,674 $558,296,866 $293,542, % Non-Hospital / Non-PPS PMO Funds Flow $71,559,831 $168,651,395 $97,091, % For the categories specifically highlighted in the Standard Modification recommendation, PPS Funds Flow distributions increased by over 100%. Partner Category Cumulative Funds Flow at MPA (DY2, Q2) Cumulative Funds Flow at DY3, Q1 Additional Funds Flow since MPA % Change in Funds Flow Practitioner Primary Care Provider (PCP) $11,703,793 $30,358,541 $18,654, % Mental Health $6,735,971 $20,610,784 $13,874, % Substance Abuse $2,669,425 $7,258,928 $4,589, % Community Based Organizations $4,283,943 $10,483,800 $6,199, %
12 * Other category includes Partner Type Categories for Uncategorized, Non-PPS Network, County Agency, CBO Tier 3. ^ Hospital IP/ED, Hospital Ambulatory, Case Management, Health Home, and Home Care categories are new following MPA. PPS Progress on Mid-Point Action Plans Standard Modification Funds Flow As of MPA (DY2, Q2) As of DY3, Q1 Changes since MPA Funds Distributed % of Funds Distributed Funds Distributed % of Funds Distributed Funds Distributed % of Funds Distributed 12 Practitioner Primary Care Provider (PCP) $11,703, % $30,358, % $18,654, % Practitioner Non-Primary Care Provider (PCP) $2,136, % $4,385, % $2,248, % Hospital $72,126, % $99,983, % $27,857,717 39% Hospital IP/ED^ $0 0.00% $58,117, % $58,117, % Hospital Ambulatory^ $0 0.00% $11,792, % $11,792, % Clinic $17,886, % $44,245, % $26,359, % Case Management / Health Home $3,462, % $7,015, % $3,553, % Case Management^ $0 0.00% $1,195, % $1,195, % Health Home^ $0 0.00% $622, % $622, % Mental Health $6,735, % $20,610, % $13,874, % Substance Abuse $2,669, % $7,258, % $4,589, % Nursing Home $1,233, % $5,268, % $4,034, % Pharmacy $277, % $902, % $624, % Hospice $563, % $1,316, % $752, % Community Based Organization $4,283, % $10,483, % $6,199, % All Other $18,748, % $28,633, % 9,885,819 53% Home Care^ $0 0.00% $886, % $886, % PPS PMO $121,068, % $219,751, % $98,682,606 82% Other* $1,858, % $5,468, % $3,610, % TOTAL All Categories $264,754,674 $558,296,866 $293,542, %
13 13 PPS Progress on Mid-Point Action Plans Partner Engagement PPS have also made progress in increasing the number of partners engaged across the DSRIP Projects since the Mid-Point Assessment. One PPS saw decreases in the number of engaged partners across multiple categories following the Mid-Point Assessment and has been excluded from these figures to avoid skewing the progress made by the remaining 24 PPS. Partner Commitments at DSRIP Application at MPA as of DY3, Q1 Additional Partners Engaged % Change in 244, , , ,134 88% Partner Engagement is defined as the PPS having a direct relationship with a partner as evidenced by a contract or other formal agreement. The contract or formal agreement should identify the services to be provided by the partner on behalf of the PPS and the compensation from the PPS to the partner. Partner compensation may be financial or through the provision of centralized service such as IT or staffing.
14 14 PPS Progress on Mid-Point Action Plans Partner Engagement Committed (in DSRIP project Plan Application) As of MPA (DY2, Q2) As of DY3, Q1 Changes since MPA % of Committed % of Committed Additional % increase in Practitioner Primary Care 53,417 37,424 70% 58, % 21,417 57% Practitioner Non-Primary Care 106, ,356 95% 198, % 97,440 96% Hospital % % % Clinic 1,709 1, % 2, % % Case Management / Health Home 1,298 1,242 96% 1, % % Mental Health 9,750 9,273 95% 20, % 11, % Substance Abuse 1, % 1, % % Nursing Home 860 1, % 1, % % Pharmacy % % % Hospice % % 37 21% Community Based Organization 2,771 2,064 74% 3, % 1,128 55% All Other 65,942 72, % 138, % 66,753 93% TOTAL All Partners 244, ,601 93% 429, % 201,134 88% *Note: Count of committed and engaged partners does not reflect an unduplicated count. PPS could commit to and engage the same partner across multiple projects.
15 15 PPS Progress on Mid-Point Action Plans Standard Modification Partner Engagement 13 PPS have also made progress in increasing the number of partners engaged across the DSRIP Projects since the Mid-Point Assessment. One PPS saw decreases in the number of engaged partners across multiple categories following the Mid-Point Assessment and has been excluded from these figures to avoid skewing the progress made by the remaining 13 PPS. Partner Commitments at DSRIP Application at MPA (DY2, Q2) as of DY3, Q1 Additional Partners Engaged % Change in Partners Engaged 164, , , ,348 71% For the categories specifically highlighted in the Standard Modification recommendation, PPS partner engagement increased for those 13 PPS. Partner Commitments at DSRIP Application at MPA (DY2, Q2) as of DY3, Q1 Additional Partners Engaged % Change in Partners Engaged Practitioner Primary Care 35,383 23,613 31,728 8,115 34% Mental Health 6,238 6,145 14,420 8, % Substance Abuse % Community Based Organizations 1, %
16 16 PPS Progress on Mid-Point Action Plans Standard Modification Partner Engagement Committed (in DSRIP project Plan Application) As of MPA (DY2, Q2) As of DY3, Q1 Changes since MPA % of Committed % of Committed Additional % increase in Practitioner Primary Care 35,383 23,613 67% 31,728 90% 8,115 34% Practitioner Non-Primary Care 74,035 70,819 96% 116, % 45,622 64% Hospital % % 87 19% Clinic 998 1, % 1, % % Case Management / Health Home % 1, % % Mental Health 6,238 6,145 99% 14, % 8, % Substance Abuse % % % Nursing Home % % % Pharmacy % % % Hospice % % 24 21% Community Based Organization 1, % % % All Other 42,757 43, % 85, % 41,786 97% TOTAL All Partners 164, , % 253, % 105,348 71% *Note: Count of committed and engaged partners does not reflect an unduplicated count. PPS could commit to and engage the same partner across multiple projects.
17 Next Steps 17
18 18 Next Steps PPS are expected to submit second Mid-Point Action Plan updates to the IA by October 31, The IA will provide updated figures relative to Funds Flow and Partner Engagement progress at the November 16, 2017 PAOP Working Session and MRT Public Comment Day. The presentation will reflect updated Funds Flow and Partner Engagement statistics through the end of DY3, Q2.
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This is only a summary If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at wwwmvphealthcarecom or by calling 1-888-687-6277 Important
Blue Cross Blue Shield of Louisiana: BlueConnect POS Plan 2 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsla.com or by calling 1-800-599-2583. Important Questions
Anthem Blue Cross Your Plan: Custom Classic HMO 20/250 Admit (Rx $15/$30/$45/$45) Your Network: Select HMO
Anthem Blue Cross Your Plan: Custom Classic HMO 20/250 Admit (Rx $15/$30/$45/$45) Your Network: Select HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Single/Family
This is only a summary If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at wwwmvphealthcarecom or by calling 1-888-687-6277 Important
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/ca or by calling 1-855-333-5730. Important
Anthem Blue Cross Your Plan: Anthem Elements Choice HMO 1500 (Essential Formulary $5/$20/$50/$65/30% $500 Deductible) Your Network: Select HMO
Anthem Blue Cross Your Plan: Anthem Elements Choice HMO 1500 (Essential Formulary $5/$20/$50/$65/30% $500 Deductible) Your Network: Select HMO This summary of benefits is a brief outline of coverage, designed
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com or by calling 1-800-421-1880. Important Questions
County of Cuyahoga: MMO SuperMed EPO
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.medmutual.com/sbc or by calling 1-800-540-2583. Important
Anthem Blue Cross Your Plan: Modified Value HMO 30/40/30% Your Network: California Care HMO
Anthem Blue Cross Your Plan: Modified Value HMO 30/40/30% Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This
The Harvard Pilgrim PPO Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts
Massachusetts The Harvard Pilgrim PPO Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts Coverage Period: 01/01/2017 12/31/2017 Coverage for: Individual + Family Plan Type: PPO This is only
Implementing the DSRIP Finance Function
Implementing the DSRIP Finance Function DSRIP Support Team February 27, 2015 February 2015 2 Contents Developing the DSRIP Finance Function Defining The Vision Responsibilities/Structural Considerations
$5,000 Individual/ $10,000 Family. Important Questions Answers Why this Matters: What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.cvtrust.org or by calling 1-800-288-9870. Important Questions
Western Health Advantage: WHA Platinum 90 HMO 0/20 w/child Dental. Coverage Period: 1/1/ /31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.westernhealth.com or by calling 1-888-563-2250. Important
Massachusetts. Coverage Period: 03/01/ /31/2015 Coverage for: Individual + Family Plan Type: HMO
Massachusetts The Harvard Pilgrim Best Buy HMO Summary of Benefits and Coverage: WhatthisPlanCovers&WhatitCosts Coverage Period: 03/01/2015 12/31/2015 Coverage for: Individual + Family Plan Type: HMO This
Anthem Blue Cross Your Plan: Custom Premier HMO 25/100% (Custom $5/$20/$30/$50/30%) Your Network: Select HMO
Anthem Blue Cross Your Plan: Custom Premier HMO 25/100% (Custom $5/$20/$30/$50/30%) Your Network: Select HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection
Blue Cross Blue Shield of Louisiana: Blue Max 2500 Maternity Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsla.com or by calling 1-800-599-2583. Important Questions
Important Questions Answers Why this Matters:
Anthem BlueCross Value HMO 20/30/20% Select Plus HMO / $10/$30/$45/20% Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2014-12/31/2014 Coverage For: Individual/Family
You can see the specialist you choose without permission from this plan.
Calvert County Public Schools HMO Open Access Coverage Period: 07/01/2016-06/30/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type: HMO This
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.summacare.com or by calling 1-800-996-8701. Important
The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits.
The Harvard Pilgrim Core Coverage HMO Massachusetts Coverage Period: 01/01/2017 12/31/2017 Coverage for: Individual + Family Plan Type: HMO This is only a summary. If you want more detail about your coverage
Your cost if you use an Limitations & Exceptions. Common Medical Event. Services You May Need
Questions: If you are a member please call the number on your ID card or by logging into My Account. Otherwise, please call 1-800-628-8549. If you aren t clear about any of the underlined terms used in
The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits.
The Harvard Pilgrim Best Buy HMO Massachusetts Coverage Period: 01/01/2017 12/31/2017 Coverage for: Individual + Family Plan Type: HMO This is only a summary. If you want more detail about your coverage
The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits.
The Harvard Pilgrim Best Buy HMO Summary of Benefits and Coverage: What this Plan Covers & What it Costs Massachusetts Coverage Period: 01/01/2017 12/31/2017 Coverage for: Individual + Family Plan Type:
Total Health Care USA, Inc.: Total Saver Complete Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.thcmi.com or by calling 1-800-826-2862 Important Questions
Auxiliary Organizations Association
Auxiliary Organizations Association Your Plan: Modified Premier HMO 20/200 admit/100 OP (Modified RX $5/$20/$60/20%) Your Network: California Care HMO This summary of benefits is a brief outline of coverage,
Employee Assistance Program (EAP) counseling is provided at no cost to the employee, spouse or dependents.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-906-225.3145. Important Questions Answers Why this
(30- to 34-day supply) 100% after $40 copay; significant or new therapeutic class drugs: 50%
C O U N T Y S I N T R A N E T S I T E : H T T P : / / I N T R A N E T. C O. R I V E R S I D E. C A. U S 25 Exclusive Care Select Medicare Coordination Plan Tier 1: Exclusive Care Network Tier 2: Any Provider
Looking Upwards Value PPO Coverage Period: 04/01/ /31/2017
Important Questions What is the overall deductible? This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling
$ 400 person/ $1,200 family; Waived for inpatient and outpatient hospital charges at Centers of Excellence and Hospitals of Distinction.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.mbpet.net or by calling 1-888-742-3380. Important Questions
You don t have to meet deductibles for specific services, but see the chart starting on page 2 for other costs for services this plan covers.
Massachusetts The Harvard Pilgrim HMO Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2017 12/31/2017 Coverage for: Individual + Family Plan Type: HMO This
Choice Plus Health Savings Plan Discount Tire/America s Tire/Discount Tire Direct
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.myuhc.com or by calling 1-855-837-1612. Important Questions
Network Providers. deductible?
Hoosier Heartland School Trust: Plan 1 Blue Access (PPO) Coverage Period: 1/01/2017-08/31/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family Plan
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com or by calling 1-888-650-4047. Important Questions
RHP 9, 10 & 18 Learning Collaborative. Ardas Khalsa Deputy Medicaid CHIP Director Texas Health and Human Services Commission February 22, 2017
RHP 9, 10 & 18 Learning Collaborative Ardas Khalsa Deputy Medicaid CHIP Director Texas Health and Human Services Commission February 22, 2017 October DY5 Reporting Results In total for October reporting,
You must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.avmed.org or by calling 1-800-477-8768. Important Questions
National Guardian Life Insurance Company: Maine College of Art Student Health Insurance Plan Coverage Period: 09/01/ /31/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.
Encompass A. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.independenthealth.com. or by calling 1-800-501-3439.