PCMH Recognized Partner: Premier HealthCare 
Cultural Competency Event | Medical Record Review 
Issue #067 | September 19, 2016

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Highlights from the August Town Hall 

Last month, Mount Sinai PPS hosted its quarterly Town Hall and covered topics from an update on Project 2ai: Integrated Delivery System, the upcoming launch of Community Gateway, updates from the Workforce Committee,  an educational brief on Fraud Awareness, and information about DY2 contracting. To learn more about the presentations from our August Town Hall, please visit here.  Below are a few of those highlights:

Senior Project Manager, Neil Patel, provides updates on Project 2.a.i. 
Project 2ai: Clinical Integration, Patient-Centered Medical Home
Senior Project Manager Neil Patel provided an update on Project 2ai: Integrated Deli very System, a key cross-PPS pr oject. He discussed the Clinical Integration Readiness Survey that will be used to inform clinical integration network development. Neil also talked about the newly for med Practice Transformation Workgroup, which will assess and inform the overall PPS practice transformation strategy. For more information about 2ai, please visit:   http://mountsinaipps.org/2-a-i/


To access Community Gateway, partners must sign-on using a two factor authentication. Community Gateway is mobile friendly. 


Community Gateway - Portal with Applications Exclusive to PPS Partners
Community Gateway will provide partners with the opportunity to connect and share data amongst one another. This portal starts with an enhanced Mount Sinai PPS website and then requires partners to log-on  using a two factor authentication sign-on to access the partner portal. Deepesh Chandra, IT Director, explained a few of the applications partners will have access to use once logged onto the portal. These applic ations include the Organization Profile to lookup other partners with the network, Performance Dashboard for projects, Community Resource Guide for resource sharing among community based organization s and for medical providers, and the Command Center to support partner questions and patient access to care. 

Currently, Community Gateway is going through a pilot rollout before it launches this Fall. It will be introduced to groups of partners at a time, so please stay tuned for an introductory email from us. As a reminder if you have not done so, please submit a description of your organization and your logo to   [email protected] . 
MSPPS Cultural Competency & Health Literacy Special Event: Site Champions Forum 

The MSPPS Cultural Competency & Health Literacy Workgroup will hold a special event for CC/HL Site Champions on Thursday, September 22 at Mount Sinai West for Mount Sinai PPS partners only.  This event will include a presentation on the MSPPS cultural competency/health literacy agenda, strategy, plans, and actions to date, as well as a discussion of the Site Champion role and ongoing engagement of partner representatives. 

All individuals designated CC/HL Site Champions by their organizations are invited to attend this special event.  (Note:  Designation of a CC/HL Site Champion and participation in this event are MSPPS DY2 contract metrics for every partner.)  Light refreshments will be available. To inquire, please e-mail [email protected]. 
Co-Lead Ambassadors Roy Wallach & Brenda Starks-Ross helped lead the kickoff CAC meeting. 
Consumer Engagement with DSRIP 

MSPPS kicked off its first Consumer Advisory Council on September 9th, which consisted of patient and consumer advocates nominated by members of the MSPPS Stakeholder Engagement Workgroup. The CAC participants will use their knowledge from previous and current participation at consumer and community boards to discuss strategies to educate and engage with patients.

The Council will offer feedback to the PPS on patient-related DSRIP initiatives. The next CAC meeting will be held in late September/early October. If you are a current/former consumer advisory council member and wish to join, please contact Tara Partovi, Senior Manager of Stakeholder Engagement at   [email protected].
Lead Ambassadors to Support MSPPS Engagement with the Community     

The Lead Ambassador program kicked off on September 16th with key partner leads who discussed strategies around engaging community-based organizations, government agencies, consumers, and practitioners. Lead ambassadors will help facilitate regional events, education programs, and other in-person activities to promote DSRIP goals and to support MSPPS and community collaboration.

The Lead Ambassador Program held its kick-off meeting to discuss next steps and strategies to promote DSRIP goals.  
Special thanks to Dorella Walters from God's Love We Deliver and Gary Carter from Catholic Guardian Services for serving as CBO- engagement lead ambassadors; Roy Wallach from Arms Acres and  Brenda Starks-Ross from  AIDS Service Center of New York City for serving as Consume r-engagement lead ambassadors; and Dr. Jeanie Tse for leading practitioner-engagement.

For more information, please contact Tara Partovi, Senior Manager of Stakeholder Engagement at  [email protected]. 
Partner Spotlight
The Young Adult Institute Network's Agency, Premier HealthCare, uses their PCMH methods with DSRIP YAI

The YAI Network's Premier HealthCare is 2014 Level 3 PCMH designated and has earned recognition with the National Council on Disability as an effective national health care model for people with intellectual and developmental disabilities (IDD). Premier HealthCare has been able to integrate its experience with DSRIP.

For YAI, being involved in DSRIP has provided YAI with an opportunity to collaborate with other providers and discuss challenges with the people they support. For example, after a DSRIP meeting, YAI was able to connect with other providers to discuss experiences in working with patients with complex needs. Brigida Hernandez, YAI's Director of Research, is excited about the increased opportunities to collaborate with other partners. "I have a feeling during year two we'll know a little bit more about what protocols are being expected of us to implement and we'll have more interaction with our partners," said Hernandez.

 
Photo courtesy of Premier HealthCare
YAI and Premier HealthCare's Commitment  

YAI is a network of six human service agencies which enhance the lives of people with IDD, including autism, Down syndrome, and cerebral palsy throughout the New York metropolitan area, including Long Island, New Jersey, and Westchester and Rockland counties. These agencies provide a variety of support to people with disabilities and their families. 

One of YAI's agencies, Premier HealthCare, proves to be pivotal for the success of DSRIP because of its National Committee for Quality Assurance (NCQA)- Patient Centered Medical Home (PCMH) 2014 Level 3 recognition. Within Mount Sinai PPS, there are four projects that require eligible PCPs to meet PCMH recognition by 2018, Projects 2.a.i, 3.a.i, 3.b.i, and 3.c.i.

Tracey Capers-Reeves, nurse administrator, and Timothy Graham, Executive Director of Premier HealthCare.  
Aligning PCMH with DSRIP

Being PCMH recognized transcends the staff's approach to care for these patients. Tracey Capers-Reeves, nurse administrator who serves as the clinical supervisor of all the support staff, praises the staff's involvement in patient care and integration with DSRIP. She said, "When I think about DSRIP, I tell the team to think about patient centered medical homes because that's what it's about at the end of the day, putting patients at the center and putting a home around the individual and giving them the best care while making them feel empowered."

Reeves has implemented effective communication strategies to ensure her staff is up-to-date with their patients' conditions. Her methods include daily meetings about each scheduled patient, monthly meetings to study metrics, and managers meetings to keep everyone informed on progress or obstacles they have faced.

Premier HealthCare provides many types of services. This room is utilized for dentistry services. 
Being involved with DSRIP focuses staff on specific goals to accomplish. Reeves shares, "DSRIP keeps all of us sensitive about what we need to accomplish. For example, I hear staff say, "Those are PCMH patients [with chronic health conditions], let's make sure we review those metrics.' Hernandez said of the involvement DSRIP has on Premier HealthCare, "We play a very important role in the continuum of care. We're helping DSRIP get to the goal of reducing admissions because we intervene in an outpatient setting and a preventative setting as opposed to allowing patients to be admitted or have an ER visit."




To read the full story please click here. 
For more information on the Young Adult Institute Network please  click here . 

*"NCQA Blog: Features and Announcements."  Health Care Accreditation, Health Plan Accreditation Organization . N.p., n.d. Web. 16 Sept. 2016.
Updates for PPS Partners Updates
Recent Survey to Inform MSPPS Clinical Integration Survey CIRS

As MSPPS continues to develop and refine its PPS hub model strategy, the recently distributed Clinical Integration Readiness Survey (CIRS) will be used to draw a baseline understanding of clinical practices from various provider types and at various partner sites. The survey is intended to capture key clinical domains such as disease programs, care protocols, quality program, care coordination capabilities, existing referral networks, business model, accreditations, patient perspective, and efficiency measures. Overall, this will help inform the PPS's clinical integration strategy, a key DSRIP requirement.

The distribution of CIRS has been divided into two groups of partners and will be sent to the main contact of your organization. Organizations in Group Two should expect to receive the survey on Monday, October 17th. More information can be found here. For any questions, please contact [email protected].
DOH To Select Partners for Medical Record Review 
 
Partners may be randomly selected by the NYS Department of Health (NYS DOH) to participate in a Medical Record Review, to collect data essential to quality improvement within the DSRIP program.  The NYS DOH and the program's independent assessor have partnered with two medical record review abstraction firms (MedReview Inc. and Verisk Health Inc) to complete chart abstractions for all PPSs participating in DSRIP Domains 2 and 3.
 
Chart reviews will be conducted for two HEDIS measures (controlling high blood pressure and comprehensive diabetes care) and one State-developed non-HEDIS measures (screening for clinical depression. The record collection process is scheduled to begin August 2016 and to conclude by January 31, 2017. This effort will not result in any costs to PPSs or participating providers.
 
The Mount Sinai PPS will work directly with partners selected to support the review process. We will keep partners informed of all next steps. If you are not contacted directly by MedReview, or the PPS, you have not been selected to participate. If you have any questions, please email [email protected] .
DY2 Amendments Distributed to Partners 

In late August, MSPPS partners received DY2 amendment packets and reporting templates for completion. Amendments are due September 30, 2016. Reporting templates are due October 31, 2016. For more information, please contact [email protected]. 
MSPPS Partner to Begin Construction of Supportive Housing in Coney Island 
 
A Mount Sinai PPS partner, Concern for Independent Living, is anticipating the start of its latest project, a $69 million, 135-unit building in Coney Island used for supportive housing of the homeless in New York City. 82 of the units will be utilized by homeless veterans while the remaining 53 will be for those individuals who earn less than 60% of the area's median income.
  
The goal of these supportive homes is to provide a safe environment for these people while providing them with different resources to help them get back to work. Concern for Independent Living will be administering case management services and job trainings to improve this process. 
  
This building is only the first phase for this organization, as it hopes to expand to more than 400 units to this neighborhood. To read more about this article click here. 

For more information on this non-profit agency click here. 

Resources for Partners Resource
  • Call 1-844-674-7463 to reach our Call Center for assistance on questions about DSRIP 
  • Click here for external resources that may be helpful for you and your organization
Mount Sinai PPS | [email protected] |   www.mountsinaipps.org |  1-844-674-7463