January 2019 Executive Director Report

Transcription

1 January 2019 Executive Director Report Date: January To: From: HealthierHere Governing Board Susan McLaughlin Dear Governing Board Members: Happy New Year! I hope that you all had a wonderful and restful holiday season. I look forward to our work together in Thank you for your continued dedication and commitment to HealthierHere and our transformation efforts. As the January 11 th ViaDOOM date quickly approaches, HealthierHere is working on identifying options for board and committee meetings as well as our partner organization meetings that doesn t involve travel into downtown. We are also adjusting times to reduce the need to travel during peak commuting times. We will keep all calendaring as up to date as possible and over-communicate any changes. You should always be able to reach us by phone and . Below are some highlights from the past month. We have also been working on updating and finalizing all of our 2019 vendor contracts and completing our very first employee performance reviews. Additionally, staff have been working hard on getting ready to launch our work as our committees refine their recommendations for an investment strategy will be an exciting year for our region as all of our design and planning work actually begins to be operationalized. I am honored to be on this journey with all of you. Warmly, Susan 1. Implementation Plan Results Are In On December 14, 2018 HealthierHere received a letter from Myers & Stauffer, the Independent Assessor for the Medicaid Transformation Project, indicating that HealthierHere received a 4/4 on our Implementation Plan. This earns us an additional $6 Million in incentive funding. The incentive funds will be distributed in Quarter 2, Kudos to HealthierHere staff and our partners that helped prepare the Implementation Plan, especially Manatt who provided support to us. Page 1 of 3

2 2. SAR 2 Our Next Deliverable to HCA Our next Pay-for-Reporting deliverable due the Health Care Authority is the 2 nd Semi-Annual Report (SAR 2). SAR 2 covers the reporting period July 1, 2018 thru December 31, 2018 and is due by 3:00 PM on January 31, The Semi-Annual Reports are a retrospective reporting of our accomplishments and progress on implementation of the Medicaid Transformation Project. We will be completing them twice a year and they will be the main source of valuation for our Pay-for- Reporting incentives. SAR 2 does not require board approval. However, we will be sure to send out the final SAR 2 report to Governing Board members when it is complete. 3. Hiring Community and Tribal Engagement Manager: HealthierHere is finishing up the process for hiring a Tribal Engagement Manager. We received many outstanding applications from talented candidates. Marya and team are completing first interviews with the top candidates and final interviews will be done by the end of the month. We hope to have our new Tribal Engagement Manager on board by mid-february. 4. DASH Mentorship Award HealthierHere is pleased to announce that we have been selected to participate in the Data Across Sectors for Health (DASH) Mentor Program. The DASH Mentor Program is a national program of the Robert Wood Johnson Foundation, and includes a 10-month mentorship to advance our local efforts to share and use multi-sector data to improve community health. Our mentorship cohort will be led by HealthInfoNet, with a focus on strategies for integrating social determinants of health data with clinical data. Specific topics of work will include investigating existing technical capacity, assessing current resources, and exploring how multi-sector data can be used in day-to-day workflows. HealthierHere will make meaningful connections with leaders in the field to accelerate learning and making significant progress towards aligning multi-sector partners around data-driven approaches that promote health equity. 5. Partner Organizations Learn About the Value of Client Registries On Dec. 5, HealthierHere hosted its second partner learning webinar: Empanelment and Registries a Population Health Perspective. Presented by Jeff Hummel, MD, MPH, Medical Director of Healthcare Analytics at Qualis Health, and Michelle Glatt, PA-C, MPH, Vice President of Population Health at HealthPoint, the lunch-time webinar covered the basics of defining a patient population and identifying those at highest risk. Dr. Hummel created sample case studies, presenting a mix of primary care and behavioral health examples. Population health management is a key component of Medicaid Transformation, and HealthierHere was pleased to make this webinar available to organizations and providers throughout the county. Fifty-five people attended, representing a mix of BHAs, FQHCs, hospitals, and other organizations. Page 2 of 3

3 Participants offered positive feedback in a follow-up survey, noting that the presenters were extremely knowledgeable, and the webinar contained very clear explanations of the value of a patient registry. Partner Webinars will be held quarterly to support all of our partners through their transformation efforts. 6. Community Partner Engagement Continues HealthierHere completed all our scheduled Community Partner Information Sessions in We followed up with a Community Information Form Questionnaire to be completed by any community-based and social service organizations that are interested in potentially partnering with HealthierHere in our transformation efforts. To date, we ve had over 75 community partners respond with a completed form. The deadline for this first engagement opportunity is January 11, The Governing Board will receive a more detailed update on our community partner engagement strategy and accomplishments at the February board meeting. Page 3 of 3

4 Committee members who participated in the Joint IPT meetings Participating Committees 1 st Joint IPT Meeting 2 nd Joint IPT Meeting Community/Consumer Voice 8/16 (50%) 9/16 (56%) Finance 6/9 (67%) 8/9 (89%) Performance Measurement 7/7 (100%) 4/7 (57%) Transformation 13/19 (68%) 10/19 (53%) Total Participants 34 31

5 HealthierHere Governing Board Meeting January 10, 2019 Seattle Foundation

6 Governing Board Meeting January 10,

7 Discussion Overview Update and Thought Partnership Community Partner Information Session Summary Update on what we did, who participated, how it went and what we learned Community Partner Engagement Strategy Next Steps Overview of where we are and what will occur in the next 90 days Community Partner Selection Criteria Thoughts and ideas related to who will be invited to partner with HealthierHere and for what purpose 2

8 Community Partner Selection Engagement Strategy Activity Share information about HealthierHere Cast the Net Completed November 16, 2018 Identify interested Community Partners In-Process Finance Committee Recommends Community Partner Payment Deliverables to Governing Board Completed October 4, 2018 Invite potential Community Partners to complete Assessment Potential Portfolio Impact + Readiness - Pending Invite potential Community Partners best positioned to impact Portfolio success to complete an Innovation Plan - Pending Select Community Practice and Innovation Partners & Negotiate Project Specific Agreements - Pending Community Partner funds distribution - Pending 3

9 Community Engagement Strategy Phase 1 Casting the Net Community Partner Information Sessions - Outreach Purpose: Share information about HH work, connect, learn How we reached out: All HealthierHere Networks/Lists; CCV; Coalitions; Governing Board; Clinical Partners; HealthierHere Staff; HealthierHere Newsletters and Blog Posts; etc. Conducted a total of 9 in-person sessions and 2 webinars between September 18 th and November 16, 2018 Guiding Principles: (1) Intentionality; (2) Meet people where they are; (3) Geographic diversity; (4) Use available data; and, (5) Earn invitations to additional tables Locations: Kent, Downtown Seattle, Bellevue, Federal Way, Des Moines, Burien, Rainier Beach, Shoreline included an evening session Additional presentations King County Alliance for Human Services, South King County Health Equity Coalition, North Urban Human Services Alliance, Neighborhood House, Catholic Community Services, Youth Eastside Services 4

10 Information Session Participation Total number of Community Partner Information Session Participants 208 Total Participants: 152 in-person; 56 webinar; does not include individual presentations 154 Total Organizations Types of Organizations Traditional CBOs; Coalitions; Youth Services; Senior Services; Faith-based; Various Sizes Clinical Partners: BHAs; Medical Centers Institutions: Government; Higher Education Private: Telehealth; Vendors; Legal Assistance Various Organizational Sizes and Populations Served 5

11 Information Session Observations Alignment with Governing Board Success Indicator Infrastructure for meaningful community/consumer involvement/voice in continuous delivery system improvement Multiple attendees from same organization People attended multiple sessions Connections and information sharing Various levels of previous involvement with HealthierHere Questions and clarity Appreciation and spirit of partnership 6

12 Moving to Phase 2 Community Partner Interest Form Community Partner Engagement/Selection Phase 2 Identify who is providing SDoH community supports: what, where, for whom Gauge interest in community partnership with HealthierHere Identify alignment in mission, vision, values and purpose Community Partner Interest Form Straightforward 33 question survey Provides additional information about HealthierHere and the MTP Project Portfolio Allows potential Community Partner to determine best fit 7

13 Community Partner Interest Form Process Dec. 5th - Invitations to submit the Community Partner Interest Form Who was invited: Information Session Attendees/Participants; CCV network; Small Grants Recipients; CSA responses re: current partnerships; Those who previously expressed an interest in Community Partnership with HealthierHere (2017 survey, design teams, work groups, partner summit attendees); and ANYONE else multiple HealthierHere Blog postings and Newsletters Time period for submission Dec. 5 th Jan. 11 th Multiple reminders to complete the form and/or send the form to anyone who might be interested 8

14 Community Partner Interest Form Preliminary Information 88 responses currently Open until 5 pm, January 11 th Over 40% self-identify as serving people who experience high rates of health disparities Over 60% self-identify as serving more that 1,001 people annually Over 50% self-identify as serving more that 75% Medicaid eligible clients Over 75% self-identify as registered 501(c)(3) Organizations Over 30% of Respondents had no previous involvement with HealthierHere Completing the survey took less than one hour for all but 7 Respondents ( less than 30 minutes for 50% of the Respondents) 9

15 Potential Community Partner Selection Criteria Engagement with the CCV, Transformation Committee and Finance Committee Community Partner Assessment designed to gather information about capacity and readiness in the following areas: Medicaid Volume Address Health Disparities Staff Capacity Balance long-term vs. emerging Organizations Technology Capacity Ability to advance portfolio metrics Number of People Served Address Priority SDoHs Sustainability Geographic Area Promote or Provide Health related services Commitment to advancing equity 10

16 Next Steps Review Community Partner Interest Forms Submitted Alignment with HealthierHere overall and Medicaid Transformation Project work Identify preliminary best fit opportunities for Community Partnership Innovation Partner Pool (includes Practice Partners) Information Partner Pool Multiple opportunities for partnership CCV; HealthierHere Work Groups, Committees, etc.; Thought Partnership Review and recommendations anticipated completion date Jan. 31st Phase 3 Community Partner Assessment Potential Innovation/Practice Partners will be invited to complete a Community Partner Assessment Assessment will help determine potential Community Partner capacity and readiness for partnership with HealthierHere 11

17 Investment Prioritization and Strategies Update to the Governing Board January 10,

18 Meeting Goals Achieve consensus on and excitement about our 2019 Investment Priorities: Follow the investment options as they move through the investment prioritization tool (the IPT). See how well the final results reflect HealthierHere s principles, values, goals, constraints, and our opportunity for transformation. Reflect on the prioritized list of investments and build consensus to advance 2019 recommendations to our Governing Board. 2

19 A Shared Stewardship HealthierHere Governing Board Executive Committee Community and Consumer Voice Committee Finance Committee Performance Measurement and Data Committee Transformation Committee 3

20 Building an Investment Strategy Individual Organizations System Level Traditional Medicaid Community CBOs & Tribes 4

21 Scope of Current Investment Discussion HealthierHere Governing Board has already provided guidance on use categories; Partner Organization Incentives = 63%. This is further allocated between Medicaid (50%), Non-Medicaid (42%) and Tribes (8%) provider types System Investments including Population Health & Workforce = 15% This is further allocated between Medicaid, Non-Medicaid and Tribes The remaining 22% of the budget allocation is NOT a part of the IPT process. These dollars are designated for Reserve, Equity & Wellness Fund and HealthierHere Administrative budget. 5

22 A Disciplined Process to Focus Investment Decisions 12/4/18 12/17/18 Investment Input List Investment Prioritization Tool Scoring & Review Cost/Budget Analysis 2019 Investment Budgets 6

23 Results of Investment Prioritization Process 7

24 Investment Input List Themes Organization Specific Resources Other - infrastructure/ system gaps System Level Investments HealthierHere Investment Input List Innovation Fund 8

25 Investment Prioritization Tool (IPT) Investment Input List Gated Model Supports systematic and fair decision-making Delivers a list of prioritized investment options Supports transparency in the Committee Review process (today!) Investments Scored Against HealthierHere Values Investments Scored for P4P Impact Investments Ranked Committee Review 9

26 Aggregate Final Scores: Balancing Values and P4P Value and P4P scores are weighted and aggregated to create a Total Score for each investment option 60% HealthierHere P4P 40% Contribution Values 10

27 The IPT Gated Model All 23 Investment Options are evaluated against HealthierHere Values Investments above the 50 th percentile on Values advance to P4P evaluation Values and P4P are weighted, aggregated, then prioritized 11

28 First Gate: Performance on HealthierHere Values H I G H M E D I U M Equitable Innovative Viable Systemic Leveraging Sustainable Addresses the areas of greatest need, health disparities, and underinvestment as determined by authentic community engagement. Extent to which investments support innovation (e.g. is a novel approach) Greater likelihood that the proposed activity will deliver intended results (during waiver). Supports the development of solutions that align w/system-wide needs. Leverages available resources in order to build momentum for scaling. Extent to which investments are sustainable 12

29 Values Performance: The Top 12 (alphabet order) Clinical Best Practices Training & TA Non-licensed Direct Care Staffing Regional Community Information Exchange (CIE) Create a Mechanism for Shared Care Planning Population Health Management Training & TA Standardized Social Determinants of Health (SDOH) Screening EHR Optimization Pre-Manage Implementation and Optimization Support for Partner-Driven Innovations Integrating Data Use into Clinical Workflows Quality Improvement Training & TA System-Level Data Integration and Analytics 13

30 Values Performance Takeaways The 12 investments performed above the 50 th percentile against the Values (Equitable, Systemic, Viable, Innovative and Sustainable). Collectively they: Promote system(s) and tools for providers to enhance care delivery through population health management, improved workflows, etc. Provide data to ensure data driven decisions Support sharing of data between partners and sectors Address provider training and technical assistance (TA) needs Advance tools to support Social Determinants of Health (SDOH) work and promote equity 14

31 Second Gate: Performance on P4P Investments that advance through the Values Gate are scored for P4P: 19 P4P Metrics Score based on likely ability to impact metric during MTP timeline Metrics weighted based on their potential for DSRIP revenue Hospital / ED All-cause ED visit rate Acute hospital utilization Follow up ED visit for chemical dependency Follow-up ED visit for mental illness Follow-up hospitalization for mental illness All-cause hospital readmission rate Behavioral Health Mental health treatment penetration Antidepressant medication management SUD treatment penetration SUD treatment penetration - opioid use disorder Chronic Disease Diabetes care: Eye exam Diabetes care: Hemoglobin A1c testing Diabetes care: Kidney screening Asthma medication management Statin therapy for heart disease Opioid Patients on high-dose chronic opioid therapy Patients with concurrent opioids & sedatives prescriptions Other Child and adolescent access to primary care Percent homeless 15

32 Key Themes Evaluation of P4P was more challenging given lack of causal relationship between strategies and measures Impact on metrics is dependent on how fast we can implement Some investments performed relatively well against three groups of metrics: Hospital/ED, BH and Chronic Disease Some of the infrastructure investments are believed to be necessary and foundational to help provider organizations achieve improvement on the metrics We may need specific innovations that target particular metrics in order to achieve our goals 16

33 The Finalists: Ranked by Overall Performance 1 Integrating Data Use into Clinical Workflows 5 Pre-Manage Implementation and Optimization 9 Quality Improvement Training & TA 2 Non-licensed Direct Care Staffing 6 Standardized Social Determinants of Health (SDOH) Screening 10 EHR Optimization 3 Create a Mechanism for Shared Care Planning 7 System-level Data Integration & Analytics 11 Clinical Best Practices Training & TA 4 Population Health Management Training & TA 8 Support for Partner-Driven Innovations 12 Regional Community Information Exchange (CIE) 17

34 Next Steps 18

35 Investment Prioritization & Strategies Next Steps 3 rd Investment Strategy Meeting January 16 th The Finance Committee will review the Ranked Investment List against: Cost/Timing Available revenue: Based on DY1 and DY2 DSRIP earnings Budget allocations between provider types and uses Cash Flow Committees will jointly make 2019 investment recommendation to the Governing Board Investment Input List Investments Scored Against HealthierHere Values Investments Scored for P4P Impact Investments Ranked Committee Review 19

36 Timeline for Developing 2019 Investments Budget DECEMBER JANUARY FEBRUARY MARCH APRIL MAY 12/4 Committees Overview of process, prioritization tool and Investment Input List 1/10 Gov. Board Update on process Preview 5-Yr Budget 2/7 Gov. Board Reviews 2019 Investments Budget 3/7 Gov. Board Approves 2019 Investments Budget Wave of 2019 Funding is Released 12/6 Gov. Board Update on process Investments Scored by Prioritization Tool & Rank Ordered Establish Cut-off & Develop 2019 Investments Budget Develop Contracts with Practice Partners 12/17 Committees Review rank order Investment Input List Provide feedback and finalize 1/16 Committees If needed, finalize rank order recommendation 20

37 Update on Projected Revenue and Cash Flow 1

38 Previous MTP Funding Projection: $139M Project Incentive Budget ($117M) Design Fund ($6M) Received All for Certification FIMC Mid-adopter & VBP Incentive ($16M) $14M Mid-adopter incentives Received $5.9M and distributed or have plan for distribution $2M VBP incentives 2

39 Approved Project Incentive Budget & Assumptions (From November 2017 Project Application) The model approved in NUMBER OF PROJECTS 4 PROJECT PLAN SCORE 100% AVERAGE P4R ACHIEVEMENT VALUE 90% AVERAGE P4P ACHIEVEMENT VALUE 70% DY DY DY DY DY year total Project Management and Administration 15% % % % % % Project Costs Project Engagement, Participation and Implementation 55% % % % % % Provider Performance and Quality Incentive Payments 0% % % % % % % % % % % % Domain 1 Financial Stability Through VBP 0% % % % % % 1.86 Population Health Management 20% % % % % % 8.79 Workforce 5% % % % % % % % % % % % ACH-defined Social Equity and Wellness Fund 0% % % % % % 6.92 Reserve (not to exceed $XXX) 5% % % % % % % % % % % % 9.97 October 2017 was based on a maximum of $191M in project incentives available HealthierHere then assumed 27% budget reduction in available revenue (up to amount) each year due to State $300M shortfall HealthierHere assumed a valuation rate of 90% for P4R and 70% for P4P dollars in millions 100% % % % % % Board Approved Project Incentive Budget: $117M 3

40 Changes since October 2017 From the State: Required minimum number of projects reduced from 6 to 4 Intergovernmental Transfer (IGT) strategy announced to help offset some of the $300M shortfall as a result of CMS s interpretation Helps account for State budget shortfall by creating a funding mechanism that uses intergovernmental transfers to draw down matching federal funds (i.e., Shared Domain 1 Incentives) From HealthierHere: Update assumptions for Pay for Reporting (P4R) Update assumptions for Pay for Performance (P4P) 4

41 Updated Assumptions for Pay for Performance (P4P): Original estimate for P4P was an average across metrics and projects of 70% HealthierHere worked with Chief Medical Officer and Transformation Committee members to establish estimates for success on each metric: Analyzed each metric based on likelihood for improvement during the waiver period which is informed by the current performance, co-occurring projects within the region (i.e., Hospital Readmission), and gap to goal Took a conservative approach in budgeting IMPACT: Lowered the overall average P4P estimate from 70% to 33%: HealthierHere will conduct an annual review of metric performance and overall assumptions and refine future budget estimates based on our performance 5

42 Results of Waiver Financing Changes and Assumptions HealthierHere s Project Incentives Budget decreases from $117M to $97M: Impact: State changes decrease a total of $18M as a result of the change for IGT financing mechanism and reduced the number of required projects Impact: HealthierHere changes decrease of $2M for increasing P4R and decreasing P4P assumptions 6

43 Revised Project Incentive Budget: $97M DY DY DY DY DY year total Project Management and Administration 15% % % % % % Project Costs Project Engagement, Participation and Implementation 55% % % % % % Provider Performance and Quality Incentive Payments 0% % % % % % % % % % % % Administration 0% % % % % % 0.00 Domain 1 Financial Stability Through VBP 0% % % % % % 0.81 Population Health Management 20% % % % % % 8.79 Workforce 5% % % % % % % % % % % % ACH-defined Social Equity and Wellness Fund 0% % % % % % 4.68 Reserve 5% % % % % % % % % % % % 7.69 The model assumes a maximum of $113M in project incentives available (excludes Shared Domain 1 Incentives) HealthierHere assumes 100% P4R and 33% P4P Revised Project Incentive Budget: $97M 100% % % % % % Average P4R N/A 100% 100% 100% 100% 100% Average P4P N/A N/A 29% 33% 35% 33% Project Plan Score 100% Note: Dollars in millions 7

44 Updated MTP Funding Projection : $119M Project Incentives ($97M) Design Fund ($6M) FIMC Mid-adopter & VBP Incentive ($16M) $14M Mid-adopter incentives $2M VBP incentives Result: A decrease of $20M in HealthierHere s overall MTP funding projection 8

45 Updated MTP Funding Projection by Year: $119M (when we earn it) 9

46 Updated MTP Funding Projection Cash Flow (When we will get it) 10

47 Next Steps Complete analysis and recommendation on 2019 Investment Strategies Finance Committee will submit a joint committee recommendation for an investment strategy and an accompanying budget allocation request to Governing Board for approval. Target Date March

48 New York Performing Provider Systems (PPS) Lessons Learned January 10,

49 The HealthierHere Team Susan McLaughlin, Executive Director HealthierHere Gena Morgan, Chief Operating Officer HealthierHere Thuy Hua-Ly, Chief Financial Officer HealthierHere Michael McKee, Director of Clinical Practice Transformation HealthierHere Marya Gingrey, Director of Equity & Community Partnerships HealthierHere Esther Lucero, Chief Executive Officer Seattle Indian Health Board Elise Chayet, Director of External & Community Partnerships Harborview Medical Center Hiroshi Nakano, Director of Value Based Care Valley Medical Center Jihan Rashid, Program Coordinator Somali Health Board Kat Latet, Director of Health System Innovation Community Health Plan of Washington Caitlin Safford, Director of Government Relations Anthem, Inc. 2

50 The New York Waiver Signed in April 2014 (the NY waiver is in the final quarter of year 4) NY had a year zero for planning DSRIP Year 5 begins April 1, 2019 $8 Billion over the 5 years 25 Performing Provider Systems (PPS) statewide RFP process to decide Multiple PPSs can be in a region Most PPSs are hospital-based entities (each has an anchor public hospital with a network of partner providers 2 are FQHC based) 3

51 Who we visited Community Care of Brooklyn (CCB) - Maimonides Hospital Bronx Partners for Healthy Communities St Barnabas Hospital/Health System Center for Regional Healthcare Innovation - Westchester Medical Center Staten Island PPS 4

52 Keys to Success Lessons Learned from New York 5

53 A thoughtful staging and phasing of strategies Most PPSs implement in WAVES Started with a focus on Patient Centered Medical Homes for primary care providers Moved to hospitals and care transitions, Behavioral health and community based organizations and addressing social determinants were added much closer to the end More manageable for all and allowed space to move work forward without overpromising Allowed for a clearer understanding of what was needed from partners and where they fit in meeting overall goals Allowed for different expectations for different sectors based on their readiness 6

54 Access to the right data at the right time Start by building on the data and systems that are already in place NY has both a statewide HIE as well as Regional Health Information Organizations (RHIO) But it is an opt-in state Created a community/provider discussion around data many of those conversations started before the waiver Those PPSs with the most success were able to provide sophisticated data analytics to providers to help them understand who their patients were with a more holistic view Much of Staten Island s success came from the ability to do predictive analytics, hot-spotting and geomapping to drive programs and interventions Most of the PPS set up proxy measures to help providers set up the right infrastructure to figure out how to better perform on measures PPS helped mine data and create chase lists for the providers to close gaps 7

55 Workforce development is foundational Workforce Development was a significant part of the NY DSRIP (driven by labor involvement) Example: Bronx Partners ~10% of earnings ($12.3M); offered 684 different courses and trained around 70,000 people across PPS Worked with local infrastructure to develop curriculum, career paths, standardization of positions, etc. Example: local colleges to accredit MAs to become Health Coaches Created a 6-month course for CBOs on Evaluation and Value Proposition Helped BHAs with practical pain points coding, billing, registries, etc. 8

56 Involve the payers early and often MCOs were not part of the planning or implementation process until the very end PPSs expressed dissatisfaction with this and are now scrambling to develop partnerships with MCOs DSRIP shifting role of the MCOs and moving some functions to providers (i.e., care coordination; Utilization Management) MCOs in NY not ready or confident that providers could perform 9

57 Leverage other local initiatives Many of the PPSs and their partners had come together for other collaborations prior to the waiver PPS really leveraged Health Homes as part of their DSRIP work Many had Health Homes At-Risk Projects Care Transitions Projects were connected to Health Homes Emphasized importance of understanding current environment and local needs around system change and building off of that Emphasized the importance of shared learning and convening of partners together who historically did not interact with each other 10

58 Maintain flexibility and be nimble Develop an innovation fund to do quick tests of change/rapid cycle Not every good idea works, be willing to take risks Be nimble enough so that if something is not working, course corrections can be made and/or resources can be added or moved to get better results 11

59 Start Community and CBO Engagement Early NY Waiver had unique requirements around CBOs predefined 3 tiers of CBOs and restricted how resources could be used Most PPSs had very little direct community engagement with individuals covered by Medicaid CBOs were generally one of the last waves of investment and the PPSs expressed a desire to have spent more time developing relationships with CBOs from the beginning Wished they had been able to invest more time and resources into capacity building for CBOs Trying to support community based providers to develop their capacity in demonstrating their value to more traditional medical providers as well as test innovations and partnerships to see what is sustainable Used Participatory Action Research done by MIT funded thru PPS had HS kids gather data in community around needs and college students analyze data and share out in a report 12

60 Sustainability Observed a lack of focus or plan for sustainability of practice transformation activities Most sustainability planning is focused on sustainability of the PPS Most PPSs are considering the development of an IPA like structure post DSRIP However, some of the PPSs are working to define their role further, see themselves as a Central Services Organization (CSO) keeping these key words in mind: broker, catalyst, facilitator to build and maintain relationships between sectors; providing ongoing education and support Maimonides (Brooklyn) also formed a separate for SDOH organizations Bringing payers in early, often and clarifying the value or ROI of some of the innovations to the payers needed to happen much earlier Build sustainability planning of strategies from the onset versus an after thought 13

61 Ideas for next steps Convene 5 MCOs with some MOU for involvement in the strategies Care Coordination landscape analysis Be mindful of healthcare trends and where the future is going impact of baby boomers vs impact of younger generations will use healthcare very differently Providers are in different places, recognize and meet them where they are 14