Mount Sinai PPS
Clinical Committee
February 10, 2015
1:30 – 3:00 PM
State and PPS Updates
State Implementation Timeline
3
MS PPS Project Application Results
▶
State released application results February 2, 2015
▶
Application Scoring break down
– 30% based on Organizational Score
– 70% based on Project Scores (good portion of scoring was
on Scale and Speed based on KPMG)
▶
Independent Assessor finalized an Executive Summary
for each PPS application covering the overall scoring,
reviewer comments, and a project by project summary
▶
Mount Sinai PPS scored 89.91 on their Project
Application compared to NYC PPS average of 90.48
Mount Sinai / Presentation Slide / December 5, 2012
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How does Mount Sinai’s Scores compare?
Project
MS Score
NYC Average Score
State Average Score
2ai
91.91
91.47
92.70
2biv
85.82
86.78
88.33
2bviii
88.94
85.95
87.41
2ci
91.22
91.84
92.46
3ai
84.40
85.25
86.93
3aiii
95.09
95.09
95.28
3bi
83.11
84.73
85.32
3ci
86.43
88.20
88.55
4bii
95.72
97.31
98.38
4cii
96.50
98.19
98.19
Average score
89.91
90.48
91.36
Mount Sinai / Presentation Slide / December 5, 2012
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Mount Sinai Average Scores compared to Overlapping
PPS NYC Scores
NYC PPS Average Scores
Advocate Community Partners (AW Medical)
92.41
The New York and Presbyterian Hospital (Manhattan)
91.5
Maimonides Medical Center (Kings)
91.44
St. Barnabas Hospital (dba SBH Health System)
91.37
NYC PPS
Nassau University Medical Center
90.6
Lutheran Medical Center (Kings)
89.96
Mount Sinai Health System (NY, Kings, Queens,…
89.91
Bronx-Lebanon Hospital Center
88.98
New York City Health and Hospitals-led PPS(NY, Kings,…
88.94
Richmond University Medical Center (Richmond)
88.37
The New York Hospital Medical Center Queens (Queens)
87.72
85
86
87
88
89
90
91
92
93
Independent Assessor Scores
Mount Sinai / Presentation Slide / February 5, 2015
6
Mount Sinai PPS Service Area and
Attribution
▶
State recently removed 3 counties from the total 6 counties delivery
service areas for Mount Sinai.
– Manhattan
– Brooklyn (Kings)
– Queens
– No longer in Staten Island, Westchester County, and Bronx
▶
Attribution is 279,751 for the MS PPS (from State Score summary
as of 2/4/2015)
– This is attribution for performance not valuation
– Valuation will come later from the State based on the Score of
the application
Mount Sinai / Presentation Slide / December 5, 2012
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Scale & Speed Submission
Overview
▶
Scale & Speed (S&S) is a key piece of the DSRIP Application
which impacts scoring and ongoing DSRIP reporting
requirements
▶
Requires PPSs to commit to numbers and timeframes that will
carry on throughout the remaining years of DSRIP
▶
Required for all projects except Domain 4 projects
▶
S&S was submitted to the DOH on January 14, 2015
▶
Received scoring summary from the State February 4, 2015
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Requirements
▶
PPSs had to commit to the following per project:
– Project Scale:
• # of committed providers (by type)
• # of committed safety net providers (by type)
– Patient Scale: How many Medicaid beneficiaries would be
impacted by each project?
– Project Implementation Speed: The demonstration year
and quarter by which all committed providers would meet
project requirements
– Patient Engagement Speed: How many Medicaid
beneficiaries would be engaged each demonstration year,
broken down by quarter
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How It Works
▶
S&S requires a balance of being aggressive yet realistic
▶
Larger numbers and faster implementation speed equals a
higher score, which then makes the PPS become eligible for a
larger sum of DSRIP dollars
▶
However, S&S is tied directly to Domain 1 Metrics & Milestones,
so if a PPS fails to meet their S&S commitments, they will not
draw down DSRIP dollars
▶
Mount Sinai PPS chose a more conservative route so we could
achieve our Metrics and Milestones
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MS PPS S&S Methodology
Data Resources:
▶ Partner Participation
Packet results (i.e.
MegaSurvey)
▶ Provider type data from the
DOH
▶ Salient data
▶ Community Needs
Assessment
Approach:
▶ Used the available data
resources to develop S&S
numbers and inputs
▶ Worked closely with the
subgroup co-leads, Clinical
Committee leads, and PPS
leadership to refine & finalize
the numbers
▶ GOAL: Submit numbers that
were aggressive, yet realistic
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Patient Scale
Project
Engaged Patients
% of Attributed
Population
2.a.i
n/a
n/a
2.b.iv
25,000
9%
2.b.viii
20,000
7%
2.c.i
62,500
22%
3.a.i
100,000
36%
3.a.iii
45,000
16%
3.b.i
41,963
15%
3.c.i
29,000
10%
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Project Implementation Speed
DY0
(Baseline)
Q1/Q2
Q3/Q4
DY1
Q1/Q2
Q3/Q4
DY2
Q1/Q2
Q3/Q4
DY3
Q1/Q2
DY4
Q3/Q4
2.a.i
Q1/Q2
Q3/Q4
X
2.b.iv
X
2.b.viii
X
2.c.i
X
3.a.i
X
3.a.iii
X
3.b.i
X
3.c.i
X
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How Do The MS PPS S&S Numbers
Compare?
▶
There was great variety in S&S submissions across PPSs
▶
Considering the spectrum of submissions, the numbers
submitted by the MS PPS tended to fall in the middle of the
spectrum between very conservative and aggressive
▶
All S&S submissions are currently posted on the DOH website
15
What’s Next?
▶
Our S&S submissions will flow directly into our implementation
planning
▶
Our commitments establish our “thresholds” for ongoing quarterly
reporting
▶
It’s a PPS-wide effort to ensure our S&S commitments are met in
order to draw down the maximum number of DSRIP dollars
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Overview of the
Implementation Planning
Phase
January 16th 2015
Conceptual Overview of the Implementation Plan
Implementation Plan timeline
January
9th
■
Structure of
■
implementation
plan released
to PPSs
January
16th
Face-to-face
meeting with
PPSs
February
1st
March 1st
■
■
Structure of
implementation
plan finalized
following
feedback from
PPSs and other
stakeholders
■
Prototype
implementation
plan released
April 1st
■
PPSs submit
draft
implementation
plan to DST for
discussion and
feedback
PPSs submit
finalized
implementation
plan
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Goals of Implementation Plan
1.
Consistent guidance about establishing a successful, effective
PPS;
2.
Collect information for release of Domain 1 payments to PPS
based on achievement of key milestones;
3.
Establish the structure of quarterly reports for submission;
4.
Provide clarity to downstream providers about their roles and
actions throughout the implementation journey; and
5.
Facilitate the monitoring of progress on key milestones.
19
Parts of Implementation Plan

The Implementation plan is split into three parts with
several sections:
 Organizational Plan
 9 sections
 Project Plan
 2 sections
 Budget and Flow of Funds
 2 sections
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Part 1: Organizational Plan

9 Sections make up the Organizational Plan
1. Governance
2. Workforce
Domain 1
3. Financial Sustainability
4. Cultural Competency
5. IT Systems and Processes
6. Population Health Management
7. Clinical Integration
8. Performance Reporting; and
9. Physician Engagement
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Part 1: Organizational Plan contd.
▶
•
•
•
•
•
•
•
All 9 sections of the Organizational Plan must
address the following:
Key Steps and Measurable Milestones;
Major Risk to Implementation & Risk Mitigation Strategies;
Major Dependencies & Other Work streams;
Roles and Responsibilities;
Key Stakeholders;
IT expectations; and
Progress Reporting.
22
Part 2: Project Plan

2 Sections make up the Project Plan:
1. General Implementation Planning
2. Measureable Implementation Risks
23
Part 3: Budget and Flow of Funds

2 Sections Budget and Flow of Funds:
1. The PPS Budget
2. Flow of Funds
24
Relationship between
Domain 1 Process Measures
and Payments
What drives DSRIP Payments?

Domain 1 Process Measures drive DSRIP Payments

Each Domain 1 Process measure and milestone will be evaluated
based on target achievements/milestones.

Milestones scored as “achieved” or “not achieved”, known as an
Achievement Value (AV).
 AV = 1 –“meeting or achieving” the process measure or milestone
 AV = 0 –“not meeting or achieving” the process measure or
milestone

Progress on Domain 1 Process Measures will be reported in DSRIP
Quarterly Reports
26
Three forms of payment linked to
Domain 1
Source: NY Department of Health
27
Project Domain 1 Reimbursement:
Example
Process Measure Type
Project Plan Application Approval
There was a
maximum of
$580,523* in
Domain 1 funding
available for Project
Example for the
DY1, Q3/Q4
payment period
Organizational Process Measures
Governance
Implementation Plan
Quarterly Progress Reports
Workforce
Implementation Plan
Quarterly Progress Reports
Cultural Competency/Health Literacy
Implementation Plan
Quarterly Progress Reports
Financial Sustainability
Implementation Plan
Quarterly Progress Reports
DSRIP Project Specific Process Measures
Implementation Plan*
Quarterly Progress Reports & Project Budget &
Flow of Funds
Patient Engagement Speed
Project Implementation Speed
Total Achievement Value Earned by PPS
Percentage Achievement Value (6/7)
Domain 1 Funding for Project Example
Domain 1 Funding Achieved for Project Example
DY1
Payment 3
N/A
N/A
1
N/A
1
N/A
1
N/A
1
N/A
1
In this example the PPS
earned 6 out of 7 AVs
or a Percentage
Achievement Value of
85.71%, resulting in the
award of $497,591* in
Domain 1 Funding for
Project Example
0
1
6
85.71%
$580,523*
$497,591*
Source: NY Department of Health
*Numbers are for demonstration purposes only – They do not reflect actual funding allocated to a
specific PPS
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Process & Partner
Participation
Mount Sinai PPS Committees
▶
5 Committees
–
–
–
–
–
▶
Leadership
Workforce
IT
Finance
Clinical
Clinical Committee oversees:
– 10 DSRIP Project Working Groups
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Implementation Plan Part 1: The Organizational Plan
Organizational Section:
Committee Responsible
Governance
Leadership Committee
Workforce
Workforce Committee
Financial Sustainability
Finance Committee
Cultural Competency
Clinical Committee and Workforce Committee
IT Systems and Processes
IT Committee
Health Management
Clinical Committee and Project Workgroups
Clinical Integration
Clinical Committee
Performance Reporting
Clinical and IT Committee
Physician Engagement
Clinical Committee and Project Workgroups
31
Implementation Plan Part 2: The Project Plan
General Project Implementation Section:
Committee Responsible
Overall approach to implementation
Leadership Committee
Major dependencies between work streams and
coordination of projects
Leadership Committee
Overview of key stakeholders (within and outside PPS
network) and how influenced by project
Clinical Committee
Roles and responsibilities
Leadership Committee
IT requirements
IT Committee
Performance monitoring
Clinical Committee
Community engagement
Workforce Committee
32
Project Working Groups Responsibilities
Implementation Plan Part 2: The Project Plan
Continued
Measurable Milestones and
Implementation Risk Section:
Ownership Group
Major risks to implementation and mitigation strategies
Each Project Working Group
Project Implementation Speed
Each Project Working Group
Patient Engagement Speed
Each Project Working Group
33
Implementation Plan Part 3: Budget &
Flow of Funds
Measurable Milestones and
Implementation Risks Section:
Committee
Responsible
The PPS Budget
Finance Committee
Flow of Funds
Finance Committee
34
Committee Meeting Schedule and getting involved
Committee Meetings Time/Day
Finance
Wednesdays 8 – 10 am
Workforce
Pending
IT
Thursdays 12-2pm
Clinical
Will Vary – Tues or Weds
Send an email, Subject: Joining [Name of Committee]
to dsrip@harbageconsulting.com
35
10 DSRIP Project Working Groups
▶
Focused on Implementation Plan Part 2
▶
Partners interested in participating can email
dsrip@harbageconsulting.com
– With subject: Join (Project Number) with your name,
contact and organization
▶
Project Working Group meetings will be done by Webinar
and Phone Conference
▶
Level of participation from Partners will be explained
further in Project working group
36
Questions?
Thank you
Email the Mount Sinai PPS Team at
dsrip@harbageconsulting.com
Visit the Mount Sinai PPS website at
www.mountsinaipps.org
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