CNY Region DSRIP Projects
PPS Name
PHIP Counties
2.a.i
Create an Integrated Delivery System focused on Evidence‐Based Medicine and Population Health Management
2.a.ii
Increase Certification of Primary Care Practitioners with PCMH Certification and/or Advanced Primary Care Models (as developed under the NYS Health Innovation Plan (SHIP))
2.a.iii
2.b.iii
2.b.iv
2.b.vi
2.b.vii
CNY Care Collaborative
Finger Lakes Performing Provider System
Oneida, Madison, Onondaga, Cayuga, Oswego
Cayuga
X
X
Health Home At‐Risk Intervention Program: Proactive Management of Higher Risk Patients Not Currently Eligible for Health Homes through Access to High Quality Primary Care and Support Services
ED Care Triage for At‐Risk Populations Care Transitions Intervention Model to Reduce 30‐day Readmissions for Chronic Health Conditions Transitional Supportive Housing Services
Cortland
X
X
X
X
X
X
X
X
Implementing the INTERACT project (inpatient transfer avoidance program for SNF)
X
X
X
2.c.i
To Develop a Community Based Health Navigation Service to Assist Patients to Access Healthcare Services Efficiently
2.d.i
Implementation of Patient Activation Activities to Engage, Educate and Integrate the uninsured and low/non‐utilizing Medicaid populations into Community Based Care
3.a.ii
Oneida, Madison
X
2.b.viii Hospital‐Home Care Collaboration Solutions
3.a.i
Leatherstocking Care Compass Collaborative Network
Health Partners
Integration of Primary Care and Behavioral Health Services
Behavioral Health Community Crisis Stabilization Services
1 of 2
X
X
X
X
X
X
X
X
X
X
X
X
X
CNY Region DSRIP Projects
PPS Name
PHIP Counties
3.a.iv
3.a.v
3.b.i
Oneida, Madison, Onondaga, Cayuga, Oswego
Cayuga
Behavioral Interventions Paradigm (BIP) in Nursing Homes Evidence‐Based Strategies for Disease Management in High Risk/Affected Populations (Adults Only)
Leatherstocking Care Compass Collaborative Network
Health Partners
Oneida, Madison
Cortland
X
X
X
Implementation of Evidence Based Medicine Guidelines for Asthma Management
3.f.i
Increase Support Programs for Maternal and Child Health (Including High Risk Pregnancies)
4.a.iii
Finger Lakes Performing Provider System
Development of Withdrawal Management (e.g., ambulatory detoxification, ancillary
withdrawalservices) Capabilities and Appropriate Enhanced Abstinence Services within Community‐Based Addiction Treatment Programs
3.d.iii
3.g.i
CNY Care Collaborative
Integration of Palliative Care into the PCMH Model
Strengthen Mental Health and Substance Abuse Infrastructure across Systems (Focus Area 3)
X
X
X
X
X
4.b.i
Promote tobacco use cessation, especially among low SES populations and those with poor mental health (Focus Area 2; Goal #2.2)
4.b.ii
Increase Access to High Quality Chronic Disease Preventative Care and Management in Both Clinical and Community Settings (Focus Area 3) (This project targets chronic diseases that are not included in Domain 3, such as cancer)
4.d.i
Reduce premature births (Focus Area 1; Goal 1)
X
X
X
X
X
X
2 of 2
X
X
X