Performing Provider System

NewYork-Presbyterian PPS Initiatives


System Transformation

Integrated Delivery System (Project 2.a.i)

Develop a sustainable system to provide community-based care coordination

Ambulatory ICU – Pediatric and Adult (Project 2.b.i)

Improve care and health outcomes for high-risk and high-cost adult and pediatric populations with complex care needs

Clinical Improvement

Behavioral Health Crisis Community Stabilization (Project 3.a.ii)

Connect psychiatric patients who frequently utilize emergency room services to comprehensive, coordinated and ongoing safety net services that diminish the incentive to seek non-emergent care in an emergency room setting

Behavioral Health and Primary Care Integration (Project 3.a.i)

Ensure that NewYork-Presbyterian and New York State Psychiatric Institute (NYSPI) outpatient behavioral health patients receive timely, coordinated and appropriate primary care services

Care Transitions to Reduce 30-Day Readmissions (Project 2.b.iv)

Strengthen continuity of care between NewYork-Presbyterian Hospital (NYP) inpatient care and subsequent settings in order to reduce the risk of avoidable readmissions within 30 days

Emergency Department Care Triage (Project 2.b.iii)

Reduce avoidable emergency department use by connecting patients to primary care and addressing the educational and cultural drivers of emergency department utilization

HIV Center of Excellence (Project 3.e.i)

Transform three HIV practices into true Centers of Excellence (CoE) where all services for People Living with HIV and/or HCV or those at risk for HIV are integrated into one practice. These services include prevention services, increasing primary care, HIV/HCV consultation and treatment, dental care, specialty care, behavioral health care, prenatal care, nutritional services and substance abuse services.

Integration of Palliative Care into the Patient-Centered Medical Home (Project 3.g.i)

Enhance Primary Care Physicians’ competencies to integrate generalist-level palliative care in the NYP Ambulatory Care Network and community-based practices as standard of care

Population-Wide Prevention

Decrease HIV Morbidity (Project 4.c.i)

Develop a network of collaborators that engages people who are at risk for HIV or who are newly diagnosed or living with HIV and/or HCV who are not engaged in care or lost-to-follow-up

Tobacco Cessation (Project 4.b.i)

Integrate evidence-based, sustainable tobacco use treatment into health services across our PPS