PPS News PPS News

On June 28, 2019 members from the community attended a stroke screening community event at Mount Sinai West where they received blood tests and hypertension screenings to get a better sense if they are at risk of a stroke. This event was a good opportunity for individuals to take preliminary prevention measures. All test results from this event will be shared with the patient and Mount Sinai staff will follow-up with the patients accordingly. 

Mount Sinai PPS offers free trainings to our partner organizations. These trainings include web-based and instructor-led opportunities on topics such as motivational interviewing, health literacy, and an introduction to value-based care. To learn more about the trainings offered, please click here to view the 2019 -2020 Population Health Training Catalog. Additionally, please click here to download the MSPPS Workforce Training Calendar to learn about upcoming trainings. MSPPS partners can register for these trainings via the Clinical Integration Learning Center (CILC) via Community Gateway. For hard copies of the catalog/calendar or for any questions, please email dsrip_workforce@mountsinai.org. 

Mount Sinai PPS and partners - Alliance for Positive Change, ACMH Inc., and CBC IPA/The Bridge will have poster presentations at the upcoming NYS Fourth Annual Statewide Learning Symposium. The presentations will highlight the Alliance’s adoption of a Pre-visiting Planning Tool to improve care coordination for patients, ACMH’s short-term crisis respite program, and CBC IPA’s high-touch CORE program for individuals with behavioral health issues. Mount Sinai PPS will be among the 25 PPSs with an exhibit booth to showcase PPS successes and lessons learned. For more information about the symposium, please visit: http://www.dsriplearning.com/

Mount Sinai PPS hosted a forum for our partners to discuss expectations and any questions as we approach the end of  DSRIP’s five year program. Peggy Chan, DSRIP Director at the New York State Department of Health, spoke at this event and provided the state’s perspective on overall DSRIP program accomplishments, lessons learned, and post-DSRIP plans. Mount Sinai PPS leadership also provided updates on our clinical initiatives, community partnership pilot programs, and overall PPS performance over the last few years.  

Mount Sinai PPS partners, Bailey House and Housing Works, have recently completed their merger on creating one of the largest providers of HIV/AIDS, housing, and primary care in New York City. The merger will allow for the creation of a housing development unit under the Bailey House name. Additionally the organizations will provide primary care services through Housing Works’ federally qualified health center while incorporating Bailey House’s mental health program in East Harlem. To learn more about this merger, please click here. 

Visiting Nurse Services of New York (VNSNY), Mount Sinai PPS partner, is expanding its LGBT outreach for senior citizens. VNSNY runs a Senior LGBT Outreach program funded by a New York Community Trust Grant that allows for collaboration with other community-based organizations that serve LGBT seniors and educates organizations, providers, and patients on clinical awareness of culture issues for this population. The goal of this program is to inform members of this LGBT population of their options and rights when it comes to health care.  In December, VNSNY presented ten workshops for senior groups on the LGBTQ Health Care Bill of Rights, which was announced last year by Dr. Mary Bassett, the former city health commissioner. For more information on VNSNY, please click here. 

Housing Works, a Mount Sinai PPS partner, recently secured financing from Manhattan-based Nonprofit Finance Fund, Primary Care Development Corp., and NYS DOH to open its fifth outpatient care clinic in New York City. The goal of this clinic will be to provide healthcare services, job trainings, and legal assistance to those living in Midtown and on the West Side. Housing Works is anticipating about 15,000 to 20,000 visits per year as the facility is close to a significant homeless population near the Port Authority Bus Terminal, Penn Station, and subway lines that run in the Bronx and Brooklyn. The Hell’s Kitchen facility is expected to open in early 2020. Read more here. 

Betances Health Center located in Manhattan's lower east side has always placed immense value on their patients' needs and decided to join the Mount Sinai PPS in 2015 and saw it as an opportunity to collaborate with other New York City health care providers, to share best practices and to learn from others. In alignment with DSRIP's clinical strategies, Betances redesigned its workflow to make behavioral health services more accessible to patients who need them. Since the redesign, Betances administers depression screenings to patients at every visit, instead of just at the annual check-up. As a result, 17% more patients have received a depression screening in the past year. Read more here. 

The recent Crain’s Health Care Summit brought together payers, health systems, community-based organizations, and other health care agencies to discuss efforts around population health especially through DSRIP.  Mount Sinai Health System’s Executive Vice President and Chief Population Officer Niyum Gandhi underscored the importance of the partnerships developed through DSRIP and discussed the influence of this collaboration in this complex health care landscape. Read more on how Mount Sinai PPS partnerships will continue after DSRIP.

Through DSRIP funding, City Health Works will provide eligible patients with locally hired health coaches for six months. The health coaches will provide patients with health education, care coordination, and support to help patients manage their chronic conditions.  During these six months, patients will receive coaching sessions and some home visits to ensure that they are staying on track with health goals and are managing their chronic conditions. For more information, click here or e-mail dsrip@mountsinai.org.

Mount Sinai PPS partners, The Institute for Community Living and Community Healthcare Network opened the $30 million East New York Health Hub. This addition gives the community of East New York vital primary care and behavioral health services that were previously lacking.

The Health Hub is a 40,000 square foot health center that provides care coordination, housings services, nutrition support, job programs and substance-use-services. The location of the health center will benefit both East New York and Brownsville neighborhoods, which have faced some of the highest rates of chronic health conditions and have nearly the highest rates of psychiatric hospitalizations in NYC. To read more on the new Health Hub click here.

Ryan Health recently launched a new pediatric development program at Ryan Health | Women and Children’s on the Upper West Side. This new program is called HealthySteps and aims to improve the well-being and developmental outcomes of babies and toddlers while providing guidance and support to parents and caregivers. Congratulations to our partner, Ryan Health on the launch of this unique program! Read more about the program launch here.  Learn more about the HealthySteps Program here. 

The Institute for Family Health (IFH) was recently awarded three federal grants from the Health Resources and Services Administration (HRSA). IFH will utilize these funds to expand its integrated substance use disorder and mental health services in Harlem along with making enhancements to its electronic health records system and health information technology for its entire network of sites. Congratulations to our partner, IFH on this achievement! Read more about this accomplishment here. 

Read the Mount Sinai PPS’ newsletter to learn about the innovative and collaborative community partnership programs we are offering to our contracted partners. Some examples of these DSRIP funded programs include free legal counseling at two local FQHCs , home visits to manage health triggers for asthma patients, and the expansion of food pantry services. Additionally, learn about ways MSPPS is engaging with our workforce with  a  ‘What is Population Health’ video following Joe’s journey through a population health model and the re-design of our learning management system.  

Rev. Dr. Zorina Costello, Director of Community Engagement at the Center for Spirituality and Health at Mount Sinai Health System has been engaging with nine churches primarily in East and West Harlem on M.I.C.A.H™ Project HEAL, which stands for the Multi-faith Initiative on Community and Health - Project (HEAL) Health through Early Awareness and Learning. The project provides church leaders with basic health education and health provider resources. Once trained, these Community Heal Advisors offer health education to community members. Learn more here: https://partner.mountsinai.org/web/mspps/community/projectheal

Since launching in April 2017, 74% of patients who utilized this service were treated at home and avoided an unnecessary visit to the hospital. Through Mount Sinai’s Community Paramedicine Program, trained community paramedics are dispatched to a patient’s resident and communicate in real-time via telemedicine technology on the patient’s treatment plan with Mount Sinai physicians. Recently, the program expanded its services to Queens, now making it available in four boroughs while continuing to be accessible 24/7. 

God’s Love We Deliver is collaborating with Mount Sinai PPS organizations, Mount Sinai St. Luke’s and Mount Sinai Doctors Jackson Heights on a three month meal delivery pilot to provide nutritional meals to high-risk Medicaid patients with diabetes. In line with God’s Love's belief that “food is medicine, food is love,” the goal of the pilot is to provide nutritional stability, increase comfort, and reduce hospital utilization for participants. MSPPS identified fifteen high-need adult Medicaid patients with diabetes for this pilot. God's Love will develop a nutritional assessment with each enrolled patient and tailor menus to each patient’s needs. Meals will be delivered to each patient for three months. Learn about  the initiative here. 

Little Sisters of the Assumption (LSA) and AIRnyc will provide home-based asthma services to Medicaid patients with persistent and uncontrolled asthma. LSA and AIRnyc are using DSRIP funds to support these services. Through home visits, patients receive assessments on environmental factors impacting their asthma condition and learn strategies to manage asthma triggers and symptoms. LSA is available to patients who reside in East Harlem and AIRnyc is available to patients in other parts of Manhattan, Queens, and Brooklyn. Read more here: https://partner.mountsinai.org/web/mspps/community/asthma 

In July, Betances Health Center hosted the grand opening of its new location in Bushwick, Brooklyn, where it plans to serve about 1,200 patients annually, most of who are uninsured and low-income. The goal of this new health center is to provide this diverse population with quality health care services regardless of their ability to pay or not. Some of these services will include adult primary care, women’s health care, family planning, HIV/AIDS screening, pediatric care, and behavioral health care.  In attendance of this event were life-long Bushwick residents, Betances staff members, and City Councilman Antonio Reynoso, who represents the Bushwick location of District 34.  For more information on this new community health center, please click here. Congratulations to our PPS partner, Betances!

MSPPS partners Dr. Theresa Soriano Senior Vice President of Care Transitions and Population Health at Mount Sinai St. Luke's Hospital and Shoshanah Brown with AIRnyc joined the “Leveraging Value-Based Payment to Address Social Determinants” panel at United Hospital Fund’s recent Medicaid conference. Dr. Soriano shared with the audience the MSPPS created social determinant of health (SDH) screening tool that is being used at St. Luke’s as a way to connect patients to community resources. Shoshanah from AIRnyc, addressed how her organization provides community health workers with in-home interventions to address SDH. The panel discussed how SDH could contribute to value-based contracting discussions with payers.  

The event was presented with support from The Commonwealth Fund. To learn more about the United Hospital Fund, please visit https://uhfnyc.org/.

LegalHealth, a division of the New York Legal Assistance Group (NYLAG), is collaborating with Mount Sinai PPS partners, Settlement Health in East Harlem and the Ryan Health on the Upper West Side, to address socioeconomic and healthcare disparities through legal counseling. In addition to bi-weekly legal sessions available to members of the community, LegalHealth will also train Ryan Health and Settlement Health staff to identify when legal intervention and referrals are needed. To learn more about the initiative, visit: https://partner.mountsinai.org/web/mspps/community/nylag 

In July,  New York Common Pantry (NYCP), one of New York City’s largest single-site community based food pantries, expanded its mission to reduce hunger throughout New York City while promoting dignity and self-sufficiency. Through DSRIP funding, NYCP is expanding a few of its programs. Learn more here: https://partner.mountsinai.org/web/mspps/community/nycp 

Gay Men’s Health Crisis (GMHC) will launch the Terry Brenneis Hub in early June, a program dedicated to supporting and caring for long-term survivors of HIV/AIDS by providing them with resources and services to address their needs. Some of the services in this program include meals and nutritional counseling, support groups, workforce placement, and on-site pharmacy usage. For more information on GMHC, please visit their website here or MSPPS’ Partner Spotlight Series article here.

The New York State Department of Health released its latest DSRIP quarterly report announcing that the state had met all its required milestones set, achieving 12 out of the 16 targets for delivery system improvement. Additionally, the 25 performing provider systems (PPS) involved in DSRIP received a total of $923.9 million during this quarter. For more information on the latest quarterly report, please click here. 

Community Healthcare Network is partnering with the Medical Alumni Volunteer Expert Network Project (MAVEN), a non-profit telehealth mentoring program, to reduce physician burnout.  The MAVEN Project is comprised of retired and practicing physicians who volunteer as online mentors and consultants in medically underserved areas with the goal of providing support, guidance, and advice to CHN’s providers. The partnership is initially being rolled out to 42 CHN clinicians including doctors, nurse practitioners  and midwives and will take place over a three month time-frame where providers will engage in group and one-on-one sessions and complete surveys to track their progress. For more information on CHN, please visit their website here or MSPPS' Partner Spotlight Series article here. For more information on the MAVEN Project, please click here. 

Read about Mount Sinai PPS’ support with ACMH’s  short-term crisis respite program available to MSPPS partners, a highlight of the Analytics application to support partners in care gap closure activities, stories about how our partners are implementing clinical initiatives, and our partner spotlight on Gay Men’s Health Crisis.  Please click here to access the newsletter visit our partner spotlight page here. 

Mount Sinai St. Luke's Hospital launched a pilot program with the support of Mount Sinai PPS to screen for social determinants of health. The full story is available here (note that Crain's subscription and log-in is required). As quoted in Crain's, Dr. Theresa Soriano, senior vice president of care transitions and population health at Mount Sinai St. Luke's says: "The innovation is not that social determinants of health exist, [rather to systematize] how we collect a broader set of social determinants that we can then quantify and use to characterize a population in a meaningful way." Learn more about the project and the social determinant of health screening tool.

For additional  information on key dates for DY 4 please click here.

Vasantha Kondamudi, Senior Vice President and Chief Quality and Safety Officer for The Brooklyn Hospital Center (TBHC) was named by the 7^th Congressional District’s Multi Ethnic Advisory Task Force as one of the 20 top global women of excellence at the task force’s International Women’s Day Celebrations in Elmhurst, IL. To learn more about TBHC, please click here. 

Community Gateway is now available as a mobile app through the Apple App Store or Android Google Play! Log in from your phone today. Search for "Community Gateway," download the app, and navigate through the website and CG applications just like you would on your desktop.

Read about our social determinant of health screening tool, a highlight of the Community Resource Guide, an application to curate community resources for patients featured on MSPPS’ web platform Community Gateway, and our partner spotlight on the Brooklyn Hospital Center. Additionally, learn about our updated clinical strategies and efforts to achieve performance improvement. Please click here to view the newsletter and visit our partner spotlight page here. 

At a learning symposium with DSRIP stakeholders and PPSs, Mount Sinai PPS, Community Health Care Network, Mount Sinai St. Luke’s Hospital, and Montefiore Health System will share insights on how their partners and providers have been using social determinants of health (SDH) screening tools. Mount Sinai PPS designed a screening tool through the guidance and feedback of a core group of partners and then testing this tool with a group of pilot partners.  Through this process, Mount Sinai PPS partners learned of top social determinants of health issues impacting patient care. Findings from this pilot will help inform strategies to address these issues. Presenters will share individual experiences in understanding social determinants of health in their communities through their screening tools. Read more under the 11:00am slot on this agenda page. 

On Tuesday, February 6th, Urban Institute hosted an event highlighting the work of City Health Works (CHW), discussing the critical role of health coaching to improve the health of patients with chronic illnesses and address their complex needs outside the doctor’s office. Dr. Theresa Soriano, SVP for Care Transitions and Population Health at Mount Sinai St. Luke’s Hospital and Clinical Quality Committee Co-Chair at Mount Sinai PPS spoke at the event, sharing the Mount Sinai St. Luke’s and Mount Sinai PPS experience in utilizing the health coaching model to address needs of patients with congestive heart failure. Supported by DSRIP, CHW and Mount Sinai St. Luke’s Hospital are partnering on a pilot to reduce hospital admission for Medicaid patients with congestive heart failure. Hear more about it here. Learn more about the pilot here. 

This is the second of two options for partners to participate in the DY2 PP2 Contracting Webinar. During this webinar, the PPS will provide an update on the contracting process to date, describe the new funding allocation method, and review how you can access key contracting information through Community Gateway. Partner main contacts to receive invitations in January by e-mail. For more information, visit the Contracts page under Resources or email us.

This is the first of two options for partners to participate in the DY2 PP2 Contracting Webinar. During this webinar, the PPS will provide an update on the contracting process to date, describe the new funding allocation method, and review how you can access key contracting information through Community Gateway. Partner main contacts to receive invitations in January by e-mail. For more information, visit the Contracts page under Resources or email us.

Read about our new contracting methodology as we enter into the second performance period of DSRIP Demonstration Year 2, our first consumer focus group, and our partner spotlight on God’s Love We Deliver. Click here to view newsletter

Mount Sinai PPS’s final Mid-Point Assessment Report can be found here. The Mid-Point Assessment evaluates the progress of each of the 25 PPSs across the state. The report details Mount Sinai PPS’ progress with its approved DSRIP project plan, funds flow process, quality improvement activities, partner engagement, and other topics alike.

Read about the launch of Project 2.b.viii’s Community Paramedicine Pilot, the integrated model of care from the Care Coordination Cross Functional Group, and our partner spotlight on Settlement Health. Click here to view the newsletter and visit our partner spotlight page here.

The New State Office of Information Technology Services will host webinars to help partners understand how to use the PSYCKES application to support DSRIP projects. The webinar will provide an overview of the application, review quality improvement reports and the process of using client level data through clinical summaries to improve care and implement DSRIP projects across provider sites. For more information about PSYCKES, visit the website or e-mail us

The New State Office of Information Technology Services will host webinars to help partners understand how to use the PSYCKES application to support DSRIP projects. The webinar will provide an overview of the application, review quality improvement reports and the process of using client level data through clinical summaries to improve care and implement DSRIP projects across provider sites. For more information about PSYCKES, visit the website or e-mail us

The DSRIP Project Approval and Oversight Panel met with PPSs in early February to discuss findings from the Independent Assessor's Mid-Point Assessments of all 25 PPSs in New York State. The Mid-Point Assessments include a review of PPS's progress on project work plans, their funds flow process, quality improvement activities, partner engagements, and others alike. These meetings were open to the public, including a session on January 31st where the public had an opportunity to provide feedback and comments on these findings. View the recorded sessions. Read more about Mount Sinai PPS’ Mid-Point Assessment.

Read about March Home Health Awareness Forum to learn more about the health home services. Please click here to view the newsletter and visit March's partner spotlight series.

To learn more about MSPPS’ innovative use of Salesforce, please click here. .

You'll learn about the New York State Health Home Program and how to connect with Health Home Leads in the Mount Sinai PPS network. For more information, please e-mail dsripcommunications@mountsinai.org.

This is the second of two options for partners to learn more about accessing and uploading their reporting templates in Community Gateway. During this webinar, project managers will walk through the reporting process for specific project metrics. For more information, please contact us.

This is the first of two options for partners to learn more about accessing and uploading their reporting templates in Community Gateway. During this webinar, project managers will walk through the reporting process for specific project metrics. For more information, please contact us.

For additional information on key dates for DY 3 please click here.

For additional information on key dates for DY 3 please click here.

The Community Paramedicine Program responded to its first patient in April. The referral was made by Visiting Nurse Service of New York for a patient in the Upper West Side who was treated by SeniorCare medics trained and dispatched by Mount Sinai.

For additional information on key dates for DY 3 please click here.

For partners who are not yet connected to a Qualified Entity (QE), New York State Department of Health (NYS DOH) and New York eHealth Collaborative (NYeC) recently updated its Data Exchange Incentive Program (DEIP). For additional information, please click here.

Read about MSPPS’ shift from planning to clinical implementation, our current work in clinical performance, and partner spotlight on Community Healthcare Network. MSPPS has also been doing a lot of exciting work with City Health Works and Mount Sinai St. Luke’s on a care transitions pilot for patients with congestive heart failure. We have also begun to implement Community Gateway to some partners within the PPS network. Community Gateway is our web-based platform designed for MSPPS health care professionals to access innovative tools and applications for clinical transformation. Please click here to view the newsletter and visit our partner spotlight page here.

For additional information on key dates for DY3, please click here.

By the end of DSRIP Year 2 (March 31, 2017) the New York State Health Department reported potentially avoidable hospital readmissions in the PPS systems were down by 14.9% and preventable emergency department visits were down by 11.8%. 

For additional information on key dates for DY3, please click here.

The Care Transitions & Population Health Team at Mount Sinai St. Luke's (MSSL) and its Mount Sinai Heart Program partnered with MSPPS partner, City Health Works, to launch a care transitions pilot program for patients with congestive heart failure. To learn more about this partnership, please click here. 

Mount Sinai PPS partner, Buena Vida Continuing Care and Rehabilitation Center, a residential healthcare center, was recently awarded a Quality Rating of five stars and an Overall Star Rating of three stars from The Centers for Medicare and Medicaid Services for its dedication and quality of care provided to patients. We congratulate the staff at Buena Vida for accomplishing this milestone and for their efforts to constant improvement while providing warm, compassionate, and experienced care. For more information on Buena Vida click here. 

Collectively, Performing Provider Systems earned 96% of the total funds available - totaling $2.5 billion through the end of DSRIP Year 2 (March 31st). For the latest quarterly reports for each PPS, please click here. 

Mount Sinai PPS and St. Luke's Hospital President Arthur Gianelli and Dr. Kenneth L. Davis, President and CEO of Mount Sinai Health System contributed on an article about how Republicans and Democrats must give a little to get a little to improve the delivery of healthcare. To read the full article, click here. 

Last day for participate in the program to help defray the cost for an organization connecting to a local Qualified Entity for Health Information Exchange adoption. Read more.

Sharen Duke, Executive Director/CEO at The Alliance for Positive Change is featured in an issue of The Hill  where she provided her thoughts on the opioid epidemic.  

City Health Works and Mount Sinai St. Luke’s (MSSL) are collaborating on a one-year pilot, launched in mid-July, to reduce hospital readmissions for patients with congestive heart failure. The program will provide 100 eligible Medicaid patients in Harlem, Washington Heights, and the Upper West Side with individualized health coaching and care, enabling them to self-manage their condition in their homes and, in the process, reduce hospital readmissions, which is a central goal of the New York State Delivery System Reform Incentive Payment Program (DSRIP). Through this collaboration fostered through the Mount Sinai Performing Provider System (MSPPS), nurse specialists from the MSSL Heart Failure Team have trained City Health Works’ health coaches on heart failure and key self-management tools for congestive heart failure patients. Read the full press release here. Read more here. 

City Health Works and Mount Sinai St. Luke’s Hospital is collaborating on a pilot to reduce the number of ED visits for patients with congestive heart failure (CHF) through health coaching. The partnership is highlighted in an article from Modern Healthcare. Through this pilot, health coaches educate patients on CHF and provides them with healthy living activities and information on how they can better manage their condition. Over the next six months both organizations along with the MSPPS clinical team will evaluate the pilot with the hopes of expanding to other areas of New York including Brooklyn and the Bronx.  Read more here. 

Mount Sinai's Community Paramedicine Program promotes partnership between Mount Sinai physicians and specially trained paramedics, by having the paramedic dispatched to the patient's residence and communicating with the physician on next steps via telemedicine technology. Read more about the partnership with VNSNY here. Learn more about Community Paramedicine here. 

Read about a patient's experience with the congestive heart failure pilot between MSPPS partners City Health Works and Mount Sinai St. Luke's, an update to the PPS performance achievements, and our partner spotlight on William F. Ryan Community Health Network. Additionally, be sure to read about the great and innovative work our partner organizations are accomplishing. Please click here to view the newsletter and visit our partner spotlight page here. 

This Politico article shares the importance of community health worker programs and highlights MSPPS partner, City Health Works and their use of a health coach to interact with patients to really reduce his/her hospital readmission rates. Read more here. 

Executive Vice President and Chief of Provider Operations at VNSNY, Marki Flannery, discusses the benefits of the Community Paramedicine partnership with VNSNY and Mount Sinai in an article from the Huffington Post.

Sharen Duke, Executive Director/CEO at The Alliance for Positive Change is featured in an article of The Wall Street Journal where she discusses how the organization’s hard work has helped in meeting the ever-changing needs of New Yorkers over the last 27 years. 

MSPPS Partner Betances Health Center receives HRSA funding opportunity. Funding will offer community health centers with increasing personnel, leveraging health information technology, and providing trainings on prevention and awareness of opioid abuse. Please click here to read their press release. 

MSPPS presented to NYS DOH on technology plans to support PPS project implementation. Each PPS was asked to prepare a brief presentation on current capabilities, future needs, the role of the QE/RHIO, and provide feedback on their experience with DOH tools. more...

Read about our upcoming Consumer Advisory Council, new MSPPS staff, and our partner spotlight on Goodwill NYNJ. Click here to view the newsletter and visit our partner spotlight page here.

The Centers for Medicare and Medicaid Services (CMS) requires the state to submit quarterly reports on its progress with the DSRIP Program on meeting deliverables and milestones. Please click here for the DY2 Second Quarter Report.

MSPPS is developing an ambassador program to improve PPS engagement with community-based organizations and consumers. The program will include both Lead Ambassadors and Co-Ambassadors, who are partners within the PPS network. They will work on strategies to create DSRIP awareness and education within each Ambassador’s community.

During the August Town Hall, audience members saw an overview of the upcoming website and Community Gateway portal, which will provide partners with access to data on performance metrics and outcomes. Read more...

As a PPS partner, you may be selected to participate in a survey by the New York State Department of Health (DOH) to assess your engagement with your PPS. The online survey is planned for distribution on August 1, 2016. Responses will be due by August 31, 2016.

The event included an overview of the CC/HL strategy as well as a presentation on the expectations and responsibilities of the Site Champion role. Each partner organization is expected to have a site champion whowould ultimately serve as a liaison between the MSPPS CCHL workgroup and the partner organization. Additionally, Callen-Lorde Community Health Center's Finn Brigham presented on "LGBT Cultural Competence in Healthcare" and discussed strategies to manage the diverse health concerns of LGBT patients.

Project 2.b.iv MD Champion, Dr. Kevin Munjal presented the Community Paradmedicine Program and Senior IT Director, Patti Cuartas, and Care Coordination Project Manager, Dennis Lumbao co-presented on lessons learned from the early stages of piloting a care plan exchange.

Read about highlights from our August Town Hall, the kick-off of our Lead Ambassador Program, and our partner spotlight on The Young Adult Institute. Click here to view the newsletter and visit our partner spotlight page here.

Consumer Advisory Council kicked off its first meeting which consisted of patient advocates nominated by members of the MSPPS Stakeholder Engagement Workgroup. For reach out to Senior Stakeholder Engagement Manager, Tara Partovi about nominations, Click to e-mail.

Read about highlights from our CCHL event, new Health Home eligibility services, and partner spotlight on Callen-Lorde. Click here to view the newsletter and visit our partner spotlight page here.

The segment focused on its coaches, clients, and clinicians. Click here to watch.

The Centers for Medicare and Medicaid Services (CMS) requires the state to submit quarterly reports on its progress with the DSRIP Program on meeting deliverables and milestones. Please click here for the DY2 Third Quarter Report.

November Town Hall will highlight the events from the past quarter include the PPS’ focus towards performance-based reporting and analytics. Partners will hear from PPS leadership and have an opportunity to network with other partners in the PPS. Click to e-mail for more information.

This event is for MDs, DOs, NPs, PAs, RDs, RNs and administrative personnel with a strong interest in treatment of diabetes patients with various co-morbidities and various socioeconomic and demographic challenges. May be of interest to 3ci participating partners.

Read about the launch of the new MSPPS website, results from the Clinical Integration Readiness Survey and partner spotlight on VillageCare. Click here to view the newsletter and visit our partner spotlight page here.

>Mount Sinai St. Luke’s Hospital and Mount Sinai PPS President Arthur Gianelli will present on “Navigating Value-Based Care: Making it Work in New York.” Click here more information.

MSPPS ranked fourth out of 25 PPS’s across New York for strong partner encouragement. This assessment included a 360 survey to randomly selected partners, a site visit from the DSRIP Independent Assessor (IA), and the IA’s review of the PPS’ quarterly reports to the New York State Department of Health. Read more..

City Health Works (CHW) received a $2 million grant awarded from the Helmsley Charitable Trust. The money awarded from the grant will be invested in the organization's core operations as it prepares to increase its clientele throughout New York City. City Health Works utilizes community members to serve as health coaches to provide individualized support for its patients. Click here to read the full article.  CHW is currently collaborating with Mount Sinai St. Luke's on a year-long congestive heart failure pilot to reduce hospital readmissions. To learn more about this pilot, please click here. 

Coordinated Behavioral Care (CBC) won the Heritage Healthcare Organizational Leadership Award at the 3rd Annual Heritage Healthcare Innovation Awards sponsored by Heritage Provider Network HPN and Crain’s New York Business. The event is an award ceremony dedicated to honoring those organizations and individuals who have improved the access and quality of affordable healthcare across New York. As a part of their innovative work, CBC has been developing a clinically integrated delivery system for their 50 network providers to ensure care gap closures and to provide patients with access to different quality programs.  Nominees for this award included Mount Sinai Health System, Essen Health Care, Healthfirst, and Weill Cornell Community Clinic.  For more information on these awards, please click here. To learn more about CBC, visit their webpage at www.cbcare.org. 

The Mount Sinai PPS is supporting ACMH to provide short-term referral-based crisis respite services for patients experiencing a mental health crisis. Behavioral health patients receive crisis respite services following an inpatient stay, or as an alternative to hospitalization. During their stay, patients receive a wide range of services ranging from daily living skills to entitlement assistance, and includes around-the-clock support from peer counselors. This program is available to Mount Sinai PPS partners. Find out more on how to refer your patients to this program, contact us at dsrip@mountsinai.org or read more here. 

Mount Sinai PPS selected 20 sites for this first pilot launch of the Care Hub initiative and anticipates work around these efforts to begin in January 2017. Click here for the Hub Implementation presentation from the November Town Hall.