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Adrian Roselli’s Upcoming Speaking Gigs

One of the things I enjoy about my job is having the opportunity to share my knowledge and experience (and get corrected). This year already started out well with my talk at HTML5 Developer Conference back in May. Happily I have five more speaking engagements coming up in the next couple months.

WordCamp Buffalo

On Saturday, September 13, I will have the pleasure of speaking at WordCamp Buffalo for its (and my) third year. Based on the speaker line-up there will be plenty of great topics, so I look forward to being an attendee as well. My talk this year will be about accessibility.

If you are new to WordCamp Buffalo, a quick overview:

WordCamp Buffalo is a one day conference held in Buffalo, NY focusing on WordPress. Our goal is to increase knowledge about WordPress for people who already are working with it, and show some benefits of using it for anyone who may be interested, but aren’t currently working with WordPress.

Tickets are available now, so you have plenty of time to prepare for heckling me. This year the event is being held at the new Science Hall on the Canisius College campus. A map is embedded below, and information on metro stops, hotels, and parking is available on the WordCamp Buffalo site.

Accessibility Camp Toronto

I am excited to say that I will be speaking at Accessibility Camp Toronto in late September. It probably goes without saying that I’ll be speaking on accessibility. Given Toronto’s proximity to my home town of Buffalo, and the fact that I used to wander up to Toronto about once a month, it will be nice to visit a city I’ve neglected for a couple years now.

Instead of re-stating what Accessibility Camp Toronto is all about, I am going to cheat and quote the site directly:

Focusing on users with different disabilities, sessions can cover digital accessibility topics from the web (technical to tactical), desktop software, mobile apps, eLearning, online gaming, open source innovations, and everything in between. Watch this brief video from the first Accessibility Camp Toronto to get a feel for what to expect during the day. Also, video recordings from the 2013 camp are available.

Regardless of your level of knowledge, this event is for you. It will be a great opportunity for members of the design/development, usability, accessibility, other IT and end-users with disabilities communities to interact and learn from each other. We recommend you browse the Frequently Asked Questions, especially if you have never attended a participant-driven BarCamp/unconference before.

Please support the event with a $5 suggested donation at the door. Your donation will help cover the costs for miscellaneous expenses – event materials, food, etc.

Please follow event updates on Twitter via @a11yto.

Make sure you register as it is my understanding that the event is three quarters full. If you don’t follow @a11yto for updates, at least check in on the #a11yto hashtag.

The nitty gritty: the event is held from 9:00am until 4:00pm on Saturday, September 27, 2014. It is being held at OCAD University, 100 McCaul Street, Toronto, ON M5T 1W1.

UX Singapore

By far the farthest-from-home of my speaking engagements to date, I’m thrilled to be speaking at UXSG (User Experience Singapore). Having attended its sister event, UX Hong Kong (UXHK), last year I can say that I am excited not just to speak but to hear from all the other great speakers who will be imparting wisdom, knowledge, and perhaps a few local dining suggestions.

For those not familiar with it, UXSG is a three day event intended to onnect UX professionals across disciplines and cultures. As one of the founders of (way back in 1998), this statement from the conference organizers resonates with me: It is a platform made for and by UX professionals to foster stronger professional collaborations and personal friendships. Given that I made some great connections as an attendee at UXHK, I don’t doubt I’ll have a similar experience here.

I will be giving a lightning talk on the third day of the conference, Friday, October 3, at 11:00am Singapore time. I’ll be updating my “Selfish Accessiblity” talk for the UX audience. The abstract of my talk is posted at the UXSG site.

I’ve been to Singapore once before, but only for a day. This time I am looking forward to spending a little more time there and, in particular, experiencing the venue for the event, the relatively new Star Performing Arts Centre.

National Association of Government Web Professionals

Much as I would like to say that I will be speaking at the National Association of Government Web Professionals (NAGW, I don’t know where the “P” went, perhaps it was originally “Webmasters?”) conference in September, I won’t be. I was, however, asked to do a separate webinar for members for one of the conference topics I submitted — an intro to responsive web design.

As far as I know you need to be a member of NAGW to be able to attend the webinar, so I can’t share a URL, let alone a Google Map. I can, however, point you to the slides from a similar talk I gave last September: Slides: Responsive Web Design Primer

While the federal government may have its own crack web team now (or so the reports claim), state and local governments don’t have that same team and can’t as easily share their expertise. It seems NAGW fills a gap by providing a forum for these web professionals to share and help one another, as noted in its own description:

NAGW is the National Association of Government Web Professionals, an organization of local and state government web professionals working together to share knowledge, best practices, innovative ideas, and other resources. We collaborate on technologies, and network with other web professionals to improve our capacity to provide value across the web to our communities.

If you are a member, the webinar is Tuesday, October 21 at 11am mountain time. I hope I am able to provide some value to its membership, and if not, maybe they can be amused by how deftly I don’t do webinars.

Learning Choices Network

In a break from the last speaking engagements listed above, which have all been about web technologies and best practices, I get to list an event that isn’t about the web at all. Sorta.

Learning Choices Network (LCN) is a local (to Buffalo) organization focusing on alternative education such as self-directed learning and life-long learning. To let the organization speak for itself, this is from its Facebook page:

LCN exists to create, facilitate, and promote alternative opportunities for authentic learning in the local community while connecting educators, community advocates, parents, and business people who are seeking workable solutions for educational choice.

As someone who has built a career around the web, but for whom the web had barely sprung into existence when I started, being self-taught was the only option I had. For a sense of timing, Mosaic was released while I was in college (with Netscape Navigator soon to follow), so there weren’t classes to take, let along many with experience to help me get started. As I developed skills and started to rely on mailing lists to refine them, I co-founded and started writing, trying to become the kind of teaching and training resource I never had. I have been following that approach ever since (I believe evidenced by this very blog).

I’ve followed the same learn-as-you-go model for when I co-founded my business, Algonquin Studios, 17 years ago as well as other companies we’ve spun off since then. Just as I formed to help provide a resource like I didn’t have when I started, we’ve been spinning up VCAMP, our own local incubator/accelerator to help provide a platform for other business that we didn’t have when we started.

At the LCN event I will speak about how I started down my self-directed learning path, identified (and sometimes discarded) mentors, and somehow managed to be a (so far) successful entrepreneur when both the technology and economy have flolloped up and down like a mattress from Sqornshellous Zeta (sorry, it really is the best word to use). If you’re lucky, I’ll even (probably incorrectly) speculate on the future of education and learning, something for which I am woefully unqualified.

The event will be held from November 8 through November 10, 2014. Tickets are available online. The event will be held at Buffalo History Museum.

Eliminating 500,000 Avoidable Hospitalizations: Let the Data be your Guide

In my last post, we discussed the importance of regional and state-wide collaboration within the NYS DSRIP initiative.  This time we’ll take a look at the overall goal of the project, give it some context and look at some ways we can use open data sets to focus our efforts as we begin this 5+ year journey.

The goal: NY and CMS aim to reduce avoidable hospital use by 25% state-wide over 5 years. According to the DSRIP FAQ:

“Avoidable hospital use encompasses not only avoidable hospital readmissions, but also inpatient admissions that could have been avoided if the patient had received proper preventative care services.”

The following 4 measures will be used to measure DSRIP’s success:

If you combine the state-wide aggregates from each of these data sets, we’re looking at about 2.2 million instances of potentially avoidable hospital use. Those are our targets.  To reduce that by 25%, we must eliminate over 550K admissions!   To put that in perspective, if you think of each admission as an individual person, that’s enough people to fill Ralph Wilson Stadium more than 7 times!

Ralph Wilson Stadium - 7

This is a monumental task.  I suggest that DSRIP teams utilize the open data sets made available by NY DOH and others to “short-circuit” their planning and quickly focus in on the most advantageous targets.

If we take another look at the source data sets, we can see that they’re not equally represented across the state. In fact, Potentially Preventable ER Visits make up 95% of the pool with over 2.1M of the 2.2M potential targets!

Potentially preventable hospital use across NYS in 2012.

Potentially preventable hospital use across NYS in 2012.

In other words, we can eliminate ALL of the PPR, PQI and PDI state-wide and still fail miserably unless also we take a huge bite out of those ER visits.

So let’s start with the 95%. Are there any areas that stand out? Any low hanging fruit?

Lets identify the region with the most PPV Events.  In 2012, that distinction went to Kings County with around 350K events.  On the flip side, they were “expected” to have about 87K more.  Even though they had the most events, they performed better than all but 5 counties on a per capita basis.  Kings county is doing pretty well… probably not the place to start.

Who’s performing the worst relative to their NYS expected rate?  Comparing the number of actual PPV events to the expected number, we can identify the “Excess PPV” events. Since these counties are performing worse than the NYS expectation, they represent good places to start digging for answers and potential savings. The 10 worst performers by rate represent a pool of more than 65K events to target for elimination:

Actual PPV Events - Expected PPV Events = Excess PPV Events

Missed expectations: Worst PPV performers based on difference in observed vs. expected rate in 2012. Excess PPV Events = Actual PPV Events – Expected PPV Events

We could also target counties performing worse than expected, but prioritize those generating the largest volume of Excess events regardless of their per capita rate  – this group yields nearly 125K viable targets.  It also bumps 2 of the NYC region counties to the top of the list, reminding us that downstate might represent the biggest opportunity to move the DSRIP needle.

Worst PPV Counties by volume

Opportunities for change: Worst PPV performers by volume. Excess PPV Events = Actual PPV Events – Expected PPV Events

The data helps us to quickly identify some targets for further evaluation. Now we can  start doing the real work: Why is the ER so heavily utilized in St. Lawrence, Albany and Schenectady?  What’s being done differently in Kings and how can it be applied in these trouble areas?  Why is Kings doing so much better than nearby New York and Bronx counties? What innovations can we bring in from outside of NY? Here’s a few ideas that sound interesting:

We won’t find all the answers in open data sets, but they can really help us to focus our efforts. Let’s identify the low-hanging fruit, common problems and best practices and focus our energy on the areas that are likely to give the best results.  $8 Billion sounds like a lot of cash, but its going to go quickly in a state-wide effort incorporating 6-8 Million patients. We need to work smart. The data can help us do that.

CSS Summit 2014 Slides: Making Your Site Printable

This post originally appeared on my blog on July 15.

CSS Summit

This afternoon I awkwardly stumbled through my talk for CSS Summit, Making Your Site Printable. I can tell you that speaking to a screen instead of to a room full of people is a whole different experience than I was expecting. Fortunately for you I do not have an audio/video recording. I do however, have all the slides.


Making Your Site Printable: CSS Summit 2014 from Adrian Roselli


Links to resources referenced in the slides (in the order they appear):

Ticket Giveaway

I’d like to note that thanks to the generosity of CSS Summit, I was provided with two tickets to today’s talks that I could give away as I saw fit. I opted to offer them to two deserving young women from the Buffalo chapter of Girl Develop It (neither heckled me):

The Twitters

Finally, one of the novel things about an online conference is that attendees seem to be more active on Twitter. I got feedback and questions, and even fielded a few sub-tweets (I happen to know the print styles aren’t glamorous, but most of the fundamentals aren’t). I’ve collected the tweets in a Storify, which I have embedded here:

Update: July 21, 2014

Based on the activity from these two tweets alone, I am really hopeful that web developers are starting to see that print styles have value and belong in a responsive workflow. Only time will tell. The tweets:

A Simple Step to Growing Your Business Relationships

Dangling Conversation #2, Scott LoftesnessThere are people out there who can help you grow your business – as customers or vendors – that you aren’t talking to because you are prejudging them based on flawed assumptions. Consider that young tech entrepreneur who doesn’t follow you on Twitter because he’s not using it for business or the executive who doesn’t reply to your email because he gets 10K of them a day and missed it. You assume that all young people are on Twitter. They aren’t. You assume that your email makes it to everyone’s attention. It doesn’t. Its human nature to react negatively toward people you’ve valued worthy of your time and who don’t seem to reciprocate. But the truth is, most everyone is just as busy as you are.

So here’s the advice. Try to talk to everyone and see if there is a fit. But make the effort to talk to people you’ve heard negative things about to see if those comments are justified. If you’ve heard something about someone from a lot of people you tend to assume its true. But what if only one of those people has actually interacted with the “negative” person and the others are sharing opinions in a game of telephone? There is plenty of time in business to be cynical about relationships. I’ve run into my fair share of genuinely negative people in the business world and occasionally the person who can only claim a win if someone else claims a loss. But by and large, most people I’ve encountered are looking for a win-win and a long-term partner. Don’t let what is possibly one person’s opinion from one meeting on one day derail a possibly great relationship.

Stop wasting time and energy reacting to people you haven’t even interacted with and stop chasing people who won’t interact with you because of their perceived “value”. After all, the guy in the Lexus you think is going to invest in your business might be over-leveraged, while his plumber with the stained knuckles just cleared 1M last year.

Update to Verizon Using Disabilities to Fight Net Neutrality

In June I discussed rumors that Verizon was arguing, behind closed doors, that net neutrality harms those with disabilities.

Perhaps in reaction to the Verizon rumors, or just because the cause makes sense, on July 18 five different organizations related to accessibility filed their own joint comments with the FCC. The organizations are: Telecommunications for the Deaf and Hard of Hearing, Inc. (TDI), the National Association of the Deaf (NAD), the Hearing Loss Association of America (HLAA), the Deaf and Hard of Hearing Consumer Advocacy Network (DHHCAN)), and the Rehabilitation Engineering Research Center on Telecommunications Access (RERC-TA) along with Professor Clayton Lewis. Together they filed a brief, which you may read online (and which I have copied locally as I suspect this URL will be allowed to rot by the FCC), outlining their support of net neutrality. An excerpt:

[We] seek to promote equal access for the 48 million Americans who are deaf, hard of hearing, late-deafened, deaf-blind, or deaf with mobility or cognitive disabilities to the informational, educational, cultural, and societal opportunities afforded by the telecommunications revolution.

The letter outlines six arguments in particular, with far more detail in its sixteen pages:

  1. Retaining and improving transparency rules will improve the ability of consumers who are deaf or hard of hearing to access the Internet on equal terms.
  2. A no-blocking rule would help ensure the availability of accessible telecommunications services for consumers who are deaf or hard of hearing.
  3. The Commission should bar paid prioritization while ensuring that Internet-based services and applications are accessible to consumers who are deaf or head of hearing.
  4. Title II reclassification would afford the Commission additional flexibility to ensure that broadband services are accessible, and the Commission should exclude accessibility-related Title II provisions from forbearance if it reclassifies.
  5. The Commission should ensure that the enterprise services and premise operator exceptions avoid facilitating illegal discrimination against people who are deaf or hard of hearing.
  6. The Commission should ensure that the use of data caps do not result in discrimination against people who are deaf or hard of hearing.

The same day, the American Association of People with Disabilities and the National Council on Independent Living also filed their own joint letter with the FCC (also available from a non-FCC URL). In addition to an open internet, the letter argues for an ombudsman:

Over the past few years, Congress shifted the focus of universal service from mere availability to adoption and utilization. […] This important review of Open Internet policy provides an opportunity to ensure that people with disabilities have full and open access to broadband communications and enjoy the important consumer protections mentioned in our comments. […] An Ombudsman Office Can Monitor and Report on Access Issues Associated with Consumers with Disabilities

Ars covered the latter filing in its Tuesday, July 22 post, “Deaf advocacy groups to Verizon: Don’t kill net neutrality on our behalf.”

Hopefully these two are among the comments that will work their way to the top of the pile of the 1.1 million of comments the FCC has received (good luck finding them on your own). And then hopefully they’ll be read, and understood, as the FCC weighs the information in making a decision on net neutrality.

Competition in DSRIP?

competitionraceLet’s talk about competition for a moment. As a result of its approach, the NYS Department of Health received fifty DSRIP design grant applications covering 11 regions in NYS. Although the state urges collaboration to reach the point where there’s just one Performing Provider System (PPS) per region, only five of eleven regions have just one PPS today. In fact, we have five PPSs in WNY. In NYC, there are twenty.

Clearly the state’s goal is not reality in the field, at least not this quickly. Many of the lead organizations have been bitter rivals historically. It’s unclear to me whether the state will award design grants in a way that forces team mergers, or whether they’ll allocate Medicaid patients proportionally and let PPSs compete within a region. While competition could be seen as breeding duplication of service (wasteful among not-for-profits), it’s easy to forget that this is a pay-for-performance incentive program.

Incentive for what? Both for taking on more programs, and for delivering effective strategies. On this second point, I think there’s a lot of room for competing PPSs within a region. DSRIP is an experiment that tracks outcome performance and the money spent on it. Even though there may be a wide variation in the size of competing PPSs in a region such as WNY, couldn’t a smaller PPS with an innovative and more effective program teach it to others? A rising tide lifts all boats.

We’re still missing competition from the patient’s perspective. I understand that NYS Department of Health expects to assign each Medicaid patient to a single PPS, reducing choice (if you don’t want to move to a different region). This also leaves a lot of questions open. What happens if you feel that the PPS failed you? Is there an appeal process to get a different provider? Will changing providers in the same PPS be enough to overcome the problem? How quickly can you get a different provider? What pressure makes sure your dissatisfaction gets included in metrics to the state, since PPSs self-report?

From the collaborating provider’s perspective, things could be just as difficult. Imagine you’re a provider located in a rural county in WNY. All five PPSs in your region are strongest in urban parts of Erie and Niagara Counties. Does that mean you’ll be participating in several PPSs so they can cover rural patients? How will you manage separate processes and systems for several Medicaid patient pools without losing money from the administrative burden?

I think these kinds of problems need to be worked out during the program design period between now and March, 2015.



DSRIP as Organizational Behavior: Top Down Part 2

emergencyredsmockContinuing my last post, I think the Delivery System Reform Incentive Payment (DSRIP) has a lot of teach anyone learning how to change an entire industry from the throne of the main payer. It’s happening right now, like an experiment in action, to reduce preventable hospital admissions by 25% over five years.  The same program from the Centers for Medicare and Medicaid Services (CMS) at the federal level, DSRIP, has been implemented in different ways by different states.

Lesson #6: Give participants many ways to accomplish an objective, and let them choose the ones that suit them.

Medicaid has the reputation among payers of offering break-even compensation at best, and CMS has reformulated it under DSRIP as a potential money-maker. How? CMS offered states a menu of programs they could take on.

Lesson #7: Setup projects to share the risk and incent behaviors that accomplish the change you envision.

Each program comes with a tradeoff. The revenue per patient per month in the program has a cap. There are a bunch of factors that affect the cap, influencing your choices and strategies in pursuit. But setting that aside for a moment, if it costs you more than the cap to take care of your population, you lose. Likewise, if it costs you less then you gain. CMS and the state Department of Health have chosen projects that they believe will lead to more efficient delivery of care, so that CMS and the State can ultimately target spending less while providers keep a larger share than they do today – a win for both sides. Going further, the state even setup a High Performance Fund worth up to 30% of DRSIP project value for closing the gap to goal to 20% or placing within the 90th percentile of all PPSs in the state.

Lesson #8: Pay for performance, and give time to get the process down initially followed by actual outcomes later.

Looking at those factors affecting the cap again, some cover outcomes: projected ones at the start and actual ones later. Also, the state expects participants to report on defined metrics at the start and real performance later.

Lesson #9: A project advisory committee can increase partner accountability and investment in the team.

Many of the safety net, behavioral health, and community health providers partnered with hospital systems have never collaborated before. Who will charter project committees, enforce compliance with reporting and metric gathering, oversee financial transactions? The state requires each PPS to establish a Project Advisory Committee made of representatives from each collaborating partner.

Lesson #10: Identify key resources for your program to succeed and make sure they’ll survive the transition.

Earlier, we mentioned Medicaid’s reputation as a low-reimbursement program. Some of the hospitals serving Medicaid patients may not survive the uncertain transition to payment for value. This risks losing some of the critical capacity to serve the population, which would likely cost more to replace than to bridge. To counter this, in parallel NYS is offering $20M in Interim Access Assurance Funds to four WNY hospitals.

Lesson #11: By tying all providers in the state together to avoid a penalty, you can encourage collaboration.

Under DSRIP, a lead PPS can do great but still not earn its full incentive. How? There are four statewide goals that must be satisfied, or all PPSs will suffer a proportional reduction in payments. The goals include statewide metrics, composite success of projects, growth in Medicaid spending kept to less than the trend, and overall adoption of reimbursement for value (not service). The state formalized a Learning Collaborative program to transparently share best practices, but I suspect this will only work in the absence of competition. This also gives the state a relief valve to re-negotiate the program or pull the plug if it fails to hit its big picture goals, regardless of how the blame gets dished out.



DSRIP as Organizational Behavior: Top Down Part 1

How do you change the way a whole industry works? You can unearth a vast hoard of a key ingredient, dropping its price. You can innovate, radically altering individual behavior as the change spreads. You can legislate, changing the flow of business.

But what about healthcare, a big industry that’s full of innovation on the delivery side yet lags behind its own vision in the way it does business? Healthcare has a stated goal, a triple aim: improve the experience of care, reduce per capita cost, and increase population health. Change is slow on the business side for many reasons, such as:

  • Lots of stakeholders must work together: payers, providers, facilities, suppliers, manufacturers, IT firms, and on and on.
  • The system is big enough that individual teams within a stakeholder can’t see the big picture, so they optimize locally.
  • The consequences could mean life or death.
  • As a result, government has heavily regulated how stakeholders work together.
  • The same data field could be used or misused in different ways from place to place.

I think the Delivery System Reform Incentive Payment (DSRIP) has a lot of teach anyone learning how to change an entire industry from the throne of the main payer. It’s happening right now, like an experiment in action, to reduce preventable hospital admissions by 25% over five years. The same program from the Centers for Medicare and Medicaid Services (CMS) at the federal level, DSRIP, has been implemented in different ways by different states.

Lesson #1: Without the commitment to change, one probably won’t, and not everyone is ready at the start.

Think about that for a minute. To influence our whole nation to make progress on the triple aim, CMS invited proposals from all fifty states. Not all of them responded, and certainly not all at the same time.

Lesson #2: Don’t change everything at once. Pick a channel through the system and make a pilot of it, building on its successes and pivoting where it fails.

Further, CMS started with Medicaid, just one of the payers it operates and one of many in the marketplace, albeit a very large one. I wouldn’t doubt if Medicaid will follow soon, and laws will be written to convert commercial payers to fit the same format.  By the time we get to other payers, we’ll have grown the capacity to work differently.

Lesson #3: Assume that there are already organizations acting the way you seek; encourage them. Where you need to grow new ones, look for volunteers.

By June 26, 2014, the state required all responding organizations to submit design grant applications. An organizations is called a Performing Provider System (PPS), the set of all participants collaborating to serve a specific population of patients. Essentially, the state did not dictate leads and teams; it drew back the curtain on a large sum, gave a ton of criteria, and asked for volunteers.

Lesson #4: Pay for organizations to plan how they’ll achieve goals, and use your budget applications to ensure good project management.

Design grant applications disclose the PPS’ partners, service area, selected projects, community needs assessment plans, vendors, timeline, data requests, budget, collaborating partners (providers), and a project advisory committee.

Lesson #5: Use qualifiers on participants to encourage behavior and focus actions even before you begin your project.

The state was careful to describe which organizations could qualify to participate in the program. For example, they banned applications from any organization without at least one other partner. In this way, the state focused participants on collaboration, an effective strategy identified from prior successes. Some organizations may be changing themselves too, adopting Health IT systems that gather metrics to position themselves as better partners.

NYS DSRIP: An $8 Billion Experiment in Working Together for Better Healthcare

In a recent post on this site, my colleague David Thiemecke told us why we should care about NYS’ $8 Billion investment in Medicaid Reform. He explains how NY is using this money to realign healthcare delivery so that providers work together to provide the best possible care, avoid costly admissions and reduce the overall cost of healthcare delivery.  I believe the specific goal  “to achieve a 25 percent reduction in avoidable hospital use over five years” was identified by NYS to serve as tangible, measurable outcome to drive the project.  However, the real goal is collaboration.

In the first of a series of 5-minute videos titled “5 Themes in 5 minutes“, New York State Medicaid Director, Jason Helgerson drives this point home.  He states that “Collaboration, Collaboration, Collaboration!” is key and that both Performing Provider System (PPS) and statewide performance will drive the money. The ultimate goal is to produce a sustainable, long-term transformation of our healthcare delivery system.  In this post I’ll focus on the collaboration aspect. and we’ll use Medicaid data sets made available by NYS to dig a little deeper.

How will we measure success?

The goal is clear: Reduce avoidable hospital use by 25% within 5 years.  In order to do this Performing Provider Systems (PPS) will be formed to get many providers to collaborate within their region to tackle between 5 and 10 projects from the DSRIP Strategies Menu and Metrics document.  For each project, the success metrics and corresponding payments are clearly laid out.  For example, all PPSs will be required to complete the “Create Integrated Delivery Systems” project and report on their performance against the Prevention Quality Indicators (PQI):

Prevention Quality Indicators (PQIs) are a set of population based measures that can be used with hospital inpatient discharge data to identify ambulatory care sensitive conditions. These are conditions where 1) the need for hospitalization is potentially preventable with appropriate outpatient care, or 2) conditions that could be less severe if treated early and appropriately. All PQIs apply only to adult populations (over the age of 18 years). The rates were calculated using Statewide Planning and Research Cooperative System (SPARCS) inpatient data and Claritas population information. For more information, check out:

What’s great for all of us: this data is open and freely available to anyone who wants to do some digging.  The PQI data set and many, many more are neatly organized for our perusal on the DSRIP Performance Data page.

Collaboration within the Performing Provider System (PPS)

Using the open PQI data set we can quickly identify some areas where collaboration within a PPS can be beneficial.  For instance, here’s a look at the rate of PQI discharges in the NYC region:

012 Prevention Quality Overall Composite - Rate of Discharges per 100,000 people vs. NYS Expected rate - NYC Region

2012 Prevention Quality Overall Composite – Rate of Discharges per 100,000 people vs. NYS Expected rate

If you check out the Letters of Intent for the NYC-region PPS, you’ll notice that 4 of the Emerging PPSs would cover all of these counties. It stands to reason that the providers in Bronx county could benefit from working with those in the better performing Queens county to implement best-practices.  Further, incentives payments to the PPS will take the performance of the entire system into account, so Queens and Westchester will not “get paid” unless they work with the under performing counties to produce better outcomes overall.  To borrow a quote from GE-legend Jack Welch, “Everyone’s life raft is tied to the same boat”.

Collaboration at the State Level

As I mentioned earlier, performance at the state level matters too.  In fact, if the program doesn’t meet specific metrics laid out by CMS, then overall funding to the state will be put at risk.

“What happens in Binghamton, truly matters in the Bronx.” – Jason Helgerson, New York State Medicaid Director

Taking a look at PQI discharges across the state we can identify a few more potential collaborators:

How can the best performing large counties (i.e. those with at least 1,000 discharges) help those not doing so well.  The data suggests we might send emissaries from Erie county to share best practices with providers in Suffolk and Oneida counties.

2012 Prevention Quality Overall Composite - Rate of Discharges per 100,000 people vs. NYS Expected rate - Regions with at least 1,000 discharges

2012 Prevention Quality Overall Composite – Rate of Discharges per 100,000 people vs. NYS Expected rate – Regions with at least 1,000 discharges

And in smaller regions (i.e. those with fewer than 1,000 discharges), pairing providers from Cortland or Orleans with those in Cattaraugus and Franklin counties may make a lot of sense.

2012 Prevention Quality Overall Composite - Rate of Discharges per 100,000 people vs. NYS Expected rate - Regions with fewer than 1,000 discharges

2012 Prevention Quality Overall Composite – Rate of Discharges per 100,000 people vs. NYS Expected rate – Regions with fewer than 1,000 discharges (top 5 and bottom 5 counties in this group)

 Well… it sure looks good on paper

We all know that working together toward a common goal can bring about great change, and a high level glance at the data definitely suggests there is opportunity for that here.  However, DSRIP and the entire NYS healthcare system have some big hurdles to overcome.  It will be interesting to see how well providers and competing hospital systems can actually work together in practice.  Only time will tell, but CMS and NYS are betting big that it can happen.


Open Data Sets used:


Get Unstuck in Web Development

I would love to say that I always know exactly what I’m doing, but then I would be lying. Even though I’ve been building web sites for over a decade, I still need to look things up and I still face challenges that I need help to overcome. Over the years, I’ve found a few resources that I consistently turn to when I need clarification or I’m stuck.


I know that there are some critics out there, but W3Schools was one of the first resources that I relied upon when I began learning HTML and CSS. It’s got a lot of decent tutorials for beginners, but the reason that I still rely upon it is the HTML and CSS references. W3Schools cultivates a list of all HTML elements and their available attributes as well as a list of all CSS properties and their possible values. It may not be the definitive source (that would be W3C), but those lists have proven to be very handy in a pinch.


I know that this seems like a no-brainer, but, like most people, when I encounter an issue that I need help with, I usually turn to Google first. Most of the time, a quick Google search will unearth the solution I need and I’ve even developed some strategies to help dig up those gems. I usually start with the language and then follow it up with the topic that I’m trying to research, such as “CSS clear fix,” “HTML5 section tag,” or “JS print window.”


Often, when I’m searching for a CSS solution, I end up at CSS-Tricks, which I’ve come to highly revere over the last couple of years. Chris Coyier does a fantastic job providing solutions to common problems and outlining their pros and cons.

jQuery APIjqueryapi

I love jQuery’s API, because it’s incredibly robust and includes a ton of great examples. I can almost always find the answers I need just by reading the API entry for whatever function that I’m attempting to employ.

Stack Overflowstackoverflow

Chances are pretty darn good that just about any coding question that I come up with has already been asked and answered on Stack Overflow. Sometimes, Stack Overflow is incredibly helpful and steers me in the right direction and sometimes it’s not ,depending on the quality of the responses, but I love it because it gives developers an easy way to discuss a topic with a global community of peers.

Some other fine suggestions

While I don’t personally rely on these sites very often, I’m aware that many of my peers do. If you aren’t familiar with them, they may be worth checking out.

What resources to constantly rely upon?