VOLUME 2 \ ISSUE 5:February 5, 2014
I am pleased to note that our ongoing focus on quality continues to yield results. Last Thursday and Friday, the leadership of VNSNY CHOICE went through their long-anticipated FIDA Readiness Review, hosting a group of healthcare officials and experts who examined every aspect of our proposed care delivery plan for “dual eligible” Medicare and Medicaid patients. The initial feedback was extremely positive. You can read more about this visit under the Growth section of this issue. Another article in this week’s Quality section details the outstanding recent performance of the VNSNY CHOICE Call Center. My thanks to everyone for your hard work on these and VNSNY’s many other initiatives that are transforming the way we do business, and enhancing the quality of care we deliver to our patients and members.
VNSNY Hosts Delegations from Connecticut and Australian Care Providers

On January 14, 2014, VNSNY hosted a meeting at our 70th Street headquarters with nursing leaders from the Visiting Nurse Association of South Central Connecticut (VNASCC), a home care agency based in the Yale-New Haven area. “The VNASCC, which is in the process of refining their palliative care and advanced illness management programs, wanted to gain insight into our experience in these areas,” explained Eleanor Canning, Vice President, Access for VNSNY Hospice and Palliative Care.

Joining Eleanor at the meeting were Hany Abdelaal, Chief Medical Officer for VNSNY; Karol Dibello, Associate Director of the SPARK program; Regina Hawkey, Senior Vice President and Chief of Provider Services; Paulina Kim, Chief Medical Officer of Hospice; and Noreen Coyne, Clinical Development Specialist. Together, they offered an overview of the successes and lessons learned over VNSNY’s 15-year history of community-based palliative care. We look forward to providing continued assistance to VNASCC, and to learning from them as well.

The following week, from January 21st through 23rd, VNSNY hosted Glenn Payne, CIO, and Jenni Marsh, Business Excellence Manager of Feros Care, an Australian not-for-profit organization that provides senior and aging care. Although Feros is small compared to VNSNY—they provide care to 3,500-plus seniors and have about 400 staff—their service area, which extends throughout Australia, is much larger. They are growing rapidly to meet the need for home and community services in these regions, and are trying to determine the best approaches for their next phase of development.

“Feros asked to meet with VNSNY because of our reputation for innovative work in research, evidence-based practice, and clinical informatics,” said Tim Peng, Director of Outcomes and Informatics at VNSNY’s Center for Home Care Policy and Research, who helped host the meeting.
VNSNY CHOICE Undergoes FIDA Readiness Review and Gets Positive Early Feedback

On January 30 and 31, 2014, VNSNY CHOICE underwent a Fully Integrated Duals Advantage (FIDA) Readiness Review led by the National Opinion Research Center at the University of Chicago, an independent social science research organization. A team of reviewers from the University of Chicago, the Centers for Medicare and Medicaid Services (CMS), New York State’s Medicaid office and the Health Services Advisory Group met with CHOICE staff over one-and-a-half days to review our care delivery plans for “dual eligible” Medicare- and Medicaid-insured patients. This review is a key step in the approval process to participate in New York’s new FIDA program, which combines Medicare and Medicaid services into a single integrated managed-care platform.

For the CHOICE team, the visit capped months of intensive preparation that included implementation by Hugh Hale’s IT team of the Altruista online care management application, as well as developing additional provider networks and creating new enrollment, staffing, care delivery and adjudication structures for FIDA patients. During the site visit, the reviewers sat down with leadership from every department in CHOICE to examine their FIDA-related systems. Managers also ran through various case scenarios to demonstrate their ability to support the FIDA product.

Initial feedback from the reviewers, presented at the closing session, was highly favorable. They praised the CHOICE team’s extensive preparation; the Altruista online care management system, which they said was the best they had seen nationally; CHOICE’s well-designed enrollment process; and the fact that our frontline nurses knew how to operate the system and were involved in the all the key decisions in system configuration—another example of our Shared Governance initiative yielding results.

“The reviewers indicated that we will be recommended to CMS and New York for inclusion in the demonstration,” said Chris Palmieri, President of VNSNY CHOICE. “The lead reviewer also stated that she believes the VNSNY model will become the model for the nation.” My thanks and congratulations to everyone in CHOICE for this wonderful effort and great outcome. It is a powerful testament to the “One VNSNY” and “We All Lead” concepts and our Excelsior initiative.
Update on the Lillian Wald Ambassador Program

VNSNY’s six Lillian Wald Ambassadors are now midway through their half-year of training with the Jean Watson Caring Science Institute in Boulder, Colorado. The course began with a four-day session in Chicago last fall. At the Watson Institute International Caritas Consortium, held on October 10–11, 2013, the Ambassadors heard speakers present professional practice models based on applying Jean Watson’s “Human Caring Science” in their own healthcare organizations. This was followed by two days of classes in Caring Science theory—an approach to nursing and other disciplines that focuses on how caring relationships and a humanitarian attitude lead to improved patient outcomes. “My heart felt as though it was jolted with inspiration, listening to so many amazing nurses who have been living the Caring theory in their personal and professional lives,” said Amelia Muir, Psychiatric Nurse, Behavioral Health, one of our Lillian Wald Ambassadors.

Since then, the participants have been going through a series of learning guides that include reading assignments and daily centering exercises. “I begin each day by meditating and focusing on silent gratitude,” said Coleen Cox-Ballah, Manager, Centers of Excellence-Nursing, another Ambassador. Caring Science teaches that when nurses are personally centered going into patient encounters, they become better caregivers. “It also works in other situations,” added Coleen. “I was in a meeting recently, and asked everyone to center themselves. They really got it!”

The program, funded by a grant from the Balm Foundation, encourages the Ambassadors to share Caring Science principles with their VNSNY colleagues. They have also developed proposals for applying Caring Science to various aspects of VNSNY’s operations, including how this theory can be used to support our Professional Practice model for Shared Governance and our Journey to Magnet. The six-month course concludes with a visit to the Watson Institute in April.
VNSNY CHOICE Call Center Focuses on Enhanced Customer Experience

Providing a consistently excellent customer experience is one of VNSNY’s key quality goals for 2014. As part of this effort, the VNSNY CHOICE Call Center is adopting a more flexible structure that allows them to make additional Member Service Representatives (MSRs) available as needed to handle calls from plan members at peak calling times. On any given day, MSRs field an average of 6,000 calls from members in VNSNY CHOICE’s Managed Long Term Care (MLTC) plan, CHOICE Medicare Advantage, and CHOICE SelectHealth. To minimize the time callers spend on hold, the Call Center is analyzing its call patterns and carefully matching staff schedules to predicted call flow, and is also working to develop a system that routes calls to different MSR teams if one group is experiencing an unusually high call volume.

The new system remains a work in progress, but it is already having an impact: The center’s overall performance rating in the final quarter of 2013 was up 21% compared to the first three quarters of the year, and December’s performance was particularly strong, with more than 80% of customer calls answered in 30 seconds or less and a call abandonment rate of under 3% for all three CHOICE plans.

The following 2014 goals were presented at the meeting:
  • Develop and implement enterprise-wide Quality Improvement (QI) framework to improve results for Whole System Measures (WSM)
  • Demonstrate adoption of QI framework utilizing Plan, Do, Study, Act (PDSA) methodology through improvement of Overall Customer Satisfaction metrics as evidenced by improved percentile ranking to the 30th percentile for VNSNY Home Care (NRCPicker)
  • Demonstrate adoption of QI framework Plan, Do, Study, Act (PDSA) through improvement of Overall Customer Satisfaction metrics as evidenced by improved percentile ranking above the regional benchmark (above 40th percentile)
  • Implement enterprise-wide Quality Improvement framework action plans, including WSMs, standards and goals, for 5 measures: Hospitalization; Falls with injury; HgA1C levels; LDL levels; Pain; and Medication
  • Improve 2014 metrics over 2013 on 3 measures to established benchmarks
  • Improve 2014 metrics over 2013 on 3 measures to better than benchmarks
The center’s MSRs are also trained to provide a high quality interaction on each call—a goal that requires empathy, expertise and patience, as they help with issues ranging from transportation requests to questions about medications or plan benefits. “Most of our callers are elderly and ill, and some don’t have any family—we’re it for them,” noted Nancy Vitale, Director of Call Center Operations for CHOICE. “Our top priorities are to make sure their calls are answered promptly, and that we take enough time with each caller to explain everything they need explained. Sometimes, one of our members just needs someone to talk to. When that happens, we’re here for them.”
VNSNY Supplier Diversity Program Enhances Collaboration with Minority- and Women-Owned Businesses

VNSNY is committed to maintaining a supplier base that is as diverse as the people in the communities we serve. In addition to ensuring that all vendors in the marketplace have equal access to our business, developing a diverse group of suppliers lets us meet the needs of our patients and members more effectively, since it enables VNSNY to draw on a wider range of products and businesses. Several years ago, to help us achieve this goal, our Procurement & Contract Management Department established the Supplier Diversity Program—an initiative dedicated to identifying and contracting with qualified Minority and Woman-Owned Business Enterprises (MWBEs) that can provide high-quality goods and services to VNSNY.

Since the Supplier Diversity Program’s launch on Sept 7, 2011, it has thrived and become a valuable sourcing tool. Over that time, we have added 29 new MWBE suppliers to our supplier base, including such widely used vendors as printing suppliers Mendez Instant Printing and Harlin Printing Services, the car service provider Last Radio Group, and Creative Source Inc., a Graphic Design firm. The volume of business we conduct with MWBE suppliers continues to grow as well: VNSNY spent $27 Million with minority- and women-owned vendors in 2012, $38 million in 2013, and is projected to spend $45 million in 2014.

Additional details about the Supplier Diversity Program can be found on VNSNY’s public website by entering “Supplier Diversity” in the search box.
I have talked about how VNSNY caregivers provide an important lifeline to the most vulnerable members of our community, especially in the conditions of extreme cold we have been experiencing recently. The following reflection illustrates this truth vividly. It was offered by Roberta Lee Roberts, RN, a nurse with Behavioral Health in Westchester.

“I wanted to share a situation that occurred during my visit today with one of our shared patients who lives in Westchester. When I entered our patient’s home, I noticed he was wearing a woolen hat and was huddled around his little kitchen table with a small electric heater at his feet. When I inquired about the new heater, the patient casually stated the obvious: it was very cold today, about 7 degrees at 2 p.m.

I found the apartment chillier than usual, and was not able to remove my coat or scarf. I asked my patient, ‘Ed,’ how long it had been since the heat had last been on. He stated that the heat hadn’t been coming out of the vents for a few days, and that was why he purchased the heater over the weekend.

This was Wednesday. I called the patient’s residential case manager to report the situation, and was given the agency office number. We called the residential agency program director to report the situation. The case manager also advised me to try turning up the thermostat. This led to a search for a thermostat, which I was unable to locate and which the patient (who has cognitive memory deficit) could not remember ever seeing.

I spotted the next-door neighbor, who is also disabled, through the window, and approached her to inquire about the location of the thermostats in the rooms and ask if she had heat in her apartment. The neighbor said she didn’t have any heat either, but would give me the number of the building’s superintendent. She added that she’d given up calling him herself because he ‘never’ returns her calls. The neighbor also told me there are no thermostats in their garden apartments.

I called the superintendent and left a message on his voicemail. There was no answering service or beeper number to page him for emergencies. I left the patient’s apartment and phone number. I called back in 15 minutes and this time left my cell number and identified myself as the visiting nurse, explaining that I was unable to remove my coat during my visit due to the cold. I finally called a third time and left a voicemail saying that I would need to contact the authorities to report the lack of heat. The patient was afraid when I first mentioned calling the police, but later he agreed that something needed to be done. Like his neighbor, they were silently hoping the heat would magically appear, and did not want to make trouble.

Now I was on a mission. The local police office said they could take a report, but I asked for the heat emergency contact instead. The officer connected me to the White Plains Building Inspector’s office, and his secretary put me right through. The Building Inspector took the super’s name, number and address and told me he would take care of it within the hour.

I left feeling hopeful, but still worried about my patient and the other tenants with the evening approaching and the frigid temperatures predicted to continue all week. Fortunately, the story has a happy ending: I called ‘Ed’ this evening and he said the super showed up about 15 minutes after the White Plains Building Inspector did! The heat came back on about 5 p.m.  My patient said the problem was air in the heating system, and that the super told the building inspector he would fix it immediately.

Whether it was air or ‘money’ in the system, I am relieved that my patient and the other tenants are warm tonight. I am also proud to be a part of one VNSNY, and an advocate for our patients’ health and safety needs.”

The perseverance and depth of caring that Roberta displayed are an exquisite example of the qualities that make VNSNY a national leader in home- and community-based healthcare. Thank you, Roberta, and thanks to everyone in our organization for the exceptional effort you put into caring for our patients and members.

If you have any comments or questions, or if you would like to submit a mission reflection, please email them to:


Mary Ann Christopher, MSN, RN, FAAN
President and Chief Executive Officer
© 2014 VNSNY. All Rights Reserved
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