Future of Health Care 2020

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THE FUTURE OF HEALTH CARE // PAYMENTS AND REIMBURSEMENTS Programs look for new funding options as DSRIP ends CONTINUED FROM PAGE 36 we need for them in a measured way.“ But some programs will end unless new funding can be identified. ECMC announced in mid-April it will distribute $7.24 million to its partners to help ensure ongoing access to services, but there’s no guarantee all existing programs would be funded. BestSelf Behavioral Health BestSelf had contracts with Millennium and Community Partners through DSRIP. One of the most successful was the hospital bridger program that posts a staffer at ECMC to ensure patients ready for discharge are linked up with care. Another program funded through a $300,000 annual DSRIP contract links behavioral-health clients with primary-care providers to get care for chronic conditions. UBMD Family Medicine has an office at BestSelf’s clinic, so patients can develop that relationship while they’re in for treatments or therapy. People with mental-health and addiction conditions often fall through the cracks or forgo traditional healthcare needs, said Elizabeth Woike-Ganga, BestSelf’s chief operating officer. “We’re looking at different options for sustainability,” she said. “We have some grants for this year to try to transition it into a different type of model, but that would be a big loss.” Most of those services can’t be billed to Medicaid, so finding new funding is vital, especially with revenue and patient volume down and many private funders focused on Covid-19. Niagara Falls Memorial Medical Center Niagara Falls Memorial will absorb costs to enable some DSRIP programs to continue. That includes one to help behavioral-health patients connect to outpatient services within seven days of discharge. The hospital hired therapists to conduct home visits after discharge, which often provided a window to other issues to improve care. Another program enabled screenings for mental-health patients when they arrived in the ED and identified conditions such as diabetes and heart disease. And a third program provided help for mental-health patients to adhere to their medications. Funding from DSRIP totaled more than $400,000 annually. “We were really identifying a lot of people with underlying conditions that really could be very problematic if they didn’t take care of those issues,” said Sheila Kee, executive vice president and chief operating officer. To keep that going, the hospital has restructured its workflow to allow continued screenings in the ED. Home visits are on hold during the coronavirus pandemic, but Kee hopes to find a way to allow that to resume as well. “For the ED screening, the hospital is providing it at its own cost,” she said. “For the home visits, we’re taking our 15 staff and restructuring workflow and workloads to continue to do what we can, keeping them on the payroll with other responsibilities.” As fewer people come into the ED or are admitted unnecessarily, the hospital reduces expenses, Kee said. “In our world, I think it was extremely beneficial and we would not have been able to do all these things without it. I am disappointed we don’t have DSRIP Round 2, but we’ll figure it out.” BONNIE SLOMA, senior vice president, People Inc., speaking about DSRIP funding Catholic Charities of Buffalo Catholic Charities had several programs funded by DSRIP, including a community health-worker program that tracked down patients who missed appointments. Megan Lostracco is project coordinator, overseeing three staffers with a caseload of up to 75 patients. She said the agency was hoping a federal extension of the DSRIP waiver would enable the program to continue. Without that, the program is funded only through June. “Right now we’re still just in the process of reaching out and talking with community providers within our network that we already work with to try and figure out if there are additional funding opportunities,” she said. The goal is to keep the three workers on the payroll for now, even if the job titles and responsibilities change. The program has had successful outcomes, which could help the agency find support through a value-based payment model, Lostracco said. Without the program, a physician might label someone as non-compliant for not showing up. The community-health worker, who could provide job training or access to food stamps, might find out the patient lost a job and couldn’t afford the co-pay. “We had some people who didn’t understand they should have a voice in their care decisions,” she said. Catholic Charities has linked up with the Western New York Integrated Care Collaborative to find ways to adapt or expand that could lead to new funding sources. The agency also is requesting funding from the annual appeal. People Inc. People Inc. developed a telemedicine program through DSRIP with Community Partners of Western New York three years ago. The program sends a nurse with telemedicine tools to see people with developmental disabilities to avoid ambulance rides and ED visits. Launched with an initial grant of $200,000, the program has worked. Independent auditors assessed Medicaid data to show ED visits declined by 30%. Those numbers helped People Inc. land a $500,000 grant from the Mother Cabrini Health Foundation to keep the program going. An early grant from the Tower Foundation helped provide access to telehealth as the DSRIP program was ramping up. The results are especially validating as everyone shifts to telemedicine during the pandemic, said Bonnie Sloma, People Inc. senior vice president. “There wasn’t pushback, but there was a lot of apprehension on the ability to provide quality care and can it be done,” she said. “But it did work, and the outcomes were very good.” The Cabrini grant could allow expansion and to train house supervisors about telemedicine. Sloma said the DSRIP funding was clearly valuable. “In our world, I think it was extremely beneficial and we would not have been able to do all these things without it,” she said. “I am disappointed we don’t have DSRIP Round 2, but we’ll figure it out.” WORD FROM THE SPONSOR: GBUACO G-Health Enterprises’ Community Response Plan G-Health Enterprises has always strived to transform healthcare by removing barriers created by social determinants of health in underserved communities. With all the news of COVID-19 cases and death disparities in minority communities, this mission has become more important than ever. To that end, Dr. Raul Vazquez and his Value Based Payment team are leading the charge with The Community Response Plan. The Community Action Response Plan’s initiative is to unite churches, community based organizations, and medical partners in Western New York for a comprehensive approach Raul Vazquez, M.D., is President and CEO of the Greater Buffalo United Accountable Care Organization (GBUACO) to combat the coronavirus and mitigate its effects on the community. Testing is available for high risk patients of Urban Family Practice, all primary care providers in the GBUACO Network, and now to members of the community whose providers are outside of our network, in which case we will send the results your primary provider. If an individual has no primary provider, Urban Family Practice will make an appointment through them to ensure everyone has the option to get tested. Insurance covers COVID-19 tests and for those who do not have insurance and qualify for medicaid, we can connect you with an GBUAHN outreach enroller who will help get set up with insurance. Before visiting our COVID-19 testing locations, please complete a screening by our nurses to determine if you are eligible. You can begin this process by downloading the UFP, GBUAHN or GBUACO apps and completing the COVID19 surveys or by calling our Nurse Advice Line 716-604-0504. G-Health Enterprises is a health care organization which encompasses several affiliates: The Greater Buffalo United Accountable Healthcare Network (GBUAHN), The Great Buffalo United Accountable Care Organization (GBUACO), Urban Family Practice (UFP) and The Greater Buffalo United Independent Physician’s Association (GBUIPA) facilitated by CEO and President Raul Vazquez, MD. G-Health Enterprise’s mission is to cultivate hope and quality healthcare in children, families, and communities. 38 THE FUTURE OF HEALTH CARE BUFFALO BUSINESS FIRST
THE FUTURE OF HEALTH THE CARE FUTURE // PAYMENTS OF HEALTH AND CARE REIMBURSEMENTS // PATIENT CARE Boosting care ACO MODEL DESIGNED TO IMPROVE OUTCOMES WHILE SAVING MONEY Q & A It’s been four years since a Buffalo healthcare organization launched a Medicaid pilot program designed to reward physicians and providers for cutting costs and improving care and outcomes. The Greater Buffalo United Accountable Care Organization (GBUACO) remains the region’s only state-designated accountable care organization (ACO), overseeing care for about 30,000 patients across the region insured by government programs through Fidelis and YourCare Health Plan. GBUACO, an affiliate of the Greater Buffalo United Accountable Healthcare Network, includes participation by providers at Erie County Medical Center, Kaleida Health, Jericho Road Community Health Center, Greater Buffalo Independent Physicians Association, Dent Neurologic Institute and Western New York Medical Group. Growth for the program is in the works through additional contracts to take care of more patients while saving more money for the state and the overall health-care system. Dr. Raul Vazquez is CEO of GBUACO and the Urban Family Practice on Buffalo’s West Side. He talked about the challenges and opportunities of making the funding model work. Dr. Raul Vazquez says the GBUACO program continues to report the best outcomes of any state-designated accountable care organization. What makes the ACO model different? It’s the ability of bringing physicians together, both primary care and specialists, with agencies and organizations so that you’re the glue so patients don’t get lost. You’re helping individuals and doing the right assessment, whether it’s social determinants of health or using our digital platform. What’s your main focus? It is a value-based model. You’re looking at five buckets of cost: inpatient, ER, ancillary, pharmacy and professional costs. What you’re doing with the dollars is looking at how best to look for areas where there’s waste in the system because the patient isn’t being better managed. And for people with chronic diseases, why aren’t we doing better with quality metrics, while also focusing on the prevention side and wellness? SEE CHALLENGES, PAGE 40 JOED VIERA MAY 15, 2020 THE FUTURE OF HEALTH CARE 39
Page 1 and 2: BUSINESS FIRST SUPPLEMENT THE FUTUR
Page 3 and 4: Contents JOED VIERA The Covid-19 pa
Page 5 and 6: ECMC’s Virtual Care EXTENDING HEA
Page 7 and 8: Patient Care Sponsored by BEYOND TH
Page 9 and 10: For a complicated time, the simples
Page 11 and 12: Collaboration, compassion and excep
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Page 15 and 16: Technology PAID ADVERTISEMENT Spons
Page 17 and 18: ROSWELL PARK COMPREHENSIVE CANCER C
Page 19 and 20: Thank You to all Healthcare Profess
Page 21 and 22: Visit shswny.org for more info As o
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Page 28 and 29: Health Education Sponsored by NEXT-
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Page 32 and 33: To the nurses, physicians and all t
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Page 36 and 37: THE FUTURE OF HEALTH CARE // HEALTH
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Page 44: Strokes require fast action. Don’

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