NYP/Q DSRIP PPS – Finance Meeting

Meeting Title:

NYP/Q DSRIP Finance Meeting : Finance Progress Overview

Meeting Date:

November 1st, 2016

Facilitator(s):

Amanda Simmons/Daniel Notarnicola

Meeting Time:

1:00 PM – 2:00 PM

Attendees:

Finance Committee Chair : Christopher Caulfield NYP/Q 56-45 Main Street K.W Board Room

Meeting Purpose: 1. Discuss current status of DSRIP deliverables for Finance.

#

Topic

1.

Welcome & Purpose of Meeting

2.

Audit Updates  NYS I.A. (October 6th, 2016)

3.

(2) At-Risk Network Partners  Visiting Nurse Service of New York  Lexington Hearing and Speech Center

Document

Responsible Person Chris Amanda

Follow-Up Plan VNSNY.docx

Daniel

Follow-Up Action Plan - Lexington.docx

4.

5.

Equity Updates  EIP  EPP

Amanda

Revenue & Expense Trend Updates

Amanda Revenue & Expense Forecast.xlsx

ACTION ITEM: 6.

Daniel VBP Baseline Assessment (PowerPoint)

7.

8.

Partner Incentive Distribution #3 Next Steps:  Engage At-Risk Partners and execute follow-up plan  Finalize distribution checklist for payment #3 partner incentives

Value Based Payment (VBP) Survey Results [Final].pptx

Amanda

All Page 1

NYP/Q DSRIP PPS – Finance Meeting 9.

Questions / Adjourn

All

Page 2

Financial Sustainability Follow-Up Evaluation Plan: Lexington Hearing & Speech Center: 1. Confirm with the provider that the reported financial numbers are accurate, and that the metrics have, indeed, identified a financial challenge. 2. Inquire about the availability of mid-year consolidated financials that can be used to supplement the trend being reviewed. 3. Gain an understanding as to why this provider is setting off key financial risk indicators and if there is any visible trend. 4. NO visible risk indicator trend: a. Activity flagged initially may indicate an outlier performance. i. Partner requires no immediate intervention. 5. YES visible risk indicator trend: a. Detective i. Partner will go through a monitoring program that will assess financials on a 6-month basis in order to isolate risk occurrence. b. Corrective i. Reconcile partner DSRIP funding receipts with funds flow model to identify any possible discrepancies. ii. Identify potentials for engaging in additional projects to maximize funds flow. iii. Identify alternative funding sources; e.g. grants. iv. Seek alternative providers that could fulfill the project goals. c. Report findings to the Finance Committee and solicit advice on the implementation of one of the above strategies or an alternative one.

Financial Sustainability Follow-Up Evaluation Plan: Visiting Nurse Service of New York: 1. Confirm with the provider that the reported financial numbers are accurate, and that the metrics have, indeed, identified a financial challenge. a. Current notes show that 2015 financials for VNSNY were unaudited. Confirmation needs to be obtained that the status here has been updated to “audited” 2. Inquire about the availability of mid-year consolidated financials that can be used to supplement the trend being reviewed. 3. Gain an understanding as to why this provider is setting off key financial risk indicators and if there is any visible trend. 4. NO visible risk indicator trend: a. Activity flagged initially may indicate an outlier performance. i. Partner requires no immediate intervention. 5. YES visible risk indicator trend: a. Detective i. Partner will go through a monitoring program that will assess financials on a 6-month basis in order to isolate risk occurrence. b. Corrective i. Reconcile partner DSRIP funding receipts with funds flow model to identify any possible discrepancies. ii. Identify potentials for engaging in additional projects to maximize funds flow. iii. Identify alternative funding sources; e.g. grants. iv. Seek alternative providers that could fulfill the project goals. c. Report findings to the Finance Committee and solicit advice on the implementation of one of the above strategies or an alternative one.

DY1

DY2 520,619 185,210 8,500 96,468 32,944 36,300 589,947

$ $ $ $ $ $ $

DY4

DY5

Grand Total

Admin OH Cost of Implementation Workforce Revenue Loss Non-Covered Service Incentives Revenue Balance

$ $ $ $ $ $ $

Revenue

$ 1,469,988 $ 942,986

$ 2,412,974

AOH COI Workforce Incentives

$ $ $ $

520,619 185,210 8,500 165,712

$ $ $ $

Expenses

$

880,041 $ 851,779

Balance

$ 589,947 $ 91,207

$ $ $ $

397,662 25,057 134,768 50,531 10,333 233,429 91,207

DY3

397,662 25,057 134,768 294,292

$ $ $ $ $ $ $

918,281 210,267 143,268 146,999 43,276 269,729 681,154

918,281 210,267 143,268 460,004

$ 1,731,820

$

681,154

Revenue Balance 28%

Admin OH 38%

Incentives 11%

Non-Covered Service 2%

Revenue Loss 6%

Workforce 6%

Cost of Implementation 9%

Revenue & Expense Forecast

Month April May June July August September October November December January February March Grand Total

Month April May June July August September October November December January February March Grand Totals

10/27/2016

$ $ $ $ $ $ $ $ $ $ $ $ $

April 1, 2015 March 31, 2016 DY1 302,360.27 31,398.01 57,335.99 49,764.83 332,645.87 106,536.12 880,041.09

$ $ $ $ $ $ $ $ $ $ $ $ $

April 1, 2015 April 1, 2016 March 31, 2016 March 31, 2017 DY1 DY2 1,102,491.00 $ 367,497.09 $ 575,489.00 367,497.00 1,469,988.00 $ 942,986.09

$ $ $ $ $ $

April 1, 2016 March 31, 2017 DY2 369,789.82 112,921.80 115,451.78 151,266.75 57,824.39 44,524.12

April 1, 2017 March 31, 2018 DY3

EXPENSE April 1, 2019 March 31, 2020 DY5

April 1, 2018 March 31, 2019 DY4

$400,000.00 $350,000.00 $300,000.00

$250,000.00 $200,000.00 $150,000.00 $100,000.00 $50,000.00

$-

$

851,778.66

$

-

$

April 1, 2017 March 31, 2018 DY3

-

$

-

REVENUE April 1, 2019 March 31, 2020 DY5

April 1, 2018 March 31, 2019 DY4

DY1

DY2

$1,200,000.00 $1,000,000.00 $800,000.00 $600,000.00 $400,000.00 $200,000.00 $-

$

-

$

-

$

-

DY1

DY2

CONFIDENTIAL

Revenue & Expense Forecast

Month April May June July August September October November December January February March Grand Total

Month April May June July August September October November December January February March Grand Total

April 1, 2015 March 31, 2016 DY1 $ $ $ $ $ $ $ $ $ $ $ $ $

202,490.27 31,273.01 679.33 26,402.61 166,415.78 93,358.03 520,619.03

$200,000.00

$150,000.00

$100,000.00

$-

$

$ $ $ $ $ $ 99,870.00 125.00 56,656.66 14,279.22 14,279.22 185,210.10

EXPENSE : Administrative Overhead April 1, 2018 April 1, 2019 $250,000.00 March 31, 2019 March 31, 2020 DY4 DY5

April 1, 2017 March 31, 2018 DY3

$50,000.00

April 1, 2015 March 31, 2016 DY1

$ $ $ $ $ $ $

April 1, 2016 March 31, 2017 DY2 77,613.29 85,205.19 36,758.15 107,551.10 51,877.41 38,656.47

397,661.61

$

April 1, 2016 March 31, 2017 DY2 (14,563.17) 13,862.65 7,995.00 5,947.65 5,946.98 5,867.65

-

$

-

$

-

DY1

DY2

DY1

DY2

EXPENSE : Cost of Implementation April 1, 2018 April 1, 2019 $120,000.00 March 31, 2019 March 31, 2020 $100,000.00 DY4 DY5

April 1, 2017 March 31, 2018 DY3

$80,000.00 $60,000.00 $40,000.00 $20,000.00 $$(20,000.00) $(40,000.00)

$

25,056.76

$

-

$

-

$

-

All expenses are reflected in GL290 file exported from Lawson General Ledger System No Cost of Implementation expenses for March ‘16 No Workforce expenses for March ‘16 10/27/2016

No Revenue Loss cleared the GL during March ‘16

CONFIDENTIAL

Revenue & Expense Forecast

Month April May June July August September October November December January February March Grand Total

Month April May June July August September October November December January February March Grand Total

April 1, 2015 March 31, 2016 DY1 $ $ $ $

April 1, 2016 March 31, 2017 DY2 22,500.00 72,000.00 40,268.00

April 1, 2017 March 31, 2018 DY3

April 1, 2018 March 31, 2019 DY4

EXPENSE : Workforce April 1, 2019 $80,000.00 March 31, 2020 $70,000.00 DY5 $60,000.00 $50,000.00 $40,000.00 $30,000.00 $20,000.00 $10,000.00

$ $ $ $

4,083.00 4,083.00 334.00 8,500.00

April 1, 2015 March 31, 2016 DY1

$-

$

134,768.00

$

April 1, 2016 March 31, 2017 DY2 $ 50,530.84

-

$

April 1, 2017 March 31, 2018 DY3

-

April 1, 2018 March 31, 2019 DY4

$

-

DY1

DY2

DY1

DY2

EXPENSE : Revenue Loss April 1, 2019 $120,000.00 March 31, 2020 DY5 $100,000.00 $80,000.00 $60,000.00 $40,000.00 $20,000.00

$ $ $

96,467.99 96,467.99

$-

$

50,530.84

$

-

$

-

$

-

All expenses are reflected in GL290 file exported from Lawson General Ledger System No Cost of Implementation expenses for March ‘16 No Workforce expenses for March ‘16 10/27/2016

No Revenue Loss cleared the GL during March ‘16

CONFIDENTIAL

Revenue & Expense Forecast

Month April May June July August September October November December January February March Grand Total

Month April May June July August September October November December January February March Grand Total

April 1, 2015 March 31, 2016 DY1

April 1, 2016 March 31, 2017 DY2 $ 10,332.57

April 1, 2017 March 31, 2018 DY3

April 1, 2018 March 31, 2019 DY4

EXPENSE : Non-Covered Services April 1, 2019 $30,000.00 March 31, 2020 DY5 $25,000.00 $20,000.00 $15,000.00 $10,000.00 $5,000.00

$ $ $

25,199.84 7,743.70 32,943.54

$-

$

April 1, 2015 March 31, 2016 DY1 $ $ $ $

10,332.57

$

April 1, 2016 March 31, 2017 DY2 223,376.29 13,853.96 (1,301.37) (2,500.00)

-

$

April 1, 2017 March 31, 2018 DY3

-

$

-

DY1

DY2

DY1

DY2

EXPENSE : Incentives April 1, 2019 $250,000.00 March 31, 2020 DY5 $200,000.00

April 1, 2018 March 31, 2019 DY4

$150,000.00 $100,000.00 $50,000.00 $-

$ $ $

31,200.04 5,100.39 36,300.43

$(50,000.00)

$

233,428.88

$

-

$

-

$

-

All expenses are reflected in GL290 file exported from Lawson General Ledger System No Cost of Implementation expenses for March ‘16 No Workforce expenses for March ‘16 10/27/2016

No Revenue Loss cleared the GL during March ‘16

CONFIDENTIAL

Type Grant Grant DSRIP DSRIP DSRIP EIP

Payment # Grant 1 Grant 2 DY1-1 DY1-2 DY1-3 DY1

Description Grant Payment #1 Grant Payment #2 Project Plan Payment DY1 Q1 & Q2 DY1 Q3 & Q4 Emblem (Health Insurance Plan)

Month/Year Pre DSRIP Pre DSRIP Jun-15 Jan-16 Jul-16 Aug-16

EIP EIP EIP EIP EIP EIP EIP EIP EIP EIP EIP DSRIP

DY1 DY1 DY1 DY1 DY1 DY2-1 DY2-1 DY2-1 DY2-1 DY2-1 DY2-1 DY2-1

Empire (Amerigroup) Fidelis Health First MetroPlus United Emblem (Health Insurance Plan) Empire (Amerigroup) Fidelis Health First MetroPlus United DY2 Q1 & Q2

Aug-16 Oct-16 Oct-16 Oct-16 Oct-16 Oct-16 Oct-16 Oct-16 Oct-16 Oct-16 Oct-16 Jan-17

EPP

DY1

Emblem (Health Insurance Plan)

EPP

DY1

EPP

Anticipated Amount 500,000 1,299,999 1,102,491 367,497 367,497 149,270

$ $ $ $ $ $ $ $ $ $ $ $

447,539 305,165 757,571 179,286 196,998 74,635 223,770 152,583 378,786 89,643 98,499 906,854

Jan-17 2017

$

99,513

Pending DOH release of EPP data - Guess January 2017

Empire (Amerigroup)

Jan-17 2017

$

298,359.22

Pending DOH release of EPP data - Guess January 2017

DY1

Fidelis

Jan-17 2017

$

203,443

Pending DOH release of EPP data - Guess January 2017

EPP

DY1

Health First

Jan-17 2017

$

505,047

Pending DOH release of EPP data - Guess January 2017

EPP

DY1

MetroPlus

Jan-17 2017

$

119,524

Pending DOH release of EPP data - Guess January 2017

EPP EIP EIP EIP EIP EIP EIP DSRIP EIP EIP EIP EIP EIP EIP

DY1 DY2-2 DY2-2 DY2-2 DY2-2 DY2-2 DY2-2 DY2-2 DY3-1 DY3-1 DY3-1 DY3-1 DY3-1 DY3-1

United Emblem (Health Insurance Plan) Empire (Amerigroup) Fidelis Health First MetroPlus United DY2 Q3 & Q4 Emblem (Health Insurance Plan) Empire (Amerigroup) Fidelis Health First MetroPlus United

Jan-17 Apr-17 Apr-17 Apr-17 Apr-17 Apr-17 Apr-17 Jul-17 Oct-17 Oct-17 Oct-17 Oct-17 Oct-17 Oct-17

$ $ $ $ $ $ $ $ $ $ $ $ $ $

131,332 74,635 223,770 152,583 378,786 89,643 98,499 1,051,470 74,635 223,770 152,583 378,786 89,643 98,499

Pending DOH release of EPP data - Guess January 2017

$

12,042,600

2016 2016 2016 2016 2016 2016 2016 2016 2016 2016 2016 2017

$ $ $ $ $ $

Amount Received 500,000 1,299,999 1,102,491 367,497 367,497 127,950

$

447,539

2017 2017 2017 2017 2017 2017 2017 2017 2017 2017 2017 2017 2017 2017 $

4,212,973

Variance

Notes

$ $ $ $ $ $

Grand Totals

NYP/Q CY 2015 2015 2016 2016 2016 2016

$

$

21,320 EIP PPM rate issue NYS - MCO ; pending adjustment Payment received Sept 2016 - need confirmation on amount Contracts executed - pending payment Contracts executed - pending payment Contracts executed - pending payment Contracts executed - pending payment

21,320 Will we get DY2 EPP in 2017??

Source of Revenue numbers is reconciliation cover page for DSRIP account.

Value Based Payment (V.B.P.) Baseline & Readiness Network Assessment

September 2016

Purpose Create a baseline assessment of the New York-Presbyterian/Queens PPS partner network to include contracting status and a readiness assessment for moving to alternative payment methodologies. ________________________________________________________________ Financial sustainability is an overall goal of the DSRIP program; therefore, the NYS DOH has established milestones related to value based payment methodologies inclusive of a comprehensive baseline assessment. The assessment was completed utilizing a survey methodology for all network partners and is summarized in the below slide deck. This analysis is inclusive of a baseline assessment of actual alternative payment models as well as a readiness assessment for moving toward such models. To ensure compliance with all local and federal regulations, all survey questions were not specific to payer or contractual relationships but included general questions relating to categories associated with value based payment arrangements.

The PPS’ collaborative model will utilize this analysis to focus on education, connectivity, and quality analytics, which our network partners will be able to use to provide tools and resources for individual teams to work with MCO’s in order to move towards risk based models.

2

2016 V.B.P. Survey

Governing Process The VBP baseline assessment was completed by the Project Management Office with reviews and approvals for publishing by the Finance Committee as well as the Executive Committee.

Approvals of this assessment will be completed in October 2016.

3

Presentation Title

What is Value Based Payment (V.B.P.)? National healthcare strategy used by healthcare systems to promote quality and value of health care services utilizing non fee for service payment methodologies focused to quality based outcomes. Goals include:  Shift from pure volume-based payment (Fee-for-Service) to those that are outcome related  Implement pay for performance programs that reward improvements in quality metrics & aligns risks of all parties  Establish methodologies that align with the complexity of the patient base as well as the offerings of the system with the strategies of the managed care organization  Engage multiple facets of the healthcare system to encourage quality based outcomes by assigning levels of risk

 Establish data reporting & warehousing mechanisms for tracking and ongoing performance reporting 4

2016 V.B.P. Survey

Survey Categories I.

Organization Type

II.

Current Value/Equity Payment Arrangements

III.

V.B.P. Model Preferences

IV.

Current V.B.P. Aligned Medicaid Managed Care Organization (M.C.O.) Strategies

V.

Readiness to convert 90% of Medicaid revenue sources to a V.B.P. methodology

VI.

Training Topic Interest Areas

The following slides summarize the data compiled by category & organization type.

5

2016 V.B.P. Survey

Organization Types 4. Type of Organization Article 36 Certified Home Health Agency Non-licensed CBO Nursing Home/SNF Long-Term Acute Care Hospital Licensed Hospice Inpatient Home Care Agency Hospital Article 28 Outpatient Clinics Private Practice Provider – Specialty Care Private Practice Provider – Primary Care Article 16 Clinics (OPWDD) Article 28 Diagnostic & Treatment Centers Outpatient Behavioral Health (Art 31 & Art 32) 0

6

2016 V.B.P. Survey

2

4

6

8

10

12

14

16

18

20

Results

 All network partners were sent the VBP survey  (35) unique partners provided responses  (40) organization types reported - Some partners counted their business operations among multiple classifications  Nursing Homes/Skilled Nursing Facilities represented 45% of the total responses

7

2016 V.B.P. Survey

Current Value/Equity Payment Arrangements

N/A

No

Yes

0

5

8

2016 V.B.P. Survey

10

15

20

25

Results

 34% of the partner reporting population indicated, YES, to current arrangements  62% of the partner reporting population indicated, NO, to current arrangements  PPS Opportunities: - Education to increase familiarity with VBP concepts - Growth opportunity to introduce unique VBP concepts

9

2016 V.B.P. Survey

V.B.P. Model Preferences

N/A

No

Yes

0

5

10

2016 V.B.P. Survey

10

15

20

25

30

35

Results

 85% indicated NO preference to any specific V.B.P. model  15% indicated YES to a preference of a specific V.B.P. model  PPS Opportunities: - Education of unique types of VBP arrangements in the local market

- Alignment of education with the findings from the Rapid Cycle Evaluation Unit - Engagement with MCO’s for discussions of concepts that align with population strategies

11

2016 V.B.P. Survey

Current V.B.P. Aligned Medicaid Managed Care Organization (M.C.O.) Strategies

N/A

No

Yes

0

5

12

2016 V.B.P. Survey

10

15

20

25

30

Results

 80% indicated No to having any current V.B.P. Aligned Medicaid Managed Care Organization (M.C.O.) Strategies  20% indicated YES to having any current V.B.P. Aligned Medicaid Managed Care Organization (M.C.O.) Strategies  PPS Opportunities:

- Incorporation of multiple provider / payer strategies by network partners - Lessons learned among network partners for VBP arrangements

13

2016 V.B.P. Survey

Readiness to convert 90% of Medicaid revenue sources to a V.B.P. methodology

Unsure of our readiness

No confidence that our organization is ready for the change

Slightly confident our organization is ready for the change

Confident our organization is ready for the change

0

14

2016 V.B.P. Survey

2

4

6

8

10

12

14

Results  37% Unsure  34% Slightly confident  25% Confident  PPS Opportunities: - Provide basic education models for partner network - Partner with Medicaid MCO’s to roll-out any existing educational programs for VBP

- Utilize Rapid Cycle Evaluation Unit quality analysis to provide partners baseline quality assessments

15

2016 V.B.P. Survey

Training Topic Interest Areas

Other

Maximizing IT tools for VBP scenarios

National trends of value based payment methodologies

MCO sponsored learning collaborative aligned with their benefit plans

Quality based outcome analytics

Alignment of VBP with DSRIP programs

Overall education of VBP options

0

16

2016 V.B.P. Survey

5

10

15

20

25

30

35

Results

 (3) Highest Requested Topics: - Overall Education (85%) - Quality Based Outcome Analytics (85%) - I.T. Tool Maximization (80%)

 PPS Opportunities: - High interest in education of VBP models - Utilization of Rapid Cycle Evaluation Unit data analytics for quality reporting

17

2016 V.B.P. Survey

Existing V.B.P. Arrangements Within NewYorkPresbyterian/Queens PPS Network

5. All care for total population

0% 0% 60% 40.0%

4. Acute and Chronic Bundles

0% 0.90% 0% 0.0%

3. Acute and Chronic Bundles

0% 0% 0%

Level 3 VBP Level 2 VBP Level 1 VBP

65.0%

2. All care for total population

0% 0% 1% 3.0%

1. All care for total population

0% 0% 0.49%

Level 0 VBP

99.5% 0%

18

10%

2016 V.B.P. Survey

20%

30%

40%

50%

60%

70%

80%

90%

100%

Next Steps

 Receive approvals from Finance & Executive Committees  Establish an educational program for value based payment opportunities  Await VBP NYS DOH updates to all deliverables  Align VBP data needs with the Rapid Cycle Evaluation Unit (in development)

 Establish communication channels specific to VBP utilizing website, Healthstreams, or Performance Logic

19

Presentation Title

Summary

 Thank you to all our network partners that provided us with responses - Any questions regarding what was discussed or for copies of anything presented, please feel free to contact:

Sadia Choudhury Director DSRIP PMO Office E-Mail: [email protected]

20

2016 V.B.P. Survey

Daniel M. Notarnicola Financial Analyst DSRIP PMO Office E-Mail: [email protected]