G-Health 2018 Annual Report
G-Health 2018 Annual Report
G-Health 2018 Annual Report
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WELCOME TO G-HEALTH ENTERPRISES<br />
G-<strong>Health</strong> Enterprises is a health care organization which encompasses several affiliates: The<br />
Greater Buffalo United Accountable <strong>Health</strong>care Network (GBUAHN), The Greater Buffalo United<br />
Accountable Care Organization (GBUACO), Urban Family Practice and The Greater Buffalo United<br />
Independent Physician’s Association (GBUIPA) facilitated by CEO and President Raul Vazquez, MD.<br />
G-<strong>Health</strong> Enterprise’s mission is to cultivate hope and quality healthcare in children, families, and<br />
communities.<br />
Starting out as a simple Family Practice on Buffalo’s lower West Side, G-<strong>Health</strong> Enterprises has<br />
evolved into an ambitious entity bringing about positive change at the neighborhood and state levels.<br />
It is within this multi-faceted organization that we believe change is possible and unconditional,<br />
holistic care is realized. This report is a compilation of the key activities and outputs during <strong>2018</strong>.<br />
Looking back, we are proud of the work accomplished but fully recognize that the journey from<br />
“Dreams Into Action” is just beginning.
CONTENTS<br />
Urban Family Practice<br />
• Urban Family Practice Opens Primary Care on Buffalo’s East Side<br />
• GBUAHN and Urban Family Practice introduce electronic self-check-ins<br />
• The American Heart Association has awarded Urban Family Practice a<br />
Target BP Award<br />
• RevSpring Grading<br />
3<br />
GBUACO<br />
• GBUACO metrics show value-based payments are working<br />
• YourCare Partnering with the ACO Produces Two Important Grants to<br />
Help Vulnerable Patients<br />
• Grant Funds Medication to Assist in Opioid Related Deaths<br />
• GBUACO the only ACO in NY state to receive NCQA accreditation<br />
Quality in the Value Based Pilot<br />
• Agreed-upon quality metrics<br />
• Results<br />
6<br />
9<br />
GBUAHN<br />
• GBUAHN Receives 5-star Rating from NY State Department of <strong>Health</strong><br />
• GBUAHN Nationally recognized for excellence in case management<br />
• GBUAHN and Tyto Team Up for a unique Telehealth Program<br />
• G-<strong>Health</strong> now using MEDENT for face-to-face patient and care<br />
coordinator meetings anytime, anywhere<br />
• RevSpring Grading<br />
12<br />
Wellness<br />
• G-<strong>Health</strong> Member Wellness <strong>Report</strong><br />
20<br />
YourCare<br />
• Better Together<br />
22<br />
G-<strong>Health</strong> Enterprises<br />
23<br />
Events<br />
24
3<br />
URBAN FAMILY PRACTICE<br />
Urban Family Practice’s main site on Niagara Street on Buffalo’s West Side. “It’s hard to<br />
get providers around here,”.<br />
Urban Family Practice Opens<br />
the Jefferson facility. The practice is led by Dr.<br />
Primary Care on Buffalo’s East Side Chet Fox, formerly with UBMD Family Medicine<br />
and a former faculty member of UB’s Jacobs<br />
A Buffalo primary care medical practice has<br />
School of Medicine & Biomedical Sciences. The<br />
opened a second site in the city, taking over an<br />
opening comes just months after the shutdown<br />
East Side practice previously operated by UB<br />
of another City of Buffalo clinic. Lifetime<br />
from D’Youville Family Medicine. College That will site shuttered start in in February. June of<br />
<strong>Health</strong>care closed its clinic at the William E.<br />
2017 citing difficulties in attracting new family<br />
Mosher <strong>Health</strong> Center in late December. “The<br />
medicine physicians to the clinic in its decision<br />
The practice also added three medical assistants closing of and two a city coordinator, clinics six months all of has whom led<br />
to close the site after 12 years, eliminating<br />
trained at the West Side clinic and are now seeing to increased patients at volume,” the Jefferson states Vazquez. clinic.<br />
the urban component of its family medicine<br />
residency program.<br />
faculty member of UB’s Jacobs School of Medicine "It's been & Biomedical swamped. Now, Sciences. we'll<br />
Difficulty finding providers to staff the site was<br />
The opening comes just months after the shutdown be able of to another shift some City of of Buffalo them clinic:<br />
also an issue for Urban Family Practice, leading<br />
Lifetime<br />
to<br />
<strong>Health</strong>care<br />
a six-month<br />
closed<br />
delay in<br />
its<br />
its opening.<br />
clinic at<br />
Urban<br />
the William back E. Mosher to the east <strong>Health</strong> side Center clinic in late<br />
Family Practice reopened the site Jan. 22, <strong>2018</strong> closer to home. It’s right in the<br />
practice at sites. Jefferson and West Utica. The location will<br />
community and it’s easier or<br />
“The closing complement of two Urban city Family clinics Practice’s in six main months site has led to increased patient volume,”<br />
on Niagara Street on Buffalo’s West Side.<br />
them to get there.”<br />
Still, Vazquez was successful in recruiting and training seven nurse practitioners to the<br />
region, including individuals from Pennsylvania and the Carolinas, of whom five stayed.<br />
They also had to wait for insurance and licensing information to be finalized, a process<br />
that can take 90 days. Additionally, two new physician assistants recently graduated<br />
The practice is led by Dr. Chet Fox, formerly with UBMD Family Medicine and a former<br />
December after a decision by its Rochester-based parent to close all of its primary care<br />
states Vazquez.<br />
“It’s been Dr. swamped,” Vazquez was successful he said. in “Now, recruiting we’ll and be able to shift some of them back to (the<br />
East Side training clinic), seven so Nurse it’s Practitioners closer to to their region, homes. It’s right in the community and it’s easier<br />
for them including to get individuals there.” from Pennsylvania and<br />
The practice the Carolinas. expects Urban to Family see close Practice to assisted 50,000 patients in <strong>2018</strong>, nearly double the volume<br />
from 2017.<br />
the practitioners<br />
Vazquez<br />
with<br />
has<br />
obtaining<br />
also implemented<br />
insurance and<br />
new technology to ease entry, using<br />
licensing information, a process that can take 90<br />
computer kiosks reception areas. The kiosk allow patients to check-in, update their<br />
days. Additionally, two new physician assistants<br />
information in the electronic record system, sign consent forms, upload patient photos<br />
recently graduated from D’Youville College and<br />
and even make co-pays with a credit card.<br />
have joined the practice.<br />
“We’re trying to innovate new ways of streamlining the process,” states Vazquez.<br />
The practice also added three medical assistants<br />
and a coordinator, all of whom trained at the<br />
West Side clinic and are now seeing patients at<br />
The practice expects to have close to 35,000<br />
patient visits in <strong>2018</strong>, nearly double the volume<br />
from 2017. Vazquez has also implemented new<br />
technology to ease entry, using computer kiosks<br />
in reception areas. The kiosk allows patients<br />
to check-in, update their information in the<br />
electronic record system, sign consent forms,<br />
upload patient photos and even make co-pays<br />
with a credit card.<br />
“We’re trying to innovate new ways of<br />
streamlining the process,” states Vazquez.
6<br />
GBUACO<br />
GBUACO metrics show<br />
value-based payments are working<br />
It has been more than three years since the New<br />
York State Department of <strong>Health</strong> gave the Greater<br />
Buffalo United Accountable Care Organization<br />
(GBUACO) the green light to operate as the first<br />
Medicaid ACO in the state. GBUACO is a pioneer<br />
in the movement from a treatment system – a<br />
system that responds when someone is ill – to<br />
a prevention system that focuses on keeping<br />
people healthy. GBUACO operates a valuebased<br />
payment system for the providers in its<br />
network, emphasizing the triple aim of health<br />
care – improved population health, improved<br />
patient care, and decreased costs. Value-based<br />
care models center on patient outcomes –<br />
outcomes based on clearly defined metrics that<br />
demonstrate how the providers within the ACO<br />
network are doing in keeping patients healthy.<br />
Value-based payments compensate providers<br />
based on the quality versus the quantity of<br />
services rendered. As a result, expensive<br />
duplicative medical tests are reduced, as are<br />
unneeded, costly and inconvenient repeat office<br />
visits.<br />
Some of the health metrics used<br />
to measure quality in a Medicaid<br />
accountable care organization<br />
include:<br />
• Behavioral health medication<br />
management effectiveness<br />
• Nephropathy treatment of<br />
diabetic patients<br />
• Sexually Transmitted Infection<br />
(STI or STD) screening rates<br />
• Breast cancer screening rates<br />
During a six-month timeframe during year one<br />
of the pilot value-based payment program,<br />
GBUACO was able to successfully meet six of<br />
the required quality metrics and came in at<br />
just 5% over the estimated medical loss ratio<br />
budget (the proportion of insurance premium<br />
revenues spent on clinical services and quality<br />
improvement; or, how much of a premium dollar<br />
is a loss to the insurance company in the form<br />
of paying for medical benefits). Achievements<br />
include 91% compliance for nephropathy<br />
treatment of diabetic patients and 71%<br />
compliance in chlamydia screening for women<br />
ages 16 – 20. “Through focused attention on<br />
the medical loss ratio within GBUACO, analysts<br />
were able to determine that GBUACO patients<br />
are on average more complex and riskier<br />
than other comparable patients,” states Raul<br />
Vazquez, M.D., President and Chief Executive<br />
Officer of GBUACO.<br />
“Ostensibly, it should be more<br />
expensive and challenging to<br />
keep these individuals well.<br />
However, GBUACO’s network<br />
of providers is still able to keep<br />
costs low, while improving the<br />
most serious chronic conditions<br />
applying a value-based care<br />
model.”<br />
In fact, GBUACO has improved further in budget<br />
containment for pilot year two by providing<br />
quality care at only 74% of its medical loss<br />
ratio budget. Decreased costs are achieved<br />
by utilizing techniques such as choose wisely,<br />
prescribing generic medications rather than<br />
name brands, and avoiding costly hospital visits.
7<br />
The second is a New York State AIDS Foundation<br />
Through the implementation of a valuebased<br />
care model, GBUACO has leveraged grant to help people with HIV – AIDS to be more<br />
its relationship with Greater Buffalo United engaged in their disease management. Through<br />
Accountable <strong>Health</strong>care Network (GBUAHN) to this grant, patients are closely monitored to<br />
provide care coordination services and assist in increase medication compliance. This was<br />
decreasing avoidable emergency room visits. In supposed to be a six-month program, but it<br />
fact, GBUACO has decreased avoidable ER visits was so successful statewide, that it has been<br />
by over 30% during <strong>2018</strong> compared to the same extended for at least one more year.<br />
time frame during 2017.<br />
Grant Funds Medication to Assist in<br />
“Physicians in the past did not work together as Opioid Related Deaths<br />
a rule,” states Vazquez. “ GBUACO is changing<br />
ovide care coordination services and assist in decreasing avoidable emergency Project room is a partnership of Monroe Plan, GBUACO,<br />
its. In fact, GBUACO that has because decreased providers avoidable know ER visits they by over can 30% give during and <strong>2018</strong> Endeavor <strong>Health</strong> Services to expand access<br />
mpared to the same better time care frame working during 2017. together to keep their<br />
to MAT treatment for Medicaid recipients The<br />
hysicians in the patients past did not as work healthy together as as possible, a rule,” states and Vazquez. they will “GBUACO Substance is Abuse and Mental <strong>Health</strong> Services<br />
anging that because rewarded providers know for doing they can so.” give better care working together to<br />
ep their patients as healthy as possible, and they will be rewarded for doing Administration so.” (SAMHSA) hasawarded a threeyear,<br />
$1.5 million grant to Monroe Plan for Medical<br />
YourCare Partnering with the ACO<br />
Produces Two Important Grants to<br />
ge (10)<br />
Care, a not-forprofit Medicaid managed care<br />
Help Vulnerable Patients:<br />
organization, to enhance access to medicationassisted<br />
treatment (MAT) services for Medicaid<br />
urCare Partnering Because with the of ACO the partnership Produces Two of Important this Value-Based Grants to Help<br />
lnerable Patients:<br />
cause of the partnership Payment, of YourCare this Value-Based was able Payment, to obtain YourCare two was major able to recipients obtain with opioid use disorder (OUD).<br />
o major grants. grants. The first was The a first $1.5 was million a three-year $1.5 million SAMHSA three-year grant that is<br />
The<br />
a<br />
Greater Buffalo United Accountable Care<br />
llaboration between YourCare, GBUACO, and Endeavor Behavioral <strong>Health</strong> to provide<br />
dication Assisted SAMHSA Treatment grant (MAT) that for people is a collaboration with opioid use between disorder. Endeavor Organization (GBUACO) and Endeavor <strong>Health</strong><br />
havioral <strong>Health</strong> YourCare, is now co-located GBUACO, in Urban and Family Endeavor Practice. Behavioral<br />
This will provide primary<br />
Services (Endeavor) will work in partnership<br />
re and substance abuse services to over 500 people who have been unfortunately<br />
ught up in the current <strong>Health</strong> opioid to provide crisis.Medication Assisted Treatment to help deliver the project titled, “Addressing<br />
(MAT) for people with opioid use disorder. Buffalo’s Opioid Epidemic with Medicatione<br />
second is a New York State AIDS Foundation grant to help people with HIV – AIDS<br />
be virus free. If Endeavor they continue Behavioral to take the <strong>Health</strong> medicine is as now prescribed, co-located they in will be Assisted Treatment.” GBUACO is a New York<br />
ectively cured of Urban AIDS. Family This was Practice. supposed This to be will a six-month provide program, primary but it was so<br />
ccessful statewide, that it has been extended for at least one more year. state-authorized Medicaid accountable care<br />
care and substance abuse services to over 500<br />
organization and Endeavor <strong>Health</strong> Services is a<br />
people who have been unfortunately caught up<br />
private, not-for-profit organization that provides<br />
in the current opioid crisis.<br />
a wide array of behavioral health services.<br />
The project will expand access to MAT services,<br />
including the medications buprenorphine and<br />
naltrexone, to primary care doctors in the GBUACO<br />
network and their patients with OUD. The goal<br />
of the program is to reduce opioid misuse and<br />
overdose deaths among Medicaid beneficiaries in<br />
Erie County. According to the Erie County <strong>Health</strong><br />
Department, 268 county residents died of a<br />
confirmed or suspected opiate overdose in 2017.
8<br />
“Long-lasting changes in brain chemistry can<br />
cause difficulty with abstaining from opioid<br />
use; withdrawal symptoms and cravings can<br />
be overwhelming,” states Raul Vazquez, M.D.,<br />
Chief Executive Officer of GBUACO. “MAT can<br />
help reduce withdrawal symptoms and curb<br />
opioid cravings that can lead to relapse. In fact,<br />
studies show that long-term MAT has an 85%<br />
chance of reducing mortality among people<br />
with OUDs. The importance of this SAMHSA<br />
grant cannot be overstated.”<br />
Among other objectives, the program is<br />
designed to drop the incidence of illicit opioid<br />
use and prescription opioid misuse among<br />
project participants from a baseline of 56%<br />
to 45% by the end of 2019; to 42.5% in 2020;<br />
and to 40% by the end of 2021. By the end of<br />
each project year, 90% of GBUACO’s primary<br />
care doctors will have completed trainings<br />
and adopted consistent evidence-based MAT<br />
treatment guidelines. A full 100 percent of<br />
GBUACO’s primary care physicians will have<br />
daily access to support from addiction medicine<br />
practitioners. By the end of September 2019,<br />
70 percent of all GBUACO practices will have a<br />
primary care doctor certified to prescribe MAT<br />
pharmaceuticals.<br />
GBUACO the only ACO in NY state to<br />
receive NCQA accreditation<br />
The National Committee for Quality Assurance<br />
(NCQA) has presented the Greater Buffalo United<br />
Accountable Care Organization (GBUACO)<br />
level two accreditation as an Accountable Care<br />
Organization (ACO).<br />
GBUACO is dedicated to delivering coordinated<br />
patient-centered care and is accountable for<br />
improving clinical quality, enhancing the patient<br />
experience and reducing cost. The NCQA sets its<br />
standards high to encourage Accountable Care<br />
Organizations like GBUACO to continuously<br />
enhance the quality of services they deliver.<br />
“This NCQA accreditation is a huge honor<br />
for GBUACO, which in its very first year of<br />
existence,” states GBUACO CEO Raul Vazquez,<br />
M.D. “We are changing the way health care is<br />
delivered in Buffalo and Western New York.<br />
GBUACO’s quality performance measures<br />
prove the success. The NCQA sets its standards<br />
high, making this accreditation very difficult<br />
to achieve, with only five other ACOs in the<br />
entire country holding this honor.” The NCQA<br />
Accountable Care Organization Accreditation<br />
not only involves a rigorous review of an<br />
organization’s structure and processes, but also<br />
requires organizations to collect data on key<br />
clinical and service measures (e.g., preventive<br />
screenings, comprehensive diabetes care;).<br />
(MORE) “By earning NCQA ACO Accreditation,<br />
GBUACO has demonstrated to payers and<br />
other purchasers that it has met challenging<br />
requirements designed to show the efficiency,<br />
integration and high quality expected of an<br />
accountable care organization,” states NCQA<br />
President Margaret E. O’Kaner.” Accreditation<br />
also shows patients and providers that GBUACO<br />
is prepared to deliver on the promise of better<br />
care on all these dimensions.”<br />
GBUACO is currently the only ACO in New<br />
York State to receive the accreditation and<br />
one of only four ACOs in the U.S. to receive<br />
this distinction. Earning NCQA accreditation<br />
as an Accountable Care Organization<br />
shows that
9<br />
QUALITY IN THE<br />
VALUE-BASED PILOT<br />
The Value-Based Payment Plan is a new way to monitor and reward doctors for providing higher<br />
quality healthcare services. In a value based payment model, metrics are monitored for a more<br />
individualized approach to population health management. Doctors are evaluated based on the<br />
ability to meet quality metrics, reduce emergency room and inpatient utilization, and provide<br />
preventive screenings to all eligible patients. GBUACO is one of the first New York State Value-<br />
Based Pilot programs. Our partnership is with YourCare <strong>Health</strong> Plan. As part of this arrangement,<br />
15 quality metrics were agreed upon to help improve care. If care was improved and cost reduced,<br />
the ACO would be deemed successful.<br />
Total Quality Score<br />
(Maximum of 15 Points Available)<br />
12 or greater<br />
10 to 11<br />
8 to 9<br />
6 to 7<br />
Below 6<br />
Reduction in Shared Savings<br />
No Reduction - full Shared Savings<br />
25% Reduction<br />
50% Reduction<br />
75% Reduction<br />
100% Reduction<br />
AGREED-UPON QUALITY METRICS<br />
Antidepressant Medication Management - Acute<br />
Asthma Medication Ratio - Age 5 - 18<br />
Asthma Medication Ratio - Age 19 - 64<br />
Adolescent Well Care Visits<br />
Breast Cancer Screening<br />
Controlling High Blood Pressure<br />
Comprehensive Diabetes Care - HbA1C Test<br />
Comprehensive Diabetes Care - Eye Exams<br />
Comprehensive Diabetes Care - Nephropathy<br />
Comprehensive Diabetes Care - Blood Pressure Control < 140/90<br />
Comprehensive Diabetes Care - Good HbA1C Control < 8.0<br />
Chlamydia Screening - Age 16 - 24<br />
Colorectal Cancer Screening<br />
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80%<br />
Well Child Visit in the 3rd, 4th, 5th, and 6th Years of Life
10<br />
GAPS IN CARE RESULTS<br />
Urban Family Practice was the leader in accomplishing this: meeting 15 out of 15 measures.<br />
Group Measures Met<br />
GBUIPA 13<br />
JERICHO 10<br />
KALEIDA 8<br />
ECMC 7<br />
WNY MED 3<br />
QUALITY METRIC RESULTS <strong>2018</strong><br />
120%<br />
100%<br />
80%<br />
60%<br />
40%<br />
20%<br />
0%<br />
* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15<br />
UFP<br />
GBUIPA<br />
GBUACO<br />
YourCare<br />
75.53%<br />
64.55%<br />
59%<br />
60%<br />
83.04%<br />
76.73%<br />
67%<br />
65%<br />
65.18%<br />
65.41%<br />
60%<br />
57%<br />
69.23%<br />
63.64%<br />
68%<br />
70%<br />
69.65%<br />
65.27%<br />
53%<br />
55%<br />
90.12%<br />
81.52%<br />
75%<br />
64%<br />
96.43%<br />
94.34%<br />
91%<br />
92%<br />
93.75%<br />
94.34%<br />
92%<br />
89%<br />
82.14%<br />
77.36%<br />
67%<br />
67%<br />
71.01%<br />
65.91%<br />
62%<br />
49%<br />
77.78%<br />
70%<br />
66%<br />
79%<br />
64.29%<br />
62.33%<br />
66%<br />
66%<br />
92.31%<br />
92.31%<br />
83%<br />
84%<br />
85.26%<br />
85.44%<br />
74%<br />
69%<br />
85.45%<br />
87.69%<br />
81%<br />
69%<br />
Source: QARR<br />
* 1 Controlling High Blood Pressure<br />
2 Comprehensive Diabetes Care - Blood Pressure Control < 140/90<br />
3 Comprehensive Diabetes Care - Good HbA1C Control < 8.0<br />
4 Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80%<br />
5 Colorectal Cancer Screening<br />
6 Asthma Medication Ratio - Age 19 - 64<br />
7 Comprehensive Diabetes Care - Nephropathy<br />
8 Comprehensive Diabetes Care - HbA1C Test<br />
9 Comprehensive Diabetes Care - Eye Exams<br />
10 Antidepressant Medication Management - Acute<br />
11 Asthma Medication Ratio - Age 5 - 18<br />
12 Adolescent Well Care Visits<br />
13 Well Child Visit in the 3rd, 4th, 5th, and 6th Years of Life<br />
14 Breast Cancer Screening<br />
15 Chlamydia Screening - Age 16 - 24
11<br />
GAPS IN CARE<br />
RESULTS COMPARISON<br />
The ACO Outperformed both State and National Averages<br />
• The ACO did better than the Nation in all 12 measurable metrics<br />
• The ACO did better than the New York State in 9 of 15 metrics<br />
EVIDENCE BASED METRICS<br />
100%<br />
90%<br />
80%<br />
70%<br />
60%<br />
50%<br />
40%<br />
30%<br />
20%<br />
10%<br />
0%<br />
* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15<br />
59%<br />
61%<br />
57%<br />
67%<br />
61%<br />
63%<br />
60%<br />
58%<br />
49%<br />
68%<br />
66%<br />
63%<br />
53%<br />
62%<br />
0%<br />
75%<br />
57%<br />
0%<br />
91%<br />
93%<br />
90%<br />
92%<br />
91%<br />
88%<br />
67%<br />
67%<br />
57%<br />
62%<br />
52%<br />
54%<br />
66%<br />
64%<br />
0%<br />
66%<br />
68%<br />
53%<br />
83%<br />
85%<br />
73%<br />
74%<br />
71%<br />
58%<br />
81%<br />
75%<br />
59%<br />
Source: QARR<br />
* 1 Controlling High Blood Pressure<br />
2 Comprehensive Diabetes Care - Blood Pressure Control < 140/90<br />
3 Comprehensive Diabetes Care - Good HbA1C Control < 8.0<br />
4 Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80%<br />
5 Colorectal Cancer Screening<br />
6 Asthma Medication Ratio - Age 19 - 64<br />
7 Comprehensive Diabetes Care - Nephropathy<br />
8 Comprehensive Diabetes Care - HbA1C Test<br />
9 Comprehensive Diabetes Care - Eye Exams<br />
10 Antidepressant Medication Management - Acute<br />
11 Asthma Medication Ratio - Age 5 - 18<br />
12 Adolescent Well Care Visits<br />
13 Well Child Visit in the 3rd, 4th, 5th, and 6th Years of Life<br />
14 Breast Cancer Screening<br />
15 Chlamydia Screening - Age 16 - 24
12<br />
GBUAHN<br />
GBUAHN Receives 5-Star Rating<br />
From NY State Department of<br />
<strong>Health</strong><br />
Western New York’s largest <strong>Health</strong> Home<br />
continues to excel with top scores. The Greater<br />
Buffalo United Accountable <strong>Health</strong>care Network<br />
(GBUAHN) has been given a 5-star score from<br />
the New York State Department of <strong>Health</strong><br />
on the <strong>2018</strong> <strong>Health</strong> Home <strong>Report</strong> Card. The<br />
honor comes as GBUAHN continues to grow<br />
and expand throughout Western New York,<br />
currently engaging with well over 10,000<br />
members. We rank in the top ten for health<br />
homes in the entire state. The recognition<br />
reinforces GBUAHN’s dedication to serving<br />
our community and solidifies that healthcare<br />
management of the highest standard is close to<br />
home for thousands of residents of WNY and<br />
Erie County.<br />
“We are very proud to be recognized not only<br />
for the hard work our organization puts in, but<br />
for the benefit it provides to our members and<br />
the community,” states GBUAHN CEO Dr. Raul<br />
Vazquez. “We will continue to keep growing<br />
and working to positively impact healthcare in<br />
Western New York. We have a vision of where<br />
we want to go and what we can do – and we will<br />
continue to strive to achieve that vision at the<br />
highest levels possible.”<br />
Receiving high marks across the board,<br />
GBUAHN also received 5-star ratings in <strong>Health</strong><br />
and Recovery Plan (HARP) conversions as<br />
well as member retention. These rankings<br />
help to cement GBUAHN as the health home<br />
of choice in WNY and directly align with our<br />
mission to transform healthcare by removing<br />
social determinants of health in underserved<br />
communities. Our organization works hard<br />
to assist members with their health issues<br />
and concerns and to help Medicaid recipients<br />
receive the health coordination services that<br />
fully address their needs.<br />
Established under the Affordable Care Act<br />
of 2010, GBUAHN was founded in 2013 as a<br />
health home that coordinates care for people<br />
with Medicaid who have two or more chronic<br />
conditions, have a serious mental or behavioral<br />
health condition, and/or HIV/ AIDS. This free<br />
service integrates all primary care, acute,<br />
behavioral health and longterm services and<br />
supports to treat the whole person. Care teams<br />
work closely with members to get them all the<br />
services they need in the community.<br />
Rated 5-star health home<br />
by New York State<br />
Department of <strong>Health</strong>
15<br />
GBUAHN NCQA Case Management<br />
GBUAHN nationally recognized for<br />
excellence in case management<br />
The National Committee for Quality Assurance<br />
(NCQA) has announced that GBUAHN has<br />
received Level Two NCQA Case Management<br />
Accreditation. GBUAHN is the first and only health<br />
home organization in New York State to achieve<br />
NCQA recognition for Case Management.<br />
Earning NCQA’s Case Management Accreditation<br />
shows that GBUAHN’s Case Management<br />
program is dedicated to care coordination,<br />
patient-centeredness and improving quality of<br />
care: getting the right care to patients. NCQA<br />
sets its standards high to encourage case<br />
management organizations like GBUAHN to<br />
continuously enhance the quality of services<br />
they deliver. NCQA Case Management<br />
Accreditation is the only program that focuses<br />
on care transition.<br />
GBUAHN CEO, Raul Vazquez, M.D. states, “This<br />
NCQA accreditation in case management<br />
for GBUAHN is huge in our organization’s<br />
commitment to providing smart, coordinated<br />
health care for the Medicaid patients we<br />
serve...Our Patient <strong>Health</strong> Navigators (PHN), or<br />
care coordinators work tirelessly to organize<br />
the right services for our members through<br />
the development of individualized care plans<br />
tailored to the individual needs of the patient.”<br />
To accomplish accreditation,<br />
GBUAHN had to meet particular<br />
standards set by the NCQA:<br />
• Staying up to date on evidence<br />
based care management<br />
techniques<br />
• Develop personalized, patient<br />
centered care plans<br />
• Monitor care plan goals so that<br />
goals are reached and adjusted<br />
as needed<br />
• Coordinate resources and<br />
share information to ensure<br />
safe transitions<br />
• Give patients access to<br />
knowledgeable, well-qualified<br />
case management staff<br />
• Keep personal information<br />
secure<br />
NCQA Accreditation standards are developed<br />
with input from researchers in the field, the<br />
Case Management Expert Panel and standing<br />
committees, employers, both purchasers and<br />
operators of Case Management programs, state<br />
and federal regulators and other experts.<br />
“Case Management Accreditation moves us<br />
closer to measuring quality across population<br />
health management initiatives,” states<br />
President, NCQA, Margaret E. O’Kane. “Not<br />
only does it add value to existing quality<br />
improvement efforts; it also demonstrates<br />
an organization’s commitment to the highest<br />
degree of improving the quality of their<br />
patients’ care.”
17<br />
United States. Those who suffer from conditions<br />
that make getting to the doctor challenging will<br />
now have unprecedented access to specialists<br />
from the comfort of their homes.”<br />
G-<strong>Health</strong> now using MEDENT for<br />
face-to-face patient and care<br />
coordinator meetings anytime,<br />
anywhere<br />
G-<strong>Health</strong> Enterprises has teamed up with its<br />
electronic health record MEDENT, to make faceto-face<br />
meetings between its members and<br />
patient health navigators (PHNs) easier. Utilizing<br />
a tele-health system from MEDENT, GBUAHN<br />
members can schedule a time to meet with<br />
their patient health navigators digitally. With<br />
the MEDENT patient portal, video-visits are<br />
scheduled to accommodate a smart phone or<br />
laptop (or desktop) computer. Once the meeting<br />
time is set up, the member and patient health<br />
navigator will be able to engage in a face to face<br />
interaction from remote locations.<br />
“Having this connection through MEDENT<br />
directly to our GBUAHN members is another<br />
fantastic way G-<strong>Health</strong> is tearing down barriers<br />
to care created by the social determinants of<br />
health,” states Raul Vazquez, M.D., Chief Executive<br />
Officer of G-<strong>Health</strong> Enterprises. “Now, members<br />
have the power right in their hands to schedule<br />
face-to-face contacts with their PHNs, and they<br />
won’t have to deal with barriers such as finding<br />
transportation and child care.” Through the<br />
use of MEDENT telehealth capabilities and other<br />
innovative strategies, G-<strong>Health</strong> Enterprises will be<br />
able to address the social determinants of health<br />
and clinical needs with a 360-degree approach.<br />
“Physicians staying connected to their patients<br />
is essential for positive outcomes... with<br />
telehealth, that communication piece has<br />
never been easier.... ultimately keeping people<br />
healthier,” states Barbara E. Cuthbert, MEDENT<br />
vice president of sales and marketing.”
19<br />
GBUAHN Affects Social<br />
Determinants of <strong>Health</strong><br />
<strong>Health</strong> Home Supportive<br />
Housing Program<br />
In <strong>2018</strong>, GBUAHN, through its partners at Hispanos Unidos de Buffalo – (HUB), and also the Delivery<br />
System Reform Incentive Program (DSRIP) and Person Centered Services Care Coordination<br />
Organization (PCSCCO) was awarded a Medicaid Redesign Team Supportive Housing <strong>Health</strong> Home<br />
Project grant. Through the use of targeted vouchers and housing retention assistance this will enable<br />
up to 40 eligible <strong>Health</strong> Home beneficiaries to secure safe, permanent housing in market –rate units<br />
close to their primary care medical homes.This grant is a five-year program with shared responsibility<br />
among eligible individuals and case managers to ensure stability.<br />
GBUAHN - In Collaboration With United <strong>Health</strong> Care<br />
Also in <strong>2018</strong> GBUAHN was approached by United <strong>Health</strong>Care with a proposal to make available up to<br />
12 one bedroom permanent and affordable housing in scattered sites to place referred members. The<br />
program will allow for full participation in benefits such as sleeping quarters, nutrition, transportation,<br />
support programs for employment training as well as navigation to health/ behavioral services and<br />
case management. In home visits during the first three months will include daily living and Life Skills<br />
coaching, financial skills management and household budgeting, utilization of social and health<br />
related services, as well as family motivation, connections with natural supports and enrollment and<br />
monitoring participation in employment skills training programs.
20<br />
WELLNESS:<br />
G-HEALTH MEMBER WELLNESS REPORT<br />
<strong>2018</strong> brought the continuation and expansion<br />
of G-<strong>Health</strong>’s successful Employee and Member<br />
Wellness programs. Located in the lower level<br />
at 564 Niagara Street, the program is comprised<br />
of a gym and teaching kitchen to help G-<strong>Health</strong><br />
employees and members improve their health.<br />
Providing services free-of-charge five days per<br />
week, Member Wellness has become a staple<br />
of how G-<strong>Health</strong> cares for the population<br />
we serve. The Member Wellness program<br />
focuses on medication (if needed), exercise,<br />
nutrition, and cooking classes to get results. All<br />
GBUAHN wellness employees are certified in<br />
health coaching which allows them to develop<br />
customized treatment plans for each member.<br />
The nutrition classes were designed by our<br />
Registered Dietitian using evidence based<br />
practice. This technique was used for chronic<br />
disease management and allowed for the<br />
translation of the material into simple and easyto-remember<br />
tools. This translation has enabled<br />
participants to easily employ new habits in their<br />
daily lifestyle. In addition, exercise classes are<br />
customized for each member by our certified<br />
personal trainer. In conjunction, the nutrition<br />
classes and gym sessions arm participants with<br />
the skills to improve their diet and lifestyle one<br />
step at a time.<br />
To add to the Member Wellness services, a<br />
partnership with Roswell Park began this past<br />
year to provide in-house smoking cessation<br />
education groups. Past, current, or neversmoker<br />
members can attend the monthly<br />
classes to learn the risks of smoking and benefits<br />
of quitting. Wellness staff are also available to<br />
help members develop a quit plan when they<br />
are ready.<br />
The benefits of the program extend past lifestyle<br />
changes. Many members attend G-<strong>Health</strong>
22<br />
YOURCARE:<br />
BETTER TOGETHER<br />
Time flies when you’re working hard to ensure vulnerable populations have healthcare coverage,<br />
collaborate with organizations to provide access to essential resources for members, significantly<br />
improve healthcare quality, and ultimately, better the communities you serve. That’s exactly what<br />
GBUACO and YourCare <strong>Health</strong> Plan have accomplished together since their historic partnership<br />
began.<br />
In September 2016, YourCare became the first Medicaid health plan to join forces with the first<br />
As of early 2019, both organizations have agreed to a three-year extension with regard<br />
Medicaid Accountable Care Organization, GBUACO. The two-year pilot program was the first of its<br />
to the value-based payment arrangement. Looking forward, GBUACO and YourCare<br />
kind in New York State. The major goals of the collaboration were to improve healthcare quality and<br />
envision countless opportunities for growth. Increasing community presence and<br />
reduce costs for Medicaid recipients enrolled in YourCare <strong>Health</strong> Plan through the value-based<br />
awareness as partners is a major key to our success. We must continue to<br />
payment system; yet, so much more has been accomplished by bringing YourCare and GBUACO<br />
demonstrate that we’re all in – all in for members, all in for patients, all in for providers,<br />
together.<br />
all in for the Western New York community, all in for better healthcare outcomes, and all<br />
In fact, we’re all in.<br />
in for one another! Follow elements of our transformative partnership on social media -<br />
@yourcarehealthplan or @gbuahn. <br />
Not only have both teams committed investments, they’ve also dedicated time – leading<br />
ideas into action. The myriad of ways the two organizations have collaborated since the<br />
partnership’s inception is listed below:<br />
• YourCare Facilitated Enrollers<br />
embedded at G-<strong>Health</strong> locations<br />
• Quality improvement initiatives<br />
• Co-hosting/co-sponsoring<br />
events<br />
• Co-branded marketing items<br />
• Co-branded media campaigns<br />
• Communications collaboration<br />
• “Feet on the street” initiatives<br />
As of early 2019, both organizations have agreed to a three-year extension with regard to the<br />
value-based payment arrangement.<br />
Page (20)<br />
Looking forward, GBUACO and YourCare envision countless<br />
opportunities for growth. Increasing community presence and awareness as partners is a major<br />
key to our success. We must continue to demonstrate that we’re all in – all in for members, all in for<br />
patients, all in for providers, all G-<strong>Health</strong> in for the Enterprises<br />
Western New York community, all in for better healthcare<br />
outcomes, and all in for one another! Follow elements of our transformative partnership on social<br />
Awards:<br />
media - @yourcarehealthplan or @gbuahn.<br />
• NAACP’s Medgar Evers Award of Distinction -Trailblazer <br />
• Lupus Alliance LEAN Forward Award<br />
• Business First of Buffalo “Who’s Who in <strong>Health</strong> Care” – Dr. Raul Vazquez
23<br />
G-HEALTH ENTERPRISES<br />
Awards:<br />
• NAACP’s Medgar Evers Award of Distinction -Trailblazer<br />
• Lupus Alliance LEAN Forward Award<br />
• Business First of Buffalo “Who’s Who in <strong>Health</strong> Care” – Dr. Raul Vazquez<br />
• Business First of Buffalo “Who’s Who in <strong>Health</strong> Care” – Dr. Chet Fox<br />
• Peter Sheehan Diabetes Care Foundation Recognition of Excellence Award<br />
• Spotlight on Population <strong>Health</strong> (SOPHi Award) – GBUAHN<br />
• Bryant and Stratton <strong>2018</strong> Community Partners award – Urban Family Practice<br />
• Business First <strong>Health</strong> Care Champions – Dr. Fox<br />
• Business First Western New York’s <strong>Health</strong>iest Employer – Finalist (GBUAHN)<br />
• UFP the Target BP Award from the American Heart Association.<br />
Greater Buffalo United IPA<br />
Raul Vazquez, M.D. F.A.A.F.P.<br />
President & CEO<br />
Kenneth L. Gayles, M.D.<br />
F.A.A.C.C.<br />
Vice President<br />
Dwight Lewis, M.D.<br />
Secretary<br />
Winston Douglas, M.D.<br />
Treasurer<br />
Frances Ilozue, M.D.<br />
Riffat Sadiq, M.D.<br />
Ted Triana, D.O.<br />
Kenton Forte, M.D.<br />
Jesslyn Perry, M.D.<br />
George Haddad, M.D.<br />
GBUACO Board of Directors<br />
Raul Vazquez, M.D. F.A.A.F.P.<br />
President & CEO<br />
Kenneth L. Gayles, M.D.<br />
F.A.A.C.C.<br />
Vice President<br />
Frances Ilozue, M.D.<br />
Secretary<br />
Riffat Sadiq, M.D.<br />
Treasurer<br />
Kenton Forte, M.D.<br />
Jesslyn Perry, M.D.<br />
George Haddad, M.D.<br />
Winston Douglas, M.D.<br />
Dwight Lewis, M.D.<br />
Faizan Haq<br />
Joseph Serghany, M.D.<br />
Nicolas P. Saikali, M.D.<br />
Rohith Saravanan, M.D.<br />
Roan Reynolds<br />
Phenerson Chillis<br />
G-<strong>Health</strong> Enterprises<br />
Executives<br />
Raul Vazquez, M.D. F.A.A.F.P.<br />
President & CEO<br />
Toni Vazquez<br />
Chief Systems Officer<br />
Chet Fox, M.D.<br />
Chief Medical Officer<br />
Ivan Agosto<br />
Chief Operating Officer<br />
Luis A. Santiago<br />
Chief Financial Officer<br />
Ava White<br />
Senior Vice President of<br />
Outreach<br />
Nadia Vazquez<br />
Senior Director of Value<br />
Based Payments<br />
Nina Vazquez<br />
Director of Value Based<br />
Payments<br />
Jason A. Isbrandt<br />
Director of Marketing/<br />
Provider Relations<br />
G-<strong>Health</strong> Enterprises <strong>2018</strong><br />
<strong>Annual</strong> <strong>Report</strong><br />
Photographers:<br />
Christian Casillas<br />
Communications Specialist/<br />
Multimedia Producer<br />
Pablo Colon<br />
Graphic Designer<br />
Writers:<br />
Christian Casillas<br />
Communications Specialist/<br />
Multimedia Producer<br />
Chet Fox, M.D.<br />
Chief Medical Officer<br />
Nadia Vazquez<br />
Senior Director of Value<br />
Based Payments<br />
Diane Livingston<br />
Member Services<br />
<strong>Annual</strong> <strong>Report</strong> Designers:<br />
Christian Casillas<br />
Communications Specialist/<br />
Multimedia Producer
24<br />
EVENTS<br />
“Soft” opening of Urban at Jefferson<br />
Urban Family Practice <strong>Health</strong> Fair<br />
Corporate Challenge<br />
Puerto Rican Day Parade and Festival<br />
Jefferson Open House (June 2)<br />
GBUACO 4th <strong>Annual</strong> Golf Tournament<br />
Juneteenth<br />
Thanksgiving Turkey Giveaway