Issue 41
September, 2018
Welcome to Synergy
We are pleased to present the forty-first 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
SCC's Medical Record Abstraction Process
The SCC Partner Medical Record Abstraction process will begin September 24, 2018. Partners selected for this review will be notified and contacted by the NYS Department of Health medical record review vendor, MedReview Inc., to begin scheduling appointments for record collection services. The medical record abstraction process applies to measures such as screening for clinical depression and follow-up, controlling high blood pressure and comprehensive diabetes care. The results from the reviews determine our final performance which is linked to funds flow payment to the PPS. 

When MedReview Inc. contacts you for records, they will also send you a pocket guide that outlines the exact information required for each measure that is being requested, along with instructions on how to securely transmit your medical records to MedReview, Inc.

Please direct any questions or concerns you may have regarding the abstraction process to:
Christopher Ray, MS
Administrative Manager, Performance Reporting & Management
Phone: (631) 638-1381 
Thank you in advance for your support and cooperation.
American Hospital Association's #123forEquity Pledge Campaign

In 2015, the American Hospital Association (AHA) launched the #123forEquity pledge campaign to encourage the expansion of health equity among the nation's hospitals and health systems. The campaign is a result of a collaboration with the AHA, American College of Healthcare Executives, Association of American Medical Colleges, Catholic Health Association of the United States and America's Essential Hospitals to expand efforts of the National Call to Action to Eliminate Health Care Disparities. The #123forEquity campaign meets emerging needs as the nation's diversity continues to grow. AHA has highlighted a U.S. Census Bureau finding that racial and ethnic minorities currently represent one-third of the U.S. population. Campaign #123forEquity encourages hospitals and health systems to commit to take actionable steps to address health equity and disparities via an online pledge. In NYS approximately 27% of organizations have pledged. For those organizations along with hospitals and health systems across the nation who commit, AHA provides the following recommended pledge goals:  
  • Increasing the collection and use of race, ethnicity, language preference and other socio-demographic data
  • Increasing cultural competency training
  • Increasing diversity in leadership and governance
  • Improving and strengthening community partnerships 
The 1,770 participating hospitals and health systems to date are encouraged to meet the pledge goals through implementing health equity programs within their organizations as well as in the communities they serve.
AHA #123forEquity pledge campaign aligns with the NYS DSRIP Program's objective of expanding culturally and linguistically appropriate care, as well as promoting community based wellness programs to meet the vast health needs of the diverse state. Along with other NYS Performing Provider Systems, the Suffolk Care Collaborative (SCC) has diligently worked on a number of health equity initiatives including providing education on cultural competency and health literacy through our online Learning Center and a regional Cultural Competency and Health Literacy Training Program.  Additionally, SCC features health education and program opportunities throughout Suffolk County on our Community Engagement Webpage.
Consider taking the pledge and committing to expanding health equity. To learn more about AHA's #123forEquity visit
Catholic Home Care's Keeping Little Lungs Healthy Program
Catholic Home Care's Pediatric Asthma Program is an interdisciplinary, holistic, evidence-based approach to asthma management. Through a partnership with the Asthma Coalition of Long Island, experienced pediatric home health nurses receive specialty training to offer education, training and support to children diagnosed with asthma and to their parents. The program experienced a tremendous growth in the number of pediatric asthma referrals and home visits completed through 2017 into 2018.

Upon referral, a home visit is scheduled with the family within 24 hours of an acute care discharge. The child undergoes a physical assessment, including a respiratory evaluation. Also, the nurse performs an environmental assessment to assist the family in the identification of any potential asthma triggers in the home and offers recommendations on reducing their impact. In addition, medications are reviewed and reconciled to ensure they are being used as prescribed and family members understand the mode of administration, purpose and desired outcomes.

A five-question Asthma Control Test is conducted during the visit and at discharge from home care, giving helpful information about the child's level of asthma control. The clinician works with the family, pediatrician and pulmonologist to reduce asthma exacerbations. Through this team approach, the family is equipped with the tools necessary for a productive, healthy life.  P lease call (631) 465-6830 for more information.
A new program at Catholic Home Care is meeting the needs of Long Island families coping with pediatric asthma
COMPASS Unity's Sticker Shock Campaign 

During South Country School District's recent prom season, COMPASS Unity partnered with local alcohol retailers to spread the word about underage drinking, by launching a Sticker Shock campaign. Sticker Shock is an initiative that raises awareness about underage drinking, with the use of bright stickers that carry prevention messaging.
These stickers were placed on alcoholic beverages in participating retail stores, reminding adults about the importance of keeping youth safe and alcohol-free during prom season. The gold colored stickers resembled fancy prom tickets, which read: 
"Your teen has a plan for prom...Do you?
  • Set a curfew
  • Know who they're with and what they're doing
  • Communicate your expectations for an alcohol-free night
Preventing underage drinking is everyone's responsibility. 
Stop an underage drinking party before it begins by calling the "Cancel the Keg"  hotline at 631-852-KEGS"

COMPASS Unity partnered with Dave's Bellport Cold Beer and Soda, Gaby's Deli & Grocery Corp., Bellport Super Deli, 1721 Grocery Inc., and Istvan Gas Station for this campaign. By establishing relationships with local alcohol retailers, the Coalition is strengthening the community's prevention efforts.
This year's sticker shock campaign was supported by Family Service League's Underage Drinking Prevention program, funded by Suffolk Care Collaborative's DSRIP initiative. The stickers were funded by the Suffolk Care Collaborative.
SCC Participates in Emmanuel Outreach Ministries' Back-to-School Health & Community Fair

On Sunday, August 26, 2018, SCC Community Engagement Liaisons participated in the 2018 Back-to-School Health & Community Fair.   Emmanuel Outreach Ministries Inc., in partnership with SCC's Community Health Activation Program Partner, Yam Community Resource, and a variety of local businesses, public sector agencies and other nonprofit community associations supported the fair at Jack Abrams STEM Magnet School in Huntington Station.  The event focused on providing social, educational and legal support, health & wellness screenings and various additional resources to community members.  Families in need received essential school materials to support their children in preparation for the upcoming school year.  Positive feedback of the event was shared by the many diverse families and community members who attended.
Sofia Gondal, MA, and Lyndsey Clark, MS, SCC Community Engagement Liaisons

Sofia Gondal and Lyndsey Clark, SCC Community Engagement Liaisons, provided an overview of the Performing Provider System's community programs and performed live website demonstrations of the Community Engagement webpage. As community based initiatives grow, the SCC Community Engagement team continues to support similar community serving collaborations.

To learn about how your organization can participate in similar events, please contact our Community Engagement Team at .
Partner Interview:  Working to Improve Quality of Life for Those in Need
Name:  Ginette Rows
Title:  Executive Director
Organization:  YAM Community Resource, Inc.

Please give a summary of your organization. 
Yam Community Resource, Inc., (Yam) based in Huntington Station, is a non-profit organization dedicated to providing services to the underserved population in the Haitian community, persons with disability and the elderly. Our overall goal is to improve conditions of living for these populations or any person in need. We provide application assistance for Medicaid and Supplemental Nutrition Assistance Program (SNAP) by helping clients in preparing documentation needed for application submission. We also assist clients with the online application process for health insurance through New York State of Health Marketplace, and assist clients with referrals to appropriate services, including translation, escorting to interviews and providing follow up until the client's needs are met.
Who does your organization serve?
Yam provides outreach primarily to the Haitian community in Suffolk County but we welcome all community members in need of assistance. Most of the clients we serve live within the areas of Huntington, Greenlawn, Central Islip and Brentwood.
Describe your involvement with DSRIP and what you hope to accomplish.
DSRIP looks at the community at large and identifies needs and the determinants to good health. DSRIP also brings together partners in diverse sections of the community through collaboration to provide services needed.  As partnerships develop, the community will become more active in their health activities and be able to improve health concerns at the community level for each individual. Yam's emphasis is on building bridges and minimizing gaps in services for the Medicaid population.
Why did you choose to participate as a partner of the SCC?  
SCC implements programs to address the gaps assessed in our communities. Yam participates in the Community Health Activation Program (CHAP) by conducting Patient Activation Measure (PAM) Surveys in Suffolk County. The PAM Survey is a tool with 10 questions and takes only 3-4 minutes to answer the questions. This tool effectively assesses how active a client is in managing their health issues. Once the level of need is identified, there is also a component of coaching and a plan to assist the client in making appropriate choices for a positive health outcome. We are gradually introducing this tool in the Haitian community to assess the needs and provide assistance based on survey outcomes.
What has your organization done to make transformational changes?   
Yam has partnered with Catholic Health Services to provide health education programs in the Haitian community through houses of worship. We are currently working in collaboration with Huntington Church of God as the central site for the Haitian Community Program. However, invitation is extended to all churches. We are working closely with one of the pastors to bring programs that address specific needs and are culturally appropriate. The programs include classes, health screenings, preventive care and demonstrations and are presented in both Haitian Creole and English.
How do you see your work making an impact on the communities and population served?
Yam has been working very closely with Pastor Edmonde Francks of the Huntington Church of God and we are now planning a fall program. We also have scheduled meetings with other churches in Suffolk County to bring awareness of the program and look forward to extending to other sites. Awareness and education are the key to making an impact.
Compliance Connection
Security Risk Assessments

Doing a Security Risk Assessment (SRA) is an important part of any healthcare compliance program.  Conducting one doesn't have to be a challenge if you avail yourself of a free tool  developed by the federal Office of the National Coordinator for Health Information Technology (ONC) and two other federal agencies.  It is easy to access, download and use and it is available by  clicking here .

A risk assessment helps your organization ensure it is compliant with HIPAA's administrative, physical and technical safeguards.  A risk assessment also helps reveal areas where your organization's protected health information (PHI) could be at risk.   Watch the Security Risk Analysis video to learn more about the assessment process and how it benefits your organization or visit the Office for Civil Rights website for official guidance.

For compliance  questions or assistance, contact SCC's Compliance Office at
 Milestone Dates
 NYS DOH DSRIP Program Milestone Dates
October 31
PPS Year 4 Second Quarterly Report (7/1/18 - 9/30/18) due from PPS

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