Thursday February 8, 2018

 

7:00 - 7:45 a.m.

Yoga


7:30 - 8:30 a.m.

Breakfast


8:30 - 9:45 a.m.

Breakout Session D

D1

Oregon’s health reform efforts have centered on redesigning its clinical delivery system to improve outcomes and lower costs. A cornerstone of this effort was the establishment of Coordinated Care Organizations, which are partnerships between local health delivery systems and community organizations. This session will explore Oregon’s progress to date, with particular attention to lessons learned from both Oregon and others around the country.

Learning Objectives

  • Become Familiar with Oregon’s efforts at health reform and the establishment of coordinated care organizations
  • Understand lessons learned from Oregon’s efforts at health system redesign
  • Understand the elements for successful partnerships between health and community based organizations
  • Understand how to overcome challenges and obstacles in health and community organization partnerships
  • Become familiar with examples from around the country of successful health and community based organization partnerships

Presenter

Bruce Goldberg, MD, Senior Fellow, Center for Health Systems Effectiveness Senior Associate Director, Oregon Rural Practice Based Research Network


D2

When “Upstream” Meets “Front Line:” Connecting the Dots with "Care Alerts”

Facilitator: Amy Boutwell, MD, MPP, Collaborative Healthcare Strategies

A transformed delivery system effectively manages care over time and across settings. To do so, relevant, actionable information needs to be available to the next provider of care, at the point of care. Learn how “Care Alerts” promote high quality, consistent care and smarter, more effective response systems for patients with combined medical, behavioral, and social needs. Who needs a “care alert?’ What is in a “care alert?” Who writes a “care alert?” How does it help? How do we get started? This topic is relevant to those seeking to achieve DSRIP goals at the state, regional, PPS, and local levels.

Facilitator

Amy Boutwell, MD, MPP, Collaborative Healthcare Strategies

Presenters

TBD


D3

Driving Improvement: Data Analytics, Process Improvement and Incentive-Based Payments

Presenters: Christopher Ray, Meredith Stanford, Suffolk Care Collaborative and Bronx Partners for Healthy Communities

This session pairs two innovative approaches to achieving better outcomes through combining process improvement, data analytics, and pay for performance strategies. Suffolk Care Collaborative’s (SCC’s) incentivizes better performance in the health care delivery system by leveraging state-provided data sources, unique visualization methods such as heat maps, and employing a “Gap-to-max” concept with corrective actions plans. They will share their approach and their use of an attribution algorithm to develop an incentive-based payment model to support providers’ transition to value-based care. Bronx Partners for Healthy Communities (BPHC) designed an incentive-based funds flow strategy to improve performance in thirteen MY4 DSRIP measures that had weak MY2 performance. During this session they will detail their two-phase contracting strategy: Pay for Reporting (P4R) and Pay for “Proxy” (P4X). In P4R, ambulatory care partners receive funds in exchange for submitting baseline reports on measures. P4X enables partners to receive added payments for improving real-time “Proxy” performance in six months relative to P4R baseline.

Learning Objectives

  • Understand performance management strategies using retrospective performance data to identify improvement opportunities and create actionable plans for partners
  • Describe innovative ways to coach providers and their front-line staff to improve performance in DSRIP measures
  • Identify ways to incentivize performance through a rigorous value-based care payment model and build performance-based incentives into contracts for funds flow

Presenters

Christopher Ray, MS, Data Analyst, Performance Management, Suffolk Care Collaborative
Samuel Lin, MHA, PMP, CPQH, Director, Strategic Operations, Integrated Care Programs, Suffolk Care Collaborative
Meredith Stanford, MS, RD, CDN, Manager, Bronx Partners for Healthy Communities
Rebekah Epstein, MPH, CPH, Project Manager, Bronx Partners for Healthy Communities
Caitlin Verrilli, MBA, Director, Project Management, Bronx Partners of Healthy Communities
Amanda Ascher, MD, Chief Medical Officer, Bronx Partners of Healthy Communities


D4

What Matters to You? The Key to Patient Engagement, Improved Outcomes and Joy in Work

Presenters: Damara Gutnick, MD and Kathy Pandekakes, Montefiore HVC

When children are hungry or housing is unstable, managing chronic disease may not be a priority. Evidence supports providing person–centered care focused on what is most important to the individuals we work with, including addressing the social determinants of health (SDH) needs, results in better outcomes and greater satisfaction with care. By encouraging providers to ask “What Matters to You?” and integrate what they learn into care planning, Montefiore Hudson Valley Collaborative (MHVC) aims to shift healthcare from “What’s the Matter?” to “What Matters to You?” During this interactive session, learn about the impact this exciting campaign has had on patient experience, quality outcomes and staff satisfaction across diverse MHVC partner organizations and how you might initiate, spread and measure the effects of a similar campaign in your work.

Learning Objectives

  • Learn how shifting healthcare from “What’s the matter?” to “What Matters to You?” can engage patients and their care teams and lead to improved outcomes and joy in work
  • Learn how to spread “What Matters to You (WMTY)” to your network providers, including available resources and toolkits
  • Learn how MHVC is supporting partners to build evaluation capacity to measure the impact of the WMTY campaign

Presenters

Damara Gutnick, MD, Medical Director, Montefiore Hudson Valley Collaborative
Kathy Pandekakes, Chief Operating Officer, Human Development Services of Westchester


D5

New York State Projects: Facilitating Effective, Sustainable HCO/CBO Partnerships

Presenters: Carla K. Nelson, MBA, Assistant Vice President, Ambulatory Care & Population Health, Greater New York Hospital Association, Kerry Griffin, MPA, Director, Population Health and Health Reform, New York Academy of Medicine, Lara Kassel, Coordinator, Medicaid Matters New York, Allison Sesso, MPA, Executive Director, Human Services Council

GNYHA and The New York Academy of Medicine have partnered on a qualitative research study funded by the Altman Foundation to explore the current Health Care Organization (HCO)/Community Based Organization (CBO) partnership environment. This panel session, including updated findings, will review statewide projects that aim to facilitate, support, and sustain partnerships between CBOs and HCOs. These partnerships are vital to the changing delivery system, particularly in addressing social determinants of health and improving health outcomes. However there are several barriers that must be overcome as HCOs and CBOs work to meaningfully engage, communicate, and partner. Panelists will describe the perspectives of HCOs and CBOs on the topics of capacity-building, partnership challenges, best practices, and lessons learned. They will also describe the challenges around sustainability and the strategies and policy recommendations being considered related to value-based payment.

Learning Objectives

  • Describe ongoing efforts being undertaken across New York State to facilitate and sustain partnerships between HCOs and CBOs
  • Learn about the research findings and common themes that have emerged
  • Describe the resulting tools, resources, and policy recommendations

Presenters

Carla K. Nelson, MBA, Assistant Vice President, Ambulatory Care & Population Health, Greater New York Hospital Association
Kerry Griffin, MPA, Director, Population Health and Health Reform, New York Academy of Medicine
Lara Kassel, Coordinator, Medicaid Matters New York
Allison Sesso, MPA, Executive Director, Human Services Council

D6

Millennium Collaborative Care has launched a new and innovative clinical integration value-based program for flowing funds to its partners under DSRIP. In addition to Millennium’s standard incentive contracts, which flow $12.5 million to partners for transformational foundational activities as well as performance, the “Bonus Program” creates high-impact, regional collaboratives that are positioned to share in $10 million in additional funding if Millennium meets or exceeds their MY4 NYS targets. This performance-based program focuses on meeting targets for high-value DSRIP pay-for-performance measures, particularly those associated with behavioral health and hospital utilization. The programs are managed in a clinically integrated manner involving multiple organizations including a regional hospital, primary care practices and clinics that serve a large number of Medicaid recipients in that region, behavioral health agencies/providers, and community-based organizations. Managed care organizations are also involved in aligning these incentives and supporting these efforts. The participants identify rapid cycle, high-impact strategies that more efficiently manage the Medicaid population in a defined region as demonstrated by meeting quality and value-based goals and targets. In the short time this program has been in effect, some dramatic and positive outcomes have been realized. The effectiveness of this model may serve as inspiration for future value-based arrangements.

Learning Objectives

  • Recognize the advantages to establishing a regional, collaborative approach to clinically integrated health care with a focus on value based outcomes
  • Summarize the early outcomes and effectiveness of Millennium’s Bonus Program
  • Use rapid cycle and MAX principles to create similar value-based arrangements

Presenters

Christine Blidy, Chief Network Officer, Millennium Collaborative Care
Al Hammonds, CSSBB, Executive Director, Millennium Collaborative Care
Sheila Kee, Vice President and Chief Operating Officer, Niagara Falls Memorial Medical Center (NFMMC)
Michelle Curto, Vice President of Administrative Operations, Horizon Health
Dr. Lavonne Ansari, Chief Executive Officer, Community Health Center of Buffalo


10:00 a.m. - 11:15 a.m.

Breakout Session E

E1

Oregon’s health reform efforts have centered on redesigning its clinical delivery system to improve outcomes and lower costs. A cornerstone of this effort was the establishment of Coordinated Care Organizations, which are partnerships between local health delivery systems and community organizations. This session will explore Oregon’s progress to date with particular attention to lessons learned from both Oregon and others around the country.

Learning Objectives

  • Become Familiar with Oregon’s efforts at health reform and the establishment of coordinated care organizations
  • Understand lessons learned from Oregon’s efforts at health system redesign
  • Understand the elements for successful partnerships between health and community based organizations
  • Understand how to overcome challenges and obstacles in health and community organization partnerships
  • Become familiar with examples from around the country of successful health and community based organization partnerships

Presenter

Bruce Goldberg, MD, Senior Fellow, Center for Health Systems Effectiveness Senior Associate Director, Oregon Rural Practice Based Research Network


E2

The MAX Series: Improving Care for High Utilizers- Presentation and Panel Discussion

Presenters: Amy Boutwell, MD, MPP, Collaborative Healthcare Strategies, Arnot Ogden Medical Center (FLPPS) – Janet King, Samaritan Medical Center (NCI) – Brian Marcolini, Nathan Littauer (AHI) – Geoffrey Peck, Niagara Falls Memorial Medical Center (MCC) – Sheila Kee , Bellevue Hospital (OCH) – Dr Ian Fagan, Jamaica Hospital (ACP) – Dr Angelo Canedo, Weill Cornell (NYP) – Julie Mirkin, North Country Intiative (NCI) Kathy Hunder

Improving care for high utilizers is at the very heart of delivery system transformation. Come learn how the MAX Series has effectively catalyzed delivery system transformation by providing a highly structured, intensive, implementation-focused program, supported by clinical-operational concepts and methodology that are applicable across different hospitals and communities. Join Dr. Amy Boutwell, MAX Series Subject Matter Professional, and several MAX teams for a series of rapid-fire presentations and panel discussion on applying the MAX methodology to drive local change – specifically, what works and how to identify and address the true “drivers of utilization” for New York’s most vulnerable patients.

Learning Objectives

  • Understand the MAX methodology used to improve care for high utilizers
  • Learn how MAX Action Teams from across New York State leveraged the MAX Methodology to drive change within local contexts

Presenters

Amy Boutwell, MD, MPP, Collaborative Healthcare Strategies, Arnot Ogden Medical Center (FLPPS)
Janet King, Samaritan Medical Center (NCI)
Brian Marcolini, Nathan Littauer (AHI)
Geoffrey Peck, Niagara Falls Memorial Medical Center (MCC)
Sheila Kee , Bellevue Hospital (OCH)
Dr Ian Fagan, Jamaica Hospital (ACP)
Dr Angelo Canedo, Weill Cornell (NYP)
Julie Mirkin, North Country Intiative (NCI)
Kathy Hunder


E3

Preparing Community-Based Practices for Value Based Medicine

Presenter: Salvatore Volpe, MD, Staten Island PPS

The Staten Island PPS has identified over 25 community-based practices to participate in Population Health Improvement Programs (PHIP). These small front-line provider practices have a great opportunity to impact outcomes. Each practice is unique and requires individualized attention related to the application of clinical guidelines and the use of an EHR to track and report on care provided. SI PPS has made available to each of these practices resources which normally would have been out of reach including: a registered dietician, home assessments for asthma risk factors, IT guidance on the use of codes to track referrals and procedures as well as EHR liaison assistant. This panel presentation led by the CMO and three PHIP practice leaders will address the opportunities, challenges and benefits of participation in the program.

Learning Objectives

  • Learn how to identify community practices for engagement
  • Learn how to quantify and rank conditions of interest
  • Understand how to provide and track clinical practice guidelines
  • Consider how best to prepare small practices for eventual transition to a Value-Based Medicine model

Presenter

Salvatore Volpe, MD, FAAP, FACP, FHIMSS, CHCQM, CMO, Staten Island Performing Provider System


E4

Mitigating Staff Resistance to Change Through Communication and Engagement

Presenters: Maria Gerena and Joan Chaya, Montefiore HVC

Open communication with staff and keeping them abreast of the organizations’ participation in healthcare transformation will foster a better informed workforce, a greater sense of engagement, and a better understanding of how DSRIP works and where they fit in. In fact, how well an organization helps employees deal with change directly drives business outcomes. The Workforce Communication Toolkit is an online support tool to help managers address communication gaps about changes in the workplace related to the New York State Delivery System Reform Incentive Payment program (DSRIP). Presenters will explain how the Montefiore Hudson Valley Collaborative (MHVC) Workforce Communication and Engagement Toolkit was developed and share the useful best practice resources for employee engagement and tools for communicating participation in DSRIP projects.

  • Learn and apply best practices on change management and employee engagement
  • Understand and be prepared to use tools and guides on employee communication

Presenters

Maria Gerena, Workforce Development Manager, Montefiore Hudson Valley Collaborative
Joan Chaya, Director, Workforce Development and Management, Montefiore Hudson Valley Collaborative


E5

Motivational Leadership: Creating Innate Demand for Organizational Transformation

Presenter(s): Jacob Reider, MD, Alliance for Better Healthcare

We have all struggled with the question: "how many PPS does it take to change a light bulb (to VBP)?" The answer, of course, is: "Only one, but the light bulb has to want to change." This interactive session will offer a short overview of two frameworks: Motivational Interviewing (Miller, Rollnick), and Tribal Leadership (Logan), and how the merger of these principles, which we call "Motivational Leadership,” can successfully be applied to the transformation work that PPS need to perform in our communities. This session will prepare attendees to apply these effective principles as soon as they return to their home organizations.

Learning Objectives

  • Apply the principles of motivational interviewing at scale: rather than helping individuals reach their transformation goals, attendees will learn to help organizations make the changes they need
  • Apply the principles of organizational readiness for change, and learn the optimal intervention(s) for each stage of readiness

Presenter

Jacob Reider, MD, Alliance for Better Healthcare


E6

Using Project ECHO to Spread Office-Based Medication Assisted Treatment: Life-Saving System Transformation

Presenter: James B. Anderson, Leatherstocking Collaborative PPS and Bassett HCN

The ECHO (Extension of Community Healthcare Outcomes) started as an innovative approach to increasing access to effective treatment for hepatitis C for rural, community-based care clinics in New Mexico. This video conferencing hub and spoke model allows specialty knowledge to spread from an expert team (hub), to community primary care clinics (spokes), and for practical, primary care focused expertise to be shared between participating primary care teams. Opioid addiction is an increasing problem in the United States. Effective treatment options exist, but are often challenging to access, especially for patients who live in remote, rural areas. There is a long history of separation of treatment of addiction and medicine and certainly a disconnect between primary care and treatment for opioid addiction. In this session, presenters will share their process of building a Medication-Assisted Treatment (MAT) program in a rural primary care network and discuss complementary components of a comprehensive effort to reduce rates of addiction. Presenters will share available data from the project-in-progress, and engage attendees in discussion about the process of building such a program, as well as the risks and benefits of this approach to treating opioid addiction.

Learning Objectives

  • Understand and describe the format of an ECHO conference
Discuss data for effectiveness for buprenorphine for treatment of opioid addiction

Presenter

James B. Anderson, PhD, DSRIP Medical Director, Behavioral Health and Integrated Services, Leatherstocking Collaborative Healthcare Partners PPS and Bassett Healthcare Network


E7

Building Cross-Sector Partnerships for ER Diversion

Presenters: Ashley Blauvelt, MPH, Director, Project Management, SI PPS, Brad Kaufman, MD, MPH, FACEP, FAEMS, First Deputy Medical Director, Fire Department City of New York, Kishor Malavade, MD, Associate Medical Director, Central Services Organization, Department of Population Health, Maimonides Medical Center, John Volpe, Special Advisor on Criminal Justice, Executive Deputy Commissioner's Office, Division of Mental Hygiene, NYC Department of Health and Mental Hygiene, Jamie Neckles, Chief Program Officer, Bureau of Mental Health, NYC Department of Health and Mental Hygiene, Leslie Treanor, New York City Police Department

Transformation, outreach, and improved health outcomes are some of the benefits realized by cross-sector partnerships to address issues among the behavioral health population. Unnecessary ER, inpatient, EMS use, and opioid overdoses remain problematic among the behavioral health population in every New York community. Those with Substance Use Disorder (SUD) frequently call 911 and utilize costly emergency services for issues better addressed in the community and frequently interact with the criminal justice system. The NYPD and other law enforcement agencies around NYS have begun training officers on using naloxone, local government units have begun partnering with health care providers on programs to address SUD needs, and other cross-sector partnerships are expanding co-response models to divert individuals from the ER and back to community providers. This moderated panel will frame the dilemma and discuss perspectives, roles and innovative approaches to transform outreach and improve health outcomes.

Learning Objectives

  • Understand the need for cross-sector partnerships with law enforcement and local government agencies
  • Learn from law enforcement officials about their perspective on co-response, their role in diversion/population health improvement, and overcoming stigma
  • Learn the benefits of cross-sector partnerships including innovative programs, transformation, outreach, and improved health outcomes

Presenters

Ashley Blauvelt, MPH, Director, Project Management, SI PPS
Brad Kaufman, MD, MPH, FACEP, FAEMS, First Deputy Medical Director, Fire Department City of New York
Kishor Malavade, MD, Associate Medical Director, Central Services Organization, Department of Population Health, Maimonides Medical Center
John Volpe, Special Advisor on Criminal Justice, Executive Deputy Commissioner's Office, Division of Mental Hygiene, NYC Department of Health and Mental Hygiene
Jamie Neckles, Chief Program Officer, Bureau of Mental Health, NYC Department of Health and Mental Hygiene
Leslie Treanor, New York City Police Department


11:30 a.m. - 12:15 p.m.

Keynote 4: Bruce Mau

A world-renowned visionary, innovator, author, and designer. Bruce laid the foundation for the new discipline of enterprise design: successfully applying design thinking to economic, cultural, governmental, environmental, and social change for designers, leading companies.


12:15 - 12:45 p.m.

Closing Remarks and Poster Awards

12:45 - 2:00 p.m.

Lunch Grab and Go

 

 

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