Issue 33
January, 2018
Welcome to Synergy
We are pleased to present the thirty-third 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
Primary Care Practice Transformation Update
Recognition Progress Across the PPS

As part of Suffolk Care Collaborative's practice transformation, the Practice Transformation Workgroup brings together experts and practice leaders that have significant experience in transforming practices under Patient Centered Medical Home (PCMH) 2014 standards.

The practice transformation efforts at SCC across its three (3) hubs, Stony Brook University Hospital (SBU), Northwell Health (NWH) and Catholic Health Services of Long Island (CHS), have been progressing well.  As of January 2018 the progress report demonstrates the status by Hub for PCMH 2014 Level 3 recognition.  The practice sites stats are identified as Completed or In Progress below.  



Click here for the list of organizations across all 3 Hubs that have been PCMH 2014 Level 3 recognized since our last update in May.  The entire list of PCMH 2014 Level 3 recognized partners can be accessed here.    

The practices that are working towards transformation have support from PCMH Certified Content Experts (CCE) and practice transformation specialists or are supported by their internal practice transformation champions.  Transformation related training is offered to our partners in a cohort or on a one-on-one basis. 

As practices continue to progress through the PCMH journey, some of our partners are engaged in the Advanced Primary Care (APC) model.  Currently, SCC Hubs have a total of 70 practice sites in progress for APC certification, working with a technical assistance vendor to support their practice transformation process.  For more information contact Shanna Willilams, Project Manager, Practice Transformation, at 631-638-1371 or email
Cultural Competency and Health Literacy Master Training Program

SCC's Community Engagement team continues to conduct Cultural Competency and Health Literacy (CCHL) Training throughout Suffolk County. The curriculum includes topics that address health equity, unconscious bias, cultural competency and humility, health literacy barriers and the "Teach-Back" method for providers serving racially and economically diverse populations. Dr. Martine Hackett, an Assistant Professor at Hofstra University in collaboration with the National Center for Suburban Studies, Suburban Health Equity Institute designed a self-sustaining region-specific curriculum.  CCHL training advances cultural and linguistic competence, promotes effective communication to eliminate health disparities and enhances patient outcomes. As a result of workforce specific needs, the CCHL training program is available for organizations in two formats:  the 2 Hour Workforce Program and 7.5 Hour Train-the-Trainer Program. In the 2 hour program participants will learn about social determinants of health in Queens and Long Island, unconscious bias, the National Culturally Linguistically Appropriate Services (CLAS) Standards, cultural humility and the Teach Back method for frontline staff.  In the 7.5 hour interactive program, participants will explore the same content curriculum as the 2 hour program and, in addition,  will be trained to deliver training sessions at their worksite(s) and other locations using a specifically designed toolkit and curriculum. 

Upon completion of the program, attendees will be Master Trainers and will host training sessions which will ensure the sustainability of the program.  For more information on the program and 2018 dates for Train-the-Trainer classes, please explore the CCHL Training Program webpage, hosted by Long Island Health Collaborative (LIHC).
For program specific questions and to learn how your organization can participate, please contact our Community Engagement Team at .
February is Heart Health Month and Long Islanders are Invited to the Seventeenth Annual Long Island American Heart Association "Go Red For Women®" Luncheon

Men and women from across Long Island will be getting all their red outfits and accessories ready for the American Heart Association's 17th Annual Long Island Go Red For Women® Luncheon.  Heart disease and stroke are the No. 1 and No. 5 killers of Long Island women, respectively. For more than a decade, women have been fighting heart disease individually and together as part of the Go Red For Women® movement. Cardiovascular diseases cause one in three women's deaths each year, killing approximately one woman every minute.
Since 1984, more women than men have died each year from heart disease and stroke. An estimated 43 million women in the U.S. are affected by cardiovascular diseases. When you get involved in supporting Go Red For Women® by advocating, fundraising and sharing your story, more lives are saved. The Long Island American Heart Association's 17th Annual Go Red For Women® Luncheon is on Wednesday, February 28, 2018, at the Crest Hollow Country Club in Woodbury from 8:30am - 2:00pm. 

The American Heart Association's 17th Annual Go Red For Women® Luncheon combines an elegant luncheon reception, silent auction, networking opportunities and moving survivor stories. The Long Island Go Red For Women® Luncheon will again feature educational breakout sessions presented by recognized and credentialed healthcare professionals, providing women with information, resources and hope to take action and live a longer, stronger life. 
The American Heart Association Go Red For Women® Luncheon is attended by both women and men from business, health, education, local and state government.  For details about sponsors and honorees of this event and sponsorship opportunities, ticket or table reservations, call the American Heart Association at (516) 962-0811 or visit the website
Go Red for Women ® captures the energy, passion, and intelligence of women to work collectively to wipe out heart disease - the No. 1 killer of women. Since 2004, The American Heart Association has fostered Go Red to grow from a grassroots campaign into a vibrant national movement. Using the simple moniker "Love Your Heart," Go Red for Women ® aims to mobilize women, men, celebrities, healthcare providers and politicians to embrace and elevate the cause of women and heart disease. For more information about Go Red for Women ®, please call 1-888-MY-HEART (1-888-694-3278) or visit
SCC & Greater New York Hospital Association Offering Health Literacy Training for Front Line Staff

SCC will be co-hosting with the Greater New York Hospital Association (GNYHA) and the Continuing Care Leadership Coalition (CCLC) a half-day health literacy training opportunity for frontline primary care, hospital, continuing care, community and faith based organization staff and managers.   

Thursday, April 5, 2018
Registration and breakfast starts at 8:30 am
Training 9:00 am - 1:00 pm
Suffolk Care Collaborative
1393 Veterans Memorial Highway, Hauppauge, NY

The session is designed to provide frontline staff with baseline information about health literacy and to support organizations in their efforts to engage frontline staff in their health literacy initiatives. The curriculum includes training on the definition of health literacy and the introduction of basic health literacy concepts; a discussion on the importance of addressing health literacy for patients who are aged, have chronic diseases or have special communications assistance needs.  Staff participation can also assist members with meeting Delivery System Reform Incentive Payment (DSRIP) program Health Literacy training expectations.

Recommended participants include: Nurses, registration and admitting staff, medical assistants, social workers, care managers, patient experience staff, health educators, discharge planners, dieticians, pharmacists, community health workers, public affairs and others who interact with patients.

Hospital employees are encouraged to register directly on the GNYHA website here If you are not a hospital employee, you may register  here  If you have questions about registration, please contact Elizabeth Wilson at
Partner Interview:  Practice Transformation Experience
Name:   Laura Lynch, CMPE, PCMH-CCE
Photo credit Jeanne Neville
Title:  Practice Administrator
Organization:  Southampton Pediatric Associates

Please give us a summary of your organization.
Southampton Pediatric Associates is a practice of Stony Brook Children's Services, caring for the children on the South Fork of Long Island for over 35 years.  We provide quality care from two locations, Southampton and Hampton Bays.  Our patient population is estimated at 20,500 visits per year; 50% of those visits are patients on Medicaid and/or Child Health Plus (CHP). 
Transformational Change: Explain the Patient Centered Medical Home (PCMH) journey to recognition and the benefits and challenges you and the practice team faced, up to your submission to National Committee for Quality Assurance (NCQA) for recognition.
The process to become PCMH recognized started with a recommendation by another practitioner in the area who already achieved PCMH Level 3 recognition.  When it was decided that the practice would move forward on becoming a patient centered medical home, as the practice administrator, I knew we had a long journey with a lot of work ahead.  We experienced some challenges, the first was moving from paper charts to electronic medical records (EMR).

One of the biggest challenges was resistance to change.  After explaining to the staff the need for the practice to transform, we discussed the necessary changes that would need to take place to enhance workflow, and most importantly, provide our patients with a better experience and better quality, everyone involved became engaged in making the necessary changes.

In an effort to assist in the transformation I reviewed our workflows and opportunities to further develop skills within our existing staff and identified an administrative coordinator, to assist with referrals and demographic maintenance, and a clinical care coordinator, to assist with diagnostic test maintenance and clinical integration of new policies and procedures.   For about a year we worked as a team and set up the framework to meet the standards and guidelines for PCMH transformation.  I created templates to track and identify our high risk patients in need of additional health services, enhanced their care plans and provided extra care management services.
A benefit of this journey was the support of the Suffolk Care Collaborative.  They provided us with technical assistance from a consultant, Hospital Association of New York State (HANYS), that specializes in practice transformation and getting primary care practices recognized.  Having the guidance of the consultants kept me focused and helped me to overcome some of the barriers the practice faced. 

Another benefit that helped in this transformation was my attendance at a 3 day NCQA PCMH 2017 Conference, which was encouraged and supported by Stony Brook Administrative Services and SCC.  Through the consultant support and education I received, I feel confident that our application submitted on December 8, 2017, will result in PCMH 2014 recognition. 
Can you explain what a PCMH-Certified Content Expert (CCE) is?  As the Practice Administrator, and now a PCMH-CCE, how do you feel your accomplishment will impact the transformation of the practice moving forward?
A PCMH-CCE is someone who is certified by NCQA through an exam process and understands the content of the model and has experience in transforming a practice in attaining PCMH recognition. 

My accomplishment of becoming PCMH-CCE was a personal goal of mine.  I had become very knowledgeable in the transformation under the PCMH 2014 standards and guidelines and after attending the NCQA PCMH 2017 Conference I felt I had gained the expertise needed to take the exam.  This certification allows me to continue improving patient experience and outcomes in the practice. 
Passing the exam and being certified will greatly assist the practice's commitment to quality.  Being recognized is an on-going commitment which requires regular reporting and oversight from NCQA to ensure we are meeting and sustaining all requirements for PCMH 2017 standards.  As an expert, I will be able to oversee and lead the process.
Compliance Connection
Data Integrity is Everyone's Responsibility 

Each quarter SCC's Performance Evaluation and Management Team conducts a Partner Data Request webinar.  This webinar walks partners through the required DSRIP patient engagement reporting to the NYS Department of Health.  The education focuses heavily on the importance of data integrity and proper safe transmission of Protected Health Information (PHI).

Partners are reminded  of the expectation for submitting data that is true, accurate and complete.  In addition, the webinar features how to securely send quarterly data to SCC.   To view the most recent webinar visit our website here .

For compliance questions, or assistance, contact the SCC Compliance Office at
 Milestone Dates
 NYS DOH DSRIP Program Milestone Dates
Opt-Out Phase IV Mailer
February 6-8
Annual Statewide Learning Symposium - Staten Island, NY
March 3
Independent Assessor provides feedback on PPS Year 3 Third Quarterly Reports; 15 day Remediation window begins

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. Administrative Assistant
  2. Care Manager
  3. Community Health Associate
  For more information, please contact the Suffolk Care Collaborative via email