New York State Wide Senior Action Council Inc

New York State. Wide Senior Action Council, Inc. DSRIP Efforts

Members Identified Health Transformation as a Major Concern • Shared overall goal of reductions in hospitalization but concerned about need to assure community involvement and reinvestment of resources. • Albany Chapter held first area forum on DSRIP in formative stages of area PPSs to fill information vacuum. 80 people attended. • Follow up included involvement in AMC PPS’s Consumer and Community Affairs Committee (Co -Chair), Cultural Competency Health Literacy, and Project Advisory Committee.

Encouraged Community Participation • Partnered with other CBOs to advocate for regional meetings. Resulted in two regional meetings Columbia/Greene and Saratoga Counties. • Also helped plan meetings at member CBOs offices to broaden awareness of other services– Alzheimer's Association and Alliance for Positive Health • Partnered with MMNY to hold a forum in August for CBOs with speakers from MMNY and two area PPSs. (over 40 groups attended). • Facilitated discussion at joint PPS meeting in Albany.

Positives • Have learned more about workings of PPS and projects. • Have encouraged CBOs to get involved as project partners. • Have improved communication with PPSs. Have assisted each other in supporting efforts to inform and involve CBOs. • Have provided input into Population Health Management Plan, the Community Engagement Plan, and the Cultural Competency and Health Literacy Plan, and the Community Needs Assessment. • The Community and Consumer Advisory Committee has provided a forum for new organizations to get involved.

Areas for Greater CBO/Consumer Involvement of Medicaid Beneficiaries Involvement of actual Medicaid beneficiaries or caregivers on the committees or input mechanisms employed by the PPS. Most committee representation occurs primarily through agency representatives. Listening sessions are helpful but engagement in projects should be developed. Involvement of CBOs in Patient Navigator/care coordination strategies These are critical components of system transformation to help reduce unnecessary hospitalizations. However, so far they have been primarily implemented through area medical providers. Initial emphasis is related to emergency room services. A broader involvement of non-medical community based organizations is needed. Involvement of CBOs to develop neighborhood strategies to address "hotspots“ These are opportunities to show measureable health improvements in areas of high need or barriers to care identified by AMC in their health population and community needs assessment. High involvement of Community in Project looking at redeployment of 100 Nursing Home Beds Close involvement of CBOs in plans to implement the PPSs Project 2. a. v. Medical Village Transformation which calls for efforts to: "transform outdated (underperforming) nursing home capacity into a stand-alone emergency department/urgent care center or other healthcare-related purpose" (for example through the development of more primary care through a Medical Village concept or through Naturally Occurring Retirement Communities) this would potentially result in the loss of or redeployment of 100 nursing home beds in the region.

Technical Assistance Needs Identified Through feedback at MMNY Forum and work on committees identified some areas for additional technical assistance: -Value Based Contracting. Carving out resources to pay CBOs. -Providing better care for limited English speaking and culturally diverse populations including changes to workforce. -Help with PPS contracting and reporting processes. -Linking discharge planning to CBOs. -Patient Activation strategies through CBOs. -Coordination with primary care.