DSRIP Organizational Components

The AHI PPS infrastructure follows the following DSRIP organizational components:

Governance

An effective governance model is key to building a well-integrated and high-functioning DSRIP PPS network. The PPS must include a detailed description of how the PPS will be governed and how the PPS system will progressively advance from a group of affiliated providers to a high performing integrated delivery system, including contracts with community based organizations. A successful PPS should be able to articulate the concrete steps the organization will implement to formulate a strong and effective governing infrastructure. The governance plan must address how the PPS proposes to address the management of lower performing members within the PPS network. The plan must include progressive sanctions prior to any action to remove a member from the Performing Provider System. See the Governance page for details including the AHI PPS Governance Model.

PPS Financing

Financial Stability The continuing success of the PPS’ DSRIP Project Plan will require not only successful service delivery integration, but the establishment of an organizational structure that supports the PPS’ DSRIP goals. One of the key components of that organizational structure is the ability to implement financial practices that will ensure the financial sustainability of the PPS as a whole. Each PPS will have the ability to establish the financial practices that best meet the needs, structure, and composition of their respective PPS. In this section of the DSRIP Project Plan the PPS must illustrate its plan for implementing a financial structure that will support the financial sustainability of the PPS throughout the five year DSRIP demonstration period and beyond.

Budget – The PPS will be responsible for accepting a single payment from Medicaid tied to the organization’s ability to achieve the goals of the DSRIP Project Plan. In accepting the performance payments, the PPS must establish a plan to allocate the performance payments among the participating providers in the PPS.

Visit PPS Financing to learn more.

Cultural Competency and Health Literacy

Health literacy is “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions”. Individuals must possess the skills to understand information and services and use them to make appropriate decisions about their healthcare needs and priorities. Health literacy incorporates the ability of the patient population to read, comprehend, and analyze information, weigh risks and benefits, and make decisions and take action in regards to their health care. The concept of health literacy extends to the materials, environments, and challenges specifically associated with disease prevention and health promotion. According to Healthy People 2010, an individual is considered to be “health literate” when he or she possesses the skills to understand information and services and use them to make appropriate decisions about health.

Visit Cultural Competency and Health Literacy to learn more.

IT Systems and Processes

The PPS plan must include provisions for appropriate data sharing arrangements that drive toward a high performing integrated delivery system while appropriately adhering to all federal and state privacy regulations. The PPS plan must include a process for rapid cycle evaluation (RCE) and indicate how it will tie into the state’s requirement to report to DOH and CMS on a rapid cycle basis. The PPS plan must have a data-sharing & confidentiality plan that ensures compliance with all Federal and State privacy laws while also identifying opportunities within the law to develop clinical collaborations and data-sharing to improve the quality of care and care coordination.

To learn more, visit IT Systems and Processes.

Performance Reporting

Progress towards achieving the project goals and core requirements will be assessed by specific milestones for the DSRIP program, which are measured by particular metrics. Investments in technology, tools, and human resources will strengthen the ability of the Performing Provider Systems to serve target populations and pursue DSRIP project goals. Domain 1 process milestones and measures will allow DOH to effectively monitor DSRIP program progress and sustainability. Milestones will be required and expected of the PPS to earn DSRIP payments. The milestone is presented for informational purposes only, however, the PPS will be expected to develop a work plan to outline the steps and timeframes in which these milestones will be achieved.

See Performance Reporting for more information.

Population Health Management

Overall DSRIP and local PPS success hinges on all facets of the PPS achieving cultural competency and improving health literacy. Each PPS must demonstrate cultural competence by successfully engaging Medicaid members from all backgrounds and capabilities in the design and implementation of their health care delivery system transformation. The ability of the PPS to develop solutions to overcome cultural and health literacy challenges is essential in order to successfully address healthcare issues and disparities of the PPS community.

Visit Population Health Management for details.

Clinical Integration

Providers in the PPS have engaged in a number of transformational initiatives over the past five years in an effort to address realigning capacity. The Adirondack Region Medical Home Pilot, Health Home, and Adirondacks ACO are improving access to primary and preventive care. These initiatives have had an impact as evidenced by the trend in declining hospital occupancy rates since 2011. The data shows that there continues to be a need to build on these programs and increase access to primary care. The AHI PPS needs to breakdown the historical separation of these services is due to regulatory restrictions for sharing health information between these types of providers, the siloed nature of funding for these two streams of care, the different facilities in which they exist, and stigma related to behavioral health disorders.

A key strategy to address these issues is a stronger, more coordinated system of primary care integrated with behavioral health services. The PPS has 337 PCMH certified primary care practices so the building blocks for coordinated care already exist.

See Clinical Integration for more information.

Practitioner Engagement

The existing health care system, including its 13 hospitals, 7 federally qualified health centers, 31 nursing homes, 4 Health Homes, 15 Certified Health Home Agencies, 6 hospices, 4 assisted living facilities, and among OMH-affiliated programs 7 inpatient mental health providers, 25 outpatient mental health programs, 8 emergency mental health programs, and 45 residential mental health programs. The vast majority of all of these organizations have been actively involved in the PPS’ Project Advisory Committee. The public health departments in each county are also a resource. There is a long list of community-based organizations that provide non-medical services including organizations that provide food bank services, housing, advocacy, faith based, peer support, and community health education. The State’s 211 hotline provides information about and access to many of these services. Many of these organizations are also active in the PAC and can be considered an asset and resource for the AHI North Country PPS.

Visit Practitioner Engagement for details.

Workforce

The overarching DSRIP goal of a 25% reduction in avoidable hospital use (emergency department and admissions) will result in the transformation of the existing health care system – potentially impacting thousands of employees. This system transformation will create significant new and exciting employment opportunities for appropriately prepared workers. PPS plans must identify all impacts on their workforce that are anticipated as a result of the implementation of their chosen projects.

Learn more about the Workforce Committee, the Advisory Council and Workgroups (including meeting overviews and presentations) by visiting the Workforce page.