Issue 40
August, 2018
Welcome to Synergy
We are pleased to present the fortieth issue of Synergy, a monthly newsletter about the progress and processes of the Suffolk Care Collaborative (SCC).

The definition of synergy is the increased effectiveness that results when two or more entities work together. We are confident that the combined efforts of the many dedicated partners within the SCC will help the Collaborative reach its goals, leading to improved health for the residents of Suffolk County.  

About Suffolk Care Collaborative (SCC):  SCC is an alliance of healthcare providers in Suffolk County, Long Island, NY, formed to support New York State's Delivery System Reform Incentive Payment (DSRIP) initiative. Under the guidance and leadership of Stony Brook Medicine, SCC established a Population Health Management Service Organization to improve county-wide health by addressing a wide range of challenges to health in order to improve outcomes by encouraging wellness, making healthcare more accessible and reducing costs by decreasing unnecessary hospital utilization.  For more information, visit our website:

In This Issue
Please join us for the Suffolk Care Collaborative's
Quarterly Project Advisory Committee (PAC) Meeting

Thursday, September 20, 2018

***Please Make Special Note That This Meeting is 
Taking Place at a  New Location***

Hilton Garden Inn - Stony Brook
1 Circle Road, Stony Brook, NY

True Population Health in the Context of Value Based Payment
Ryan Ashe, Director of Medicaid Payment Reform
NYS Department of Health
~ ~ ~ ~ ~ ~
Family Service League's Crisis Services Continuum 
Jeff Steigman, PsyD, Chief Administrative Officer
Christine Racine, PhD, Senior Director of Clinics
Jessica Acquino, LCSW-R, Director, DASH (Diagnostic, Assessment and Stabilization Hub)
~ ~ ~ ~ ~ ~
Leveraging Regional Health Information Organization (RHIO)
Alerts to Improve Outcomes
William Bishop, MHA, Director, Clinical Programs Innovation, SCC
Diana Cappabianca, RN, Education and Care Coordinator,
Meeting House Lane Medical Practice, PC
~ ~ ~ ~ ~ ~
Registration starts at 8:30 AM
Program 9:00 AM to 12:00 PM

New York State Smokers' Quitline Launches Enhanced Website
Redesigned Features Updated Healthcare Provider Resources, New Logo, Increased Visuals and Online News Room

As part of its ongoing commitment to promote tobacco cessation efforts, the New York State Smokers' Quitline (Quitline), headquartered at Roswell Park Comprehensive Cancer Center in Buffalo, N.Y., launched a fully updated, redesigned and mobile-ready website at Enhanced visuals, easier-to-read text and more intuitive navigation will help visitors quickly find the latest resources on tobacco cessation. Messages throughout the website also encourage tobacco users and healthcare providers to talk to one another for greater chances of quit-success.

Visitors to will notice a new color scheme and a new logo, with the "Q" in "Quitline" resembling a no-smoking sign. In addition, a new Online News Room will help members of the media and healthcare providers stay informed about the latest tobacco cessation news in New York State. The Online News Room includes helpful tools such as an Experts Database, a sign-up form for e-newsletters and a press release archive.

Tobacco users will encounter positive messages about the quit-process throughout the website, such as reframing thinking about slips and relapses, as well as building confidence and knowledge prior to discussing quitting with a healthcare provider. also addresses timely topics such as e-cigarettes, the truth about filters, medication enrollment and healthcare benefits.
Healthcare providers will find a special sub-section geared toward helping them deliver quality tobacco dependence treatment to their patients, including step-by-step information on how to use the Quitline's Patient Referral Program. Links to peer-reviewed resources are available for topics such as prescribing stop-smoking medications, billing codes and healthcare system-wide solutions.

Article adapted from Roswell Park Comprehensive Cancer Center & NYS Smoker's Quitline press release.
Long Island Select Healthcare, Inc. Hosts Health Fair During National Health Center Week   

Long Island Select Healthcare, Inc. (LISH) hosts a health fair during National Health Center Week every year.  This year the fair took place on August 16, 2018, at their Central Islip location.  
Alexandra Kranidis, MPH, CPH, Project Manager, SCC and Andrea Spatarella, DNP, RN, FNP-BC, Nurse Practioner, Northwell Health Center for Tobacco Control

The main goals of the fair are to extend resources to existing patients, invite non-patients in an effort to show the multitude of services and patient-centered care that LISH provides, as well as build strong relationships with participating vendors and outside resources.  In addition to the vendor booths this year, visitors enjoyed snow cones, a bouncy castle, and tours of the Central Islip facility. Guests included members of the community, friends and family of LISH employees, residential nurses and existing patients. Attendees left the health fair with various education material and giveaways such as first-aid kits, sunscreen, pens, blankets, bags, etc.
Telehealth and Data Analytics of the Future
Biomedical Informatics CME Bootcamp
Stony Brook Medicine Biomedical Informatics and Stony Brook Medicine Telehealth will be hosting  Telehealth and Data Analytics of the Future
Friday, October 12, 2018
9 am - 5 pm
Charles B. Wang Center Theater
Stony Brook University
100 Nicholls Road, Stony Brook

The future of medicine will depend on digital platforms rapidly evolving and growing today in telehealth and data analytics.   As the future of telehealth evolves, remote patient monitoring will provide a cloud of health information systems that use algorithms to process these data streams and alert healthcare teams of trends and values that signify potential problems and require healthcare provider analysis and possible intervention.  

This event is free and open to all medical and healthcare professionals.  6.0 CME credits available.  
SCC Hosts Cultural Competency & Health Literacy Master Training 

SCC's Community Engagement Team recently hosted a Cultural Competency and Health Literacy Train-the-Trainer (CCHL TTT) class.  SCC provides the CCHL Training Program in partnership with Nassau-Queens Performing Provider System, Long Island Health Collaborative (LIHC) and curriculum creator Dr. Martine Hackett, an Assistant Professor at Hofstra University.  The class was held on July 24, 2018, and included 16 partners from diverse backgrounds such as provider offices, home care agencies, Community Based Organizations and health information technology serving the Queens and Long Island regions.  The objective of the CCHL TTT program is to advance cultural and linguistic competency, promote effective communication to eliminate health disparities and enhance patient outcomes.  Participants interactively learned concepts of regional health equity data, unconscious bias, social determinants of health, cultural competency and humility, National Culturally and Linguistically Appropriate Services (CLAS) Standards, health literacy barriers and strategies, as well as the Teach-Back Method.  Upon completion of the CCHL TTT class, the participants received certificates of completion and a toolkit to help prepare them to deliver the CCHL Training Program in their organizations.  Congratulations to the new CCHL Master Trainers!

Standing left to right:   Ashish, PAL Software; Libsen, Delmont Medical Care; Kathleen Cino, Farmingdale State College; Cristina Oliveri, RR Health Strategies; Jackie Grimaldi, Western Suffolk BOCES; Peggy Osei-Tutu, Visiting Nurse Services of NY; Jeanine Pilgrim, IPRO; Glenn Grodner, Bellhaven Center; Karina Lopez, HRHCare; Barbara, Partners in Care-Visiting Nurse Service of NY
Sitting left to right:   Kennya, Partners in Care-Visiting Nurse Service of NY; Kelly Urena, Wyndanch Union Free School District; Sofia Gondal (Class Instructor), SCC; Stephanie Tam, Square Care Medical Group, LLC; Ana Abreu, EOC of Suffolk; Jacqueline 
Delmont, MD, Delmont Medical Care

For SCC's 2018 Train-the-Trainer class dates, please explore the CCHL landing page hosted on LIHC's website.   To learn more about the CCHL Training Program and how your organization can participate, please contact SCC's Community Engagement Team at .
Northwell Sponsors Mobile Farmer's Market for Food Insecure Long Islanders  

Northwell Health announced that they are sponsoring the  Family Residences and Essential Enterprises, Inc. (FREE) Fresh Truck Mobile Market, a farmer's market on wheels run by the Old Bethpage-based nonprofit FREE.  The truck, donated by Suffolk Transportation Services, Inc., filled with fresh fruits and vegetables, will make healthy, local, affordable produce available to Long Islanders, especially those who are experiencing food insecurity, each week at six locations in Nassau and Suffolk counties.
The FREE Fresh Truck Mobile Market 
The FREE Fresh Truck Mobile Market is FREE's way of making locally grown fresh produce more accessible in high need communities.  In addition, it provides FREE with a means of making a positive impact on the obesity epidemic. The FREE Fresh Truck Mobile Market will have nutrition educators on hand to help answer questions and provide guidance as well as tip sheets, books, samples and giveaways.
"As an organization that cares for two million people every year, we see many who would benefit  from adding more fresh produce to their diets and appreciate FREE's partnership to accomplish  this," said Ram Raju, MD, chief community investment officer at Northwell Health. "Many ailments, from heart disease to diabetes, could either be prevented or minimized through a healthy diet that incorporates fresh fruits and vegetables."
"The produce will primarily come from FREE's FREEdom Farm in Brentwood," said Robert S. Budd, MPS, chief executive officer of FREE. "Some additional items will come from farms at our affiliate Skills Unlimited, Inc. in Oakdale and FREE's Saddle Rock Ranch in Middle Island. We appreciate Northwell Health's partnership in this endeavor, which will go a long way to providing people with the fresh produce that is so beneficial for their diets and lives."
Left to right:  Nancy Copperman, Vice President, Community Health, Northwell Health; Kimberly Schultz, Community Projects Director, Eat Smart NY Long Island Region (ESNYLI), Family Residences and Essential Enterprises, Inc. (FREE); Melanie Levy, Nutrition Educator, ESNYLI, FREE; Seema Uppaul, Nutrition Educator, ESNYLI, FREE; Amy Bly, Senior Nutrition Educator, Cornell Cooperative Extension, (CCE) Suffolk; Anthony Garcia, Nutrition Educator, CCE Suffolk, ESNYLI; Anita Dowd-Neufeld, Chief Administrative Officer, FREE; Robert S. Budd, CEO, FREE and Joe Jankowski, Senior Director of Government and Public Relations, FREE.

The Fresh Truck Mobile Market will be available on Wednesdays from 10 a.m. to 11 a.m. at the Dolan Family Health Center in Greenlawn and the Family Medicine Center at Glen Cove Hospital from 12:30 p.m.-1:30 p.m. On Thursdays from 10 a.m. to 12 p.m., the truck will be at Adelante of Suffolk County in Central Islip and from 12:30 p.m.-2:30 p.m. at FREEdom Farm in Brentwood. On Fridays from 10:30 a.m. to 11:45 a.m. at HRHCare Health Center at Brentwood and from 12:30 p.m.-2:00 p.m. at Southside Hospital in Bay Shore.
The following can be used to purchase items from the mobile farmer's market: SNAP/EBT cards, FreshConnect Checks, New York State Farmers Market Nutrition Program WIC checks, Senior Checks, WIC Vegetables and Fruit Checks and cash.  For more information, call (516) 287-2224.
Youth Development Survey Assists in Informing Alcohol Prevention Planning

COMPASS Unity, Bellport/South Country's Drug and Alcohol Prevention Coalition, utilizes the summer months to plan its prevention initiatives for the upcoming year, which runs according to South Country Central School District's calendar. The Coalition utilizes multiple sources of data, including the results from the Youth Development Survey (YDS) to assist in its planning.
Backed by support from Family Service League's Underage Drinking Prevention program, funded by Suffolk Care Collaborative's DSRIP initiative, COMPASS Unity administered the YDS to students in grades 7 through 12 during the fall of 2017. The 128 question evidence-based survey was designed to assess risk factors and estimate the use of alcohol and other substances among adolescents, as well as other problem behaviors.  It also looks at protective factors that are reported by youth, such as school, community and family engagement.
According to the 2017 Youth Development Survey, the average age that surveyed students first began to drink alcohol regularly (more than a sip once or twice a month) varies by grade level.
  • Seventh and eighth graders reported the average age of first use and regular use at age 12
  • Ninth and tenth graders reported the average age of first use and regular use at age 13
  • Eleventh and twelfth graders reported their average first use of alcohol at age 14, but regular consumption at age 15
According to survey results, easy social access is a primary root cause for underage alcohol use within the South Country community. Underage youth are accessing alcohol in places including local stores, homes of friends or family members, older friends, as well as within their own homes with and without parents' consent.
Using the data from the Youth Development Survey, COMPASS Unity will update its action plan, in an effort to strategically address the problem of underage drinking. The Coalition will continue to implement prevention initiatives by working with youth, local retailers that sell alcohol and other stakeholders to limit the access of alcohol to youth, as well as increase the perceived danger of alcohol consumption by youth.
Partner Interview:  Diabetes Wellness Education for the Community        
Name:  Maria Curcio, RDN, CDN, CDE   
Title:  Diabetes Wellness Program Coodinator
Organization:  Long Island Community Hospital (formerly known as Brookhaven Memorial Hospital Medical Center)

Please give a summary of your organization. 
For more than 60 years, Long Island Community Hospital (formerly known as Brookhaven Memorial Hospital Medical Center) has served the diverse region of southern central Suffolk County as a patient-first community hospital. An important underpinning of the hospital's Community Service Plan is providing resources and services to at-risk members of the 400,000 community members and LI Community Hospital employees we serve, who are managing chronic diseases, including Diabetes.
As part of our three-year Plan of Action, LI Community is collaborating with various community organizations to offer educational programs and healthy living self-management services.   With the support of the Suffolk County Lions Diabetes Education Foundation  and Lions International, LI Community developed the Diabetes Wellness Center in 2006. The center offers Diabetes Self-Management Education services in partnership with the American Diabetes Association (ADA). Additionally, in partnership with The New York State Diabetes Prevention Program (NYS DPP), the Long Island Community Hospital Diabetes Wellness Center hosts free education programs provided by the Suffolk County Department of Health Services. Pre-diabetes is a serious health condition that can lead to diabetes, heart disease and stroke; most people with pre-diabetes do not know they have the condition.

What is the biggest challenge facing patients with diabetes and those at risk for developing diabetes?
Those who have diabetes and those who are at-risk for developing diabetes face many challenges. An important factor in determining a person's readiness and motivation to engage in diabetes self-care activities depends on their social situation.  Potential barriers may include financial insecurity, lack of transportation, employment status, health insurance coverage, home environment and social support.  An individual with diabetes facing one or more of these issues might feel like diabetes self-care management is an insurmountable goal.  For example, one of our clients who was living in a shelter long-term only had access to a microwave for cooking. She consistently showed up to her scheduled appointments and was engaged and motivated to improve her health.  Together we were able to develop a sensible diabetes self-care plan that took into consideration her environment and personal circumstances.  

How do your education services reach and impact your community?
Our Diabetes Wellness Center provides diabetes wellness education services, such as one-on-one nutrition classes and ADA-accredited group diabetes education classes.  We are currently implementing the Center for Disease Control's National Diabetes Prevention Program (NDPP) for individuals at-risk for developing type 2 diabetes.  These services are promoted through various referral sources such as community physician practices, multiple MyHealth locations, Bellport Primary Care and during hospital discharge. Our Marketing Department also promotes the services at health fairs and local community events, as well as on our website, email blasts and social media postings. I coordinate with hospital care managers and registered dietitian nutritionists, Suffolk Care Collaborative care managers and physicians from MyHealth locations to tailor diabetes education services to meet the needs of their patients.  Diabetes presentations are also offered in tandem with community partnerships such as the Boys & Girls Club of Bellport, senior citizen groups and the YMCA. Our goal is to be an effective resource for the community with diabetes by offering a variety of diabetes wellness education services.

Describe the benefits diabetes education provides to patients.
Proper diabetes wellness education provides patients with the skills they need to make informed daily decisions that help them live a healthier life.  As they practice these new skills, they gain confidence that their disease can be successfully managed. They are also better prepared for the stresses that inevitably occur with the disease. Numerous epidemiology studies show the health benefits of diabetes education that considers the whole person - improved clinical outcomes, reduction in use of acute care services, better coping skills and enhanced quality of life.

How can providers send their patients to you for education services?
Individual nutrition classes, ADA-accredited group diabetes education classes and NDPP classes are held at several of our locations in Patchogue and Holbrook.
You can find additional information on our website.   Patients can also contact us directly by email at or calling 631-687-4188.
Compliance Connection
Operating an Effective Compliance Program 

Periodically organizations need to review the effectiveness of their compliance program.  Here are some tips from the Office of the Inspector General (OIG) to ensure you are operating an effective compliance plan:

Policies & Procedures
  • Conduct regular reviews and update with your organization's leaders and compliance committee
  • Ensure policies are written clearly and tailored to the intended audience
Measuring Effectiveness
  • Develop compliance program with measurable goals; measure how well you are meeting those goals
  • Involve Board of Directors in creating program; provide regular updates regarding compliance risks, audits and investigations
  • Regularly review and update training programs - use different approaches using "real-life" examples; make training completion a requirement
  • Test employees' understanding of training topics
  • Train the Board of Directors
  • Continuously develop compliance staff
Lines of Communication
  • Have open lines of communication with employees
  • Maintain an anonymous "hotline" to report isssues
  • Enforce a non-retaliation policy for employees to report potential problems
Internal Auditing
  • Perform proactive reviews in coding, contracts & quality care
  • Create an audit plan and re-evaluate it regularly
  • Identify your organization's risk areas
  • Create corrective action plans to fix problems
For the entire list of tips from the OIG's Healthcare Fraud Prevention and Enforcement Action Team (HEAT) click here.  Provider compliance training videos can be viewed on the OIG's website.  For compliance 
questions or assistance, contact SCC's Compliance Office at
 Milestone Dates
 NYS DOH DSRIP Program Milestone Dates
September 14
PPS Remediation of PPS DY4 First Quarter report
September 29
IA approval of PPS DY4 First Quarter report

Frequently Asked Questions


To access NYS DSRIP FAQ, click  here.
Access previously published Synergy eNewsletters  here
Job woman showing hiring sign. Young smiling Caucasian   Asian businesswoman isolated on white background.
Office of Population Health
Career Opportunities
The SCC is pleased to invite qualified career seekers to apply for open positions. All job descriptions for current opportunities are posted here.

Current Job Opportunities:
  1. Care Management Supervisor
  2. Community Health Associate
  3. Care Manager
  4. Social Worker
  5. Project Manager
  For more information, please contact the Suffolk Care Collaborative via email