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Daniel Chambers Luke Mellis Jocelyn Nunez Jennifer Reyes

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THREE YEAR STRATEGIC PLAN

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A more integrated delivery system, better able to take on risk and deliver value.
A more sustainable delivery system, care delivered locally and in the right care setting.
A more patient-centered delivery system, with expanded access to services tailored to the unique needs of our patients and communities.

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VISION

Source: Montefiore Hudson Valley Collaborative, 2018.

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Hudson Valley Region

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2.3 Million Residents

25% Decrease in Homelessness over 3 years

1 in 5 are covered by Medicaid

57 Contract Organizations

220,000 Medicaid Lives

Source: Department of Health New York, 2017.

460,000 Medicaid Beneficiaries

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Service Area

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Focus areas:

Sullivan
Rockland
Westchester

Identification factors:

1.3 million on Public Insurance
>2,000 Homeless Population

Source: Esri, 2018. New York Department of Health, 2017.

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What is Our Challenge?

Delivery System Reform Incentive Payment (DSRIP) Program's primary goal is to reduce avoidable hospital use by 25%.
$250 million of the $6.4 billion allocated to DSRIP was granted to MHVC.
DSRIP funding ends in 2020.

Source: Department of Health New York State, Delivery system reform incentive payment (DSRIP), 2017.

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Reduce unnecessary hospital visits by 25% by 2020, from 2015 levels.

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Expand our network of contracted providers by 25%.

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Develop and implement a physician recruitment and retention strategy.

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Engage the community to promote health and wellness by developing programs to increase access to services.

Critical Success Factors

Source: Montefiore Hudson Valley Collaborative Consulting Group, 2018.

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Source: United Way 211, 2016.

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Top 4 Healthcare Referral Needs

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Source: United Way 2-1-1 Counts Hudson Valley Region, 2017.

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HudsonConnect

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Goal: To link patients with social services to decrease unnecessary health visits.

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HudsonConnect Pilot

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Source: Montefiore Hudson Valley Collaborative Consulting Group, 2018.

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Expand the MHVC Network

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25% network growth by 2021, through partnering with outside FQHCs, hospitals, and clinics.

Assist Montefiore IPA with recruitment, increasing their number of physicians 30% by 2021.

Why?

To increase access to local primary, specialty, and urgent care services.
Reduce need for safety nets like emergency departments and improve population health.

Source: Montefiore Hudson Valley Collaborative, 2018.

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Physician Recruitment and Retention

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Recruitment Goal:	Support member organizations in creating residencies for new physicians 12 new resident positions across Hudson Valley per year from 2019 through 2022
Retention Goal:	Doctors Across New York (DANY) 3-year commitment \| $120,000 loan repayment National Health Service Corps (NHSC) 2-year commitment \| $50,000 loan repayment 50% of eligible organizations registered as DANY sites by 2021

Source: American Academy of Family Physicians, 2018.

A challenge which our partners face is in recruiting and retaining qualified physicians. We see residencies as an opportunity to bring sharp, new graduates into the Hudson Valley. However, many small providers lack the resources to create their own residencies. We can provide the administrative support needed to create new residencies, especially in primary care and psychiatry, throughout our collaborative. Through Montefiore’s partnership with Albert Einstein College of Medicine and collaboration with other local medical schools, we can create a pipeline for bringing new doctors into the Hudson Valley.

But how do we retain residents? New York State and the National Health Service Corps have two generous loan repayment programs. We need to register member organizations as Doctors Across New York sites; then, doctors who work there can apply for $120,000 in loan repayment in exchange for a 3-year commitment. Much of our service area is considered a HRSA primary care-shortage area, so doctors who work in these areas can apply for $50,000 in loan forgiveness from the National Health Service Corps, in exchange for a 2-year commitment.

https://www.aafp.org/medical-school-residency/medical-school/debt/before-school/service-based.html

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Annual Budget Proposal

Total Cost of 3-Year Strategic Plan: $2,836,000

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*Salaries derived from New York State averages.

Source: Business Comp Analysis, Salary.com, 2018.

Project/Positions	Year 1	Year 2	Year 3	Total Cost
2-1-1 Contract	$ 250,000	$ -	$ -	$ 250,000
Health Educators (2)	$ 130,000	$ 130,000	$ 130,000	$ 390,000
Program Coordinator (1)	$ 50,000	$ 50,000	$ 50,000	$ 150,000
Administrative Assistant (1)	$ 22,000	$ 22,000	$ 22,000	$ 66,000
Physician Resident (12)	$ 330,000	$ 660,000	$ 990,000	$ 1,980,000
Annual Cost	$ 782,000	$ 862,000	$ 1,192,000	$ 2,836,000

By now I’m sure you’re wondering: how much is this going to cost?

Well, we will need to begin with establishing a contract with 2-1-1. Based on other contracts with organizations similar in size to MHVC, we estimate this will cost $250,000 for a 3-year contract. Once this contract is established, we will need to invest in additional staff to conduct outreach and training for our providers, empowering them to effectively use Hudson Connect.

We will provide administrative support for the residency program, and provide a portion of the cost of each residency with each provider, to the tune of 50%. This way, smaller providers aren’t overwhelmed with costs, but are still financially invested in the program.

Our existing staff can provide support in applying for loan forgiveness programs, and best of all, those programs are funded by the state of New York and the federal government, so our participation comes at little-to-no cost.

Salary.com

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Funding & Savings

Without DSRIP funding, how do we achieve our vision?

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DSRIP funding ends March 31, 2020.
During DSRIP, our budget is primarily provider incentive payments.	After DSRIP, we provide support to members which advances the triple aim, including cost savings.

2016 Member Hospital Revenue:	Annual 0.02% contribution:
$1.56 billion	$3.12 million

Source: Department of Health New York State, Delivery system reform incentive payment (DSRIP), 2017.

Finally, with the end of DSRIP in 2020, our current revenue stream will disappear. Under DSRIP, most of the $50 million dollars we receive each year goes toward incentive payments to providers. After DSRIP, our budget will go toward supporting our members, program planning, and continuing to coordinate care across the Hudson Valley.

By reducing unnecessary hospital visits, improving population health, and ultimately creating a more efficient healthcare delivery system, we are creating enormous value for our members. Once DSRIP ends, the clearest means of funding MHVC is through member contributions. If we requested, hypothetically, just 0.02% of gross revenues from hospitals alone, based on their 2016 revenues we would bring in over $3 million. If we included health centers, clinics, and other providers, this number would only increase.

Maybe 2 slides: 1 for savings, 1 for funding?

Savings:

25% decrease in unneeded hospital visits due to increased access (less reliance on safety nets like EDs), improved population health, and behavioral health interventions

Funding:

$250 million from 2015-2020

MHVC creates value for member orgs through cost savings, population health initiatives, and fostering collaboration. Therefore, after 2020, request a 2% contribution of gross revenues from member orgs?

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Evaluate and Expand HudsonConnect into remaining Hudson Valley counties.

Collaborate with local social service agencies based on identified needs/trends from metrics collected from HudsonConnect.

Evaluate and improve Physician Residency program.

Next Steps

Source: Montefiore Hudson Valley Collaborative Consulting Group, 2018.

So, where does this leave us in three years? Our next steps will be to continue evaluating and improving our existing programs, and rolling out HudsonConnect across the Valley. This 3-year plan will position us well to respond to the uncertainty coming out of a dynamic healthcare environment as well as political uncertainty, and we will be able to continue pursuing our vision of an integrated, sustainable, and patient-centered healthcare system.

Expand pilot study to other NY communities

Continue to monitor 211 health-E-connect data

Develop projects based on identified needs/trends from

health-E-connect

Continue to develop medical and non-medical partnerships throughout the community

Evaluate HudsonConnect database partnership with MHVS.
Collaborate with local social service agencies based on identified needs/trends from metrics collected from HudsonConnect.
Continue to develop medical and non-medical partnerships throughout the community.

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Thank You!

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Appendices

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Partnership to � Create HudsonConnect

Technical Assistance
Integrate Social Service Questionnaire
Referral & Follow-ups into EHR
Streamline social needs between patients & providers to provide quality care

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Social Determinants of Health

Source: United Way 2-1-1 Hudson Valley Region, Top Service Requests, 2018.

~50% decrease in ED use by homeless when connected with housing services

https://ps.psychiatryonline.org/doi/full/10.1176/ps.2006.57.7.992

Notes:

-Health E-Connect is committed to increasing the capacity of the health and human service delivery system by getting the right people to the right services and by providing information about programs and services that that can support better outcomes for people who use those services.

-People need effective tools for navigating a complex maze of services

-In this new collaboration we will be working together to help communities on their journeys to improving their health.

-MHVS and 211 will cooperate and share data, connecting residents to over 22,000 available services through NY that supports their health and well-being.

identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries will reduce health care costs and use of the healthcare system. If you have people who have these social service needs -- lack of food or housing, or if you can't keep the lights on -- you can't really focus on healthcare outcomes.

A significant amount of a person's health is influenced by what happens outside the healthcare setting

-2-1-1 is a free, confidential helpline and website supported by United Way affiliates nationwide that connects people by referral to health and human services, 24 hours a day, seven days a week. United Way of NY's help center answers more than 200,000 calls a year.

-Healthcare has been very focused on disease treatment, and this allows us to work on prevention and keeping people healthy so that they don't even need to come into the hospital

-2-1-1 will provide technical assistance to the partners to help integrate the social service questionnaire, referrals and follow-ups into a patient's electronic health record. Doctors will be able to see the information and use it in their care,

Technical assistance to the partners to help integrate the social service questionnaire, referrals and follow-ups into a patient's electronic health record. Doctors will be able to see the information and use it in their care,

http://hudson.211counts.org/

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Working together, we will champion new models of providing Medicaid beneficiaries with higher quality care, while reducing expenditures through enhanced coordination, community-focused care and education.

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MISSION

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County	Total Population 2016	% Public Insurance 2016 (medicaid, chip, other insurance, medi/medi)	Homeless Population 2016	% Change Medicaid 2013-2016
Sullivan	72,396	23.5%	163	-16%
Ulster	174,755	20.3%	328	8%
Dutchess	286128	17.2%	385	25.9%
Orange	375,480	21.4%	343	5.3%
Putnam	98,436	14.2%	na	111.9%
Rockland	324,868	28.8%	141	20.3%
Westchester	962,092	18.2%	1750	12.5%
Totals/Averages	2294155	20.3%	3110	13.9%

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Cost of Strategic Plan

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Occupation Title	Total Employment	Average Mean Salary	Average Median Salary
Mental Health Counselors	6,970	$42,070	$38,030
Healthcare Social Workers	12,540	$60,060	$58,350
Mental Health and Substance Abuse Social Workers	11,040	$56,430	$53,000
Healthcare Practitioners and Technical Occupations	528,800	$88,390	$74,730
Physicians and Surgeons, All Other	44,870	$177,330	$166,010
Physician Assistants	12,080	$107,030	$106,400
Registered Nurses	180,730	$80,830	$80,380
Nurse Practitioners	13,060	$113,450	$111,360
Healthcare Practitioners and Technical Workers, All Other	810	$80,160	$79,600
Healthcare Support Occupations	364,110	$30,540	$27,560
Nursing Assistants	98,040	$34,300	$34,640
Healthcare Support Workers, All Other	5,970	$37,800	$36,890

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What is the problem?

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Medicaid Reform

(DSRIP)

Prospective Payer System

Reducing Avoidable Hospital Use

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http://hudson.211counts.org/
https://www.aafp.org/medical-school-residency/medical-school/debt/before-school/service-based.html
https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/
http://hasdic.org/2016-chna/
Hilary K. Seligman and Dean Schillinger. Hunger and Socioeconomic Disparities in Chronic Disease. New England Journal of Medicine. 2010; 363(1): 6.
https://www.health.ny.gov/
http://montefiorehvc.org/who-we-are/
http://mhvcommunityprofiles.org/region/housing/healthy-neighborhoods/homelessness/data-tables