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Welcome to the Hospital Medical Home Demonstration Project

Annual Conference. You are joining representatives from 62

teaching hospitals, 160 primary care training clinics, and 118

residency programs across New York State. All of them have

committed to joining the New York State Department of Health

to transform care in outpatient clinics and train residents in

settings that provide the absolute highest quality of primary

care. Patients will benefit from care that is coordinated, team-

based, evidence-based, and patient-centered, and primary care

residents will have been trained to successfully practice in the

new job description for primary care. We are here today to

celebrate our many successes as you will hear from many

presenters and see from the poster session, and to collaborate

on our next steps.

Thank you for coming,

Marietta Angelotti, MD Associate Medical Director

Office of Quality and Patient Safety

New York State Department of Health

Foster C. Gesten, MD, FACP Medical Director

Office of Quality and Patient Safety

New York State Department of Health

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HOSPITAL MEDICAL HOME PROJECT ANNUAL MEETING JANUARY 23, 2014

AGENDA

9:30 CHECK-IN AND REGISTRATION BEGINS

10:00 WELCOME AND INTRODUCTIONS MARIETTA ANGELOTTI, MD

10:05 WHY A HOSPITAL MEDICAL HOME DEMONSTRATION? FOSTER C. GESTEN, MD, FACP

10:15 PRIME TIME FOR PRIMARY CARE NIRAV SHAH, MD, MPH

10:30 ARE PHYSICIANS KNIGHTS, KNAVES, OR PAWNS? IMPLICATIONS FOR GRADUATE MEDICAL EDUCATION SACHIN JAIN, MD, MBA

11:15 COLLABORATIVE CARE IN THE HMH LLOYD I. SEDERER, MD

11:30 LEADERSHIP PANEL: RESIDENCY, CLINIC, AND HOSPITAL LEADERSHIP FACILITATED BY FOSTER C. GESTEN, MD, FACP

NEIL S. CALMAN, MD TOM CAMPBELL, MD DAVID CLARK, MD JUDY TUNG, MD, FACP JON SWARTZ, MD

12:30 LUNCH BUFFET

POSTER SESSION: FACILITATED BY ANU ASHOK, MPH & CARLA NELSON, MBA

HMH PORTAL DEMONSTRATION PRESENTED BY JAZ-MICHAEL KING: JOIN MEMBERS OF THE WEB PORTAL

DEVELOPMENT TEAM TO EXPLORE FEATURES AND FUNCTIONS OF THE HMH REPORTING TOOL.

SPECIAL THANKS TO ST. LUKE’S-ROOSEVELT

1:30 BREAK OUT SESSIONS

1. BEST PRACTICES IN CARE TRANSITIONS: FACILITATED BY MARY THERRIAULT, RN, MS & NICOLE HARMON, MBA -

HEALTHCARE ASSOCIATION OF NEW YORK STATE CHRISTINA PAVETTO BOND, MS, FACHE BENJAMIN RUDD, MD VISHALAKSHI SUNDARAM, MD CARMEN TAMAYO, MD

2. INTEGRATING BEHAVIORAL HEALTH INTO ADULT PRIMARY CARE: NEW YORK STATE OFFICE OF MENTAL HEALTH &

THE AIMS COLLABORATIVE OF THE UNIVERSITY OF WASHINGTON MARISA DERMAN, MD TYLER JAMES, MPH VIRNA LITTLE, PSYD, LCSW-R, SAP ASHLEY MACON HEALD

3. PCMH FOR PEDIATRICS

EUGENE DINKEVICH, MD STEPHEN BLATT, MD BRAD OLSON, MD NEELIMA NAYYAR-GUJRAL, RN HARRIS HUBERMAN, MD, MPH

4. PCMH CURRICULA FOR RESIDENTS: FACILITATED BY PRIMARY CARE DEVELOPMENT CORPORATION

SAIMA CHAUDHRY, MD, MSHS ALAN MITCHELL WILLIAM ROLLOW, MD

2:45 AFTERNOON BREAK

3:00 FACILITATORS REPORT BACK ON BREAK-OUT SESSIONS

3:45 NEXT STEPS FOSTER C. GESTEN, MD, FACP

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BEST PRACTICES ON CARE TRANSITIONS: BREAK OUT SESSION

This breakout session of the Hospital Medical Home Annual Meeting will examine how poorly planned care transitions can result in serious health care complications and hospital readmissions. The panelists will share their strategies for successful care transitions, including how to conduct effective medication reconciliation, schedule timely follow-up care, and identify emerging health issues after discharge. CHRISTINA PAVETTO BOND, MS, FACHE, ASSOCIATE, STRATEGIC INTEGRATION, ST. JOSEPH’S HOSPITAL HEALTH CENTER BENJAMIN RUDD, MD, FAMILY MEDICINE PROGRAM, SAMARITAN MEDICAL CENTER SHALA SUNDARAM, MD, CLINICAL FACULTY, PHELPS FAMILY MEDICINE RESIDENCY PROGRAM CARMEN TAMAYO, MD, FAMILY MEDICINE RESIDENT, PHELPS MEMORIAL HOSPITAL CENTER

FACILITATORS:

NICOLE HARMON, MBA, PCMH CCE, DIRECTOR, PATIENT CENTERED MEDICAL HOME ADVISORY SERVICES, HEALTHCARE

ASSOCIATION OF NEW YORK STATE (HANYS)

MARY THERRIAULT, RN, MS, SENIOR DIRECTOR, QUALITY AND RESEARCH INITIATIVES, HANYS

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INTEGRATING BEHAVIORAL HEALTH INTO ADULT PRIMARY CARE- THE COLLABORATIVE CARE INITIATIVE

COLLABORATIVE CARE: AN INTRODUCTION

Individuals with common mental disorders such as depression, (which annually affects nearly 20% of the

population of U.S. Medicaid recipients), typically do not receive treatment in specialty mental health

settings licensed or operated by OMH, but in primary care settings. Past efforts to foster screening in

primary care settings and train primary care providers in the treatment of depression have not been

successful; the result: diminished ability of untreated individuals to care for themselves and adhere to

treatment plans, producing significant medical morbidity and mortality, reductions in quality of life and

increased health care costs.

To improve outcomes, OMH and DOH are engaged in an initiative to implement the Collaborative Care

approach to addressing common mental health conditions in primary care settings. Collaborative Care

programs follow the principles of measurement-based care, treatment-to-target, and stepped care, and

other aspects of the chronic illness care model proposed by Wagner and colleagues. This team approach

includes: 1) training the primary care team to screen for and treat depression using a collaboratively-

developed, shared care plan; 2) employing care managers in the primary care setting who engage and

educate patients, provide evidence-based psychotherapeutic interventions, support medication therapy,

measure treatment outcomes at each patient contact and use the information to prompt proactive

changes in treatment until patients achieve at least a 50% reduction in symptoms or remission, teach

patients relapse prevention strategies once they are well; and, 3) weekly check-ins between the care

manager and a psychiatric consultant who proactively reviews treatment outcomes of patients

currently engaged in care, provides consultation regarding diagnosis and treatment planning, and offers

suggestions for changes in treatment when patients are not improving as expected. The Collaborative

Care approach incorporates a standardized measurement of depression (often the PHQ-9) to detect and

track the progress of depressed patients; this monitoring allows the primary care team to recognize

when treatment needs to be changed or intensified or when referral to specialty care is necessary.

Referrals to specialty mental health care are typically reduced when effective care is delivered in the

primary care setting, thereby sparing specialty mental health resources for those with the most

significant mental health conditions.

Over the past 15 years, more than 70 randomized controlled trials have established a robust evidence-

base for Collaborative Care. Trials of Collaborative Care have been conducted in diverse health care

settings, including network and staff model health systems, and private and public providers; with

different financing mechanisms, including fee-for-service and capitation; different practice sizes; and

different patient populations, including both insured and uninsured/safety-net populations. Of note,

several studies have demonstrated that collaborative care programs are not only highly effective in

safety net patients and patients from ethnic minority groups but they can reduce health disparities

observed in such populations. The largest randomized controlled trial of Collaborative Care

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demonstrated that patients were more than twice as likely as those receiving usual care, even when

usual care included a co-located Master’s level provider in the primary care setting, to experience a

substantial improvement in depression symptoms over a 12 month period. They also had less physical

pain, better social and physical functioning, and better overall quality of life than patients in usual care.

Collaborative Care has been recognized as an evidence-based practice by SAMHSA’s NREPP Program

(National Registry of Evidence-based Practices)

[http://nrepp.samhsa.gov/ViewIntervention.aspx?id=301] It has also been recommended as a “best

practice” by the Surgeon General’s Report on Mental Health

(http://www.surgeongeneral.gov/library/mentalhealth/home.html), the President’s New Freedom

Commission on Mental Health (http://store.samhsa.gov/product/SMA03-3831), and a number national

organizations including the National Business Group on Health

(http://www.businessgrouphealth.org/benefitstopics/et_mentalhealth.cfm). In a recent evidence-based

practice report by AHRQ that reviewed the existing literature on approaches to Integration of Mental

Health/Substance Abuse and Primary Care (http://www.ahrq.gov/clinic/tp/mhsapctp.htm), the IMPACT

program was profiled as “the study with the strongest results.”

COLLABORATIVE CARE BREAKOUT SESSION AGENDA Introduction to Collaborative Care: a brief overview of the model and core principles Collaborative Care Initiative: project overview Information Technology and Collaborative Care Training Workforce and Engagement of Key Participants Finance and Regulatory Issues FACILITATORS Lloyd Sederer, MD, Medical Director, New York State Office of Mental Health Marisa Derman MD, MSc, New York State Office of Mental Health Virna Little, PsyD, LCSW-r, SAP, Senior Vice President of Psychosocial Services and Community Affairs, The Institute for Family Health Tyler James, MPH, Program Director for New York State Collaborative Care Initiative, The Institute for Family Health ADDITIONAL RESOURCES AIMS Center: http://uwaims.org For Innovative Practices sites: http://uwaims.org/nyscci/ipg/index.html For PCMH Grantee sites: http://uwaims.org/nyscci/pcmh/index.html Integrated Behavioral Health Care Quality Measures: http://integrationacademy.ahrq.gov/atlas Article of Interest: http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Downloads/HH-IRC-Collaborative-5-13.pdf

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EVIDENCE­BASED DEPRESSION CARE PRACTICES SETTING, STAFFING AND SUPERVISION

Designated staff (care manager) to support depression treatment.

Care manager who participates in regularly scheduled, ongoing (e.g., weekly) caseload supervision with a Psychiatrist who makes treatment recommendations for patients who are not improving.

Consulting psychiatrist available by phone or in person for ad hoc consultation to care manager and primary care providers.

Consulting psychiatrist available to evaluate patient and make treatment recommendations, if needed.

PATIENT EDUCATION

Education about depression and treatment options provided to patients.

TREATMENT PLANNING AND DELIVERY

Treatments used are consistent with evidence based treatment guidelines for depression.

Primary care provider makes or confirms diagnosis of depression, prescribes anti­depressant Medication, educates the patient about wellness, and makes changes in treatment in consultation with care manager and/or consulting psychiatrist if patient is not improving.

Patients receive follow­up by phone or in­person within two weeks of starting new medication or changing medication to evaluate for adherence and side effects.

Patients receive proactive assistance with management of side effects.

Activity scheduling (behavioral activation) provided by care manager as part of treatment.

Evidence­based counseling (such as Problem­Solving Treatment) offered, either as a primary treatment or adjunct to medication therapy.

Referral to mental health or substance abuse specialty care, if needed.

Evidence based Depression Care Practices

TRACKING TREATMENT OUTCOMES

In­person or phone follow­up at least once every two weeks during the active phase of treatment to monitor adherence and response to treatment.

In­person or phone follow­up at least once a month during the maintenance phase of treatment.

Use of phone to reach patients who cannot make clinic appointments.Depressive symptoms monitored at each contact with a rating scale (e.g. PHQ­9) that quantifies treatment response.

Staff and providers use a registry or other tracking system to follow patients and ensure that they do not fall through the cracks.

TREATMENT BASED ON OUTCOMES (STEPPED CARE)

All treatment plans have a ‘shelf life’ of no more than 10 weeks (12 weeks for older adults).

If the patient is not at least 50% improve at the end of the 10 weeks, the treatment plan is changed ( increase dose, medication change, add counseling, psychiatric consultation, etc.)

RELAPSE PREVENTION

Patients who are in remission complete a relapse prevention plan that is communicated to their primary care provider.

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REQUIRED METRICS

CARE MANAGER FTE

NUMERATOR DEFINITION: Outpatient site staff care manager time (FTE equivalent)

dedicated to delivering depression care management in the Collaborative Care

Initiative.

DENOMINATOR DEFINITION: Place the “#1”

DEPRESSION SCREENING

NUMERATOR DEFINITION: Number of adult patients per year from the outpatient

site who received a PHQ-2 or a PHQ-9.

DENOMINATOR DEFINITION: All patients from the outpatient site.

PATIENTS DIAGNOSED WITH

DEPRESSION

NUMERATOR DEFINITION: Number of patients screened positive from the outpatient

site who were then diagnosed with depression (eliminates false positives on

screen).

DENOMINATOR DEFINITION: All patients from the outpatient site screened positive

for depression.

PATIENTS ENROLLED IN A

PHYSICAL-BEHAVIORAL

HEALTH PROGRAM

NUMERATOR DEFINITION: Number of patients from the outpatient site screening

positive for depression who enrolled in physical-behavioral health care

coordination program (Collaborative Care Initiative).

DENOMINATOR DEFINITION: All patients from the outpatient site screened positive

for depression.

ENROLLED PATIENTS WITH

PSYCHIATRIC CONSULT

NUMERATOR DEFINITION: Number of patients enrolled in the Collaborative Care

Initiative referred for psychiatric consultation

DENOMINATOR DEFINITION: All patients enrolled in the Collaborative Care Initiative.

PHQ-9 DECREASES BELOW 10

IN 16 WEEKS OR GREATER

NUMERATOR DEFINITION: Number of patients enrolled in the Collaborative Care

Initiative whose PHQ-9 went from at >10 to <10 in 16 weeks or greater.

DENOMINATOR DEFINITION: All patients enrolled in the Collaborative Care Initiative.

RECEIVING MEDS/THERAPY

AFTER SIX MONTHS

NUMERATOR DEFINITION: Number of patients enrolled in the Collaborative Care

Initiative still receiving medication and/or psychotherapy six (6) months after

enrollment.

DENOMINATOR DEFINITION: All patients enrolled in the Collaborative Care Initiative.

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PCMH FOR PEDIATRICS This breakout session of the Hospital Medical Home Annual Meeting will examine how the HMH goal of extending ambulatory training to enhance patients’ and residents’ continuity of care experience applies in the care of pediatric patients. This session is appropriate for Pediatric and Family Medicine Residents. The session will focus on the patient-centered medical home and organizing “wrap-around care”, on implementing systematic developmental screening and follow-up, on providing culturally competent care, and on providing care coordination for high risk subpopulations – in each case emphasizing the impact on residency training. A goal of the session is for all sites to share and learn from each other. The session will be interactive, with mini-breakout sessions focusing on 4 areas of interest (see agenda below). A list of Mini-breakout: Questions to be addressed is also provided and participants are encouraged to review these questions and come prepared to share their own experiences and ideas.

PEDIATRIC BREAK OUT SESSION AGENDA

1:30 – 2:00 SPEAKER PRESENTATIONS: “UPSTATE” & “DOWNSTATE” HMH IMPLEMENTATION EFFORTS IN THE

CONTINUITY CLINIC Description of individual programs with focus on continuity resident involvement and care integration and coordination initiatives

2:00 – 2:30 4 MINI BREAKOUT GROUPS FOCUSED ON APPROACHES TO CARE INTEGRATION & COORDINATION

INITIATIVES 1. Organizing care teams to ensure access, continuity and wraparound care 2. Integration of developmental screening and follow-up in the primary care

setting 3. Improved care coordination for special needs populations 4. Enhancing interpretation services & culturally competent care

2:30 – 2:45 RECONVENE AND PRESENT PROBLEMS/APPROACHES FROM GROUP DISCUSSIONS

MINI-BREAKOUT: QUESTIONS TO BE ADDRESSED

Each of the groups can address any number of the questions listed below:

What are the priority care coordination & development/behavioral needs in the communities served by your clinic?

How do you currently provide care coordination/wrap-around care for families/children with complex needs?

How do you currently provide preventive interventions/guidance in the areas of behavior/child development?

How do you envision implementing a care coordination and/or development/behavioral initiative at your site? What will be its main components?

How do you currently implement developmental screening guidelines? How do you determine which subpopulations require care coordination? How do you/will you provide training to staff related to your care coordination and

development/behavioral initiative?

IMPACT ON RESIDENCY TRAINING How does PCMH enhance residency training? What barriers does PCMH add to residency training? What do residents learn better from PCMH than they learned before PCMH?

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SUSTAINABILITY & OUTCOMES

How do you make it sustainable? How do you/will you staff it? How will you utilize data systems to support both day-to-day operational functions and

reporting/outcome data analysis? What are the outcomes you do/plan to measure to examine efficacy of your initiative?

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RESIDENCY CLINIC PCMH CURRICULA

PCMH TRAINING FOR RESIDENTS: MEDICAL HOME EDUCATION FOR THE NEXT GENERATION OF PRIMARY CARE

PRACTITIONERS

Presenters WILLIAM ROLLOW, MD MPH PRIMARY CARE DEVELOPMENT CORPORATION CONSULTING MEDICAL DIRECTOR ALAN MITCHELL PRIMARY CARE DEVELOPMENT CORPORATION SENIOR PROGRAM MANAGER SAIMA CHAUDHRY, MD HOFSTRA NORTH SHORE LIJ SCHOOL OF MEDICINE RESIDENCY PROGRAM DIRECTOR AND VICE CHAIR OF EDUCATION Abstract In this session, an overview will be provided of issues relating to the training of primary care residents in the PCMH model: residency requirements, approaches that programs have taken to training, challenges that programs are facing, and best practices that have been identified. Panelists will discuss a training curriculum developed for the HMH program and implemented at two hospitals, and the experience of a large teaching center in PCMH incorporation into residency training. Following panel presentations, there will be panel and group discussion of questions/issues including the following:

Some programs do not have comprehensive, systematic PCMH training. Is such training desirable? Should PCMH simply be embedded into other training that residents are provided?

Some programs are using systematic curricula. What are important attributes of such curricula?

Time and logistics are significant issues in providing PCMH residency training. How have programs dealt with these issues?

PCMH training involves process and culture change. How can this be effectively incorporated into a clinical training program?

A number of programs involve residents directly in PCMH transformation, performance assessment, and continuity of care. Some involve patients in PCMH residency training. What experiences do you have in such best practices?

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GUEST SPEAKERS AND PANELIST BIOGRAPHIES STEVEN D. BLATT, MD

Dr. Blatt is Professor of Pediatrics and Director, Division of General Pediatrics at Upstate Medical University and Medical Director of University Pediatric and Adolescent Center. He holds a courtesy faculty appointment in the College of Law at Syracuse University. Since 1991 Dr. Blatt has been the Director of ENHANCE Services for Children in Foster Care, a multidisciplinary, comprehensive and primary health care program for children in foster care. He has served on the Permanent Judicial Commission on Justice for Children, chaired by Hon. Judith Kaye and the Children’s Cabinet Advisory Board to the Governor of NY. Along with faculty from Syracuse University College of Law, Dr. Blatt co-directs the Syracuse Medical-Legal Partnership that increases access to legal services for patients and their families and is a former Assistant National Medical Director of the National Center for Medical-Legal Partnership. Dr. Blatt has collaborated with the Department of Health, the Department of Social Services and other community agencies in improving the health care of medically underserved and at-risk children in Central New York. Dr. Blatt has participated on local, state and national advisory committees to governmental agencies, including the American Academy of Pediatrics, the Center on Human Policy, and the Child Welfare League of America. Dr. Blatt was an Academic Pediatric Association National Faculty Development Scholar and a member of the Regional Advisory Committee for Community Faculty Development at the University of Massachusetts.

NEIL S. CALMAN, MD

Dr. Calman is a Board Certified family physician who has been practicing in the Bronx and Manhattan for the past 35 years. He is President and co-founder of the Institute for Family Health. Since 1983 Dr. Calman has led the Institute in developing family health centers in the Bronx, Manhattan and the Hudson Valley and in establishing health professional training in medicine, nursing, administration and mental health. In 2012 Dr. Calman became Professor and Chair of the newly-established Department of Family Medicine and Community Health at the Icahn School of Medicine at Mount Sinai. Dr. Calman is a longstanding member of the New York State Council on Graduate Medical Education and on the Board of the Community Health Care Association of New York State. He is a member of the Executive Committee of the New York eHealth Collaborative and was appointed by the Obama Administration as an expert in the care of vulnerable populations to HRSA’s HIT Policy Committee where he serves on the Meaningful Use Subcommittee. Dr. Calman is also a member of the National Health IT Collaborative for the Underserved established by the Office of Minority Health of the US Department of Health and Human Services. Dr. Calman is the recipient of many national awards for his work in Public Health including the Robert Wood Johnson Foundation's Community Health Leadership Award, the American Academy of Family Physicians' Public Health Award, the Pew Charitable Trusts' Primary Care Achievement Award and the Physician Advocacy Award from the Institute on Medicine as a Profession. In September of 1999, Dr. Calman became the project director of a multi-year grant from the Centers for Disease Control, to work towards eliminating racial and ethnic differences in health outcomes in the Bronx. His published essay Out of the Shadows (Health Affairs, Jan/Feb 2000) details his experiences in dealing with racism in the care of his patients. Making Health Equality a Reality: The Bronx Takes Action (Health Affairs, Mar/Apr 2005) describes the community based legislative action that has evolved from this grassroots effort to address institutional racism in medical care. Separate and Unequal Care in New York City. (Journal of Health Care Law & Policy 2006) reports on the Institute’s investigation of discrimination in NYC

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hospitals. Dr. Calman’s work has been featured in chapters in three books, one on the history of family medicine (Caring for America, Stannard), one on not-for-profit leadership in healthcare (To Give Their Gifts, Couto) and one on primary care in America (Big Doctoring in America, Mullan). In 2002, the Institute became one of the first community health center networks in the country to implement a fully integrated electronic medical record and practice management system (Epic), improving both preventive and chronic care treatment outcomes throughout its centers. In recognition of this achievement, Dr. Calman received the prestigious 2006 Physician’s Information Technology Leadership Award, presented by the Healthcare Information and Management Systems Society (HIMSS). In 2008 the Institute received the HIMSS Davies Award in Public Health in recognition of its development of public health functionality into its EHR. In 2008 the New York Times recognized the Institute with its Non-profit Excellence Award in the Use of Technology and Focus on Mission. In 2011 the Institute initiated a project with the National Library of Medicine to hyperlink diagnoses, medication names and test names to the NLM Medline Plus database which is available free in the public domain. This project received the HRSA Innovation of the Year Award in 2011 and this free functionality is available to EHR users across the country. This year, the Institute received the Organization of the Year award from the e-Health Initiative which lauded the organization for innovations that are shared openly with other health care providers. The Institute for Family Health is a federally qualified community health center network, founded in 1983, dedicated to providing primary health services to medically underserved populations. It operates 18 full-time health centers in the Bronx, Manhattan and the Mid-Hudson Valley, including two school-based health centers, and eight part-time centers that care for people who are homeless. The organization serves nearly 100,000 patients who make 425,000 visits each year. In 2009, the Institute achieved Level 3 certification for all of its sites as a primary care medical home from the National Committee on Quality Assurance. The Institute operates more than 50 grant funded programs, several of which support the goals of eliminating health disparities and providing access to quality health care to all, regardless of ability to pay. For ten years, it has been a leader of a program designed to eliminate racial and ethnic disparities in health outcomes funded by the Centers for Disease Control and the National Institutes of Health, and was recently named a National Center of Excellence in the Elimination of Disparities. The Institute also operates three residency training programs in family medicine designed to train providers to serve the underserved, including two in Manhattan, focused on urban communities, and one in Kingston, NY, focused on rural communities. The Institute is a founding member of Family Health ACO, LLC along with Hudson River Community Health and Open Door Family Medical Centers – a Medicare Shared Savings Plan that began on January 1st of 2014.

THOMAS L. CAMPBELL, MD Thomas L. Campbell, M.D. is the William Rocktaschel Professor and Chair of Family Medicine at the University of Rochester School of Medicine and Dentistry and Associate Director of the University’s Center for Primary Care. He is the Board Chair and Past President of the Association of Departments of Family Medicine and serves on the core committee examining the Future of Family Medicine, a national

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project sponsored by the seven Family Medicine organizations. He has written extensively on the influence of the family on health and the role of mental health in primary care. His NIMH monograph, Family’s Impact on Health, has been an influential review of the research in this area. Other books, he has co-authored include: Families and Health with William Doherty, Ph.D. and Family-oriented Primary Care (second edition) with Susan McDaniel, Ph.D., Alan Lorenz MD and Jeri Hepworth, PhD. He co-edited (with Susan McDaniel) , Families, Systems & Health: The Journal of Collaborative Family Healthcare.

SAMIA CHAUDHRY, MD, MSHS

Dr. Chaudhry currently serves as Residency Program Director and Vice Chair of Education at the Hofstra North Shore LIJ School of Medicine. She graduated from New York University School of Medicine and completed her internal medicine residency at UCLA Medical Center in California. Her interests in medical education led her to pursue a fellowship with the Robert Wood Johnson Clinical Scholars Program also at UCLA where she obtained her Masters of Science in Health Services. As program director, Dr. Chaudhry was responsible for the 2010 successful merger of the North Shore and LIJ Internal Medicine Residency Programs, now with approximately 135 house staff. Her residents work in an NCQA level 3 PCMH. She serves as the vice chair of the APDIM Survey Committee, Councilor for the American College of Physicians NY Chapter, and future president for the APDIM NY Special Interest Group. She was recently nominated to the New York State Council on Graduate Medical Education (COGME).

DAVID A. CLARK, MD

Dr. Clark is Professor and Chairman of Pediatrics at Albany Medical Center. He continues to practice clinical neonatology and inpatient general pediatrics. He is a graduate of the State University of New York, Upstate Medical Center in Syracuse. He completed pediatric residency training at the University of North Carolina at Chapel Hill and Neonatology Fellowship training at Rainbow Babies and Children’s Hospital (Cleveland) and SUNY Upstate Medical Center (Syracuse). He has been an advocate for children, the primary care medical home, and community and subspecialty pediatricians for over 35 years, including 10 years in New Orleans. Since returning to New York State in 1998, he has been directly involved with many efforts of AAP District II with the various branches of New York State government. These include newborn and metabolic screening, the use of medications in schools, regionalization of perinatal care and child passenger safety. He is a member of the AAP Committee on Federal Government Affairs as the Chair of the Advocacy Committee of the Association of Medical School Pediatric Department Chairs. He has extensive experience in working with children with disabilities and special needs. He is the author and editor of 5 books, 3 which deal with children with disabilities, early intervention and continuation of care with special education. He is the author of over 100 peer reviewed articles, over 150 abstracts, and numerous invited chapters. He is a member of the American Academy of Pediatrics, the Society of Pediatric Research, the American Pediatric Society, and the Association of Medical School Pediatric Department Chairs. He and his wife Darlene have three daughters and six grandchildren.

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EUGENE DINKEVICH, MD Dr. Dinkevich is an associate professor of clinical pediatrics in the Department of Pediatrics at SUNY Downstate Medical Center and the Director of Downstate’s Pediatric Ambulatory Services. He is the Director of Downstate’s HMH pediatric Patient Centered Medical Home program. An area of interest is childhood obesity including feeding practices and other factors which shape excessive weight gain, and primary care approaches to help children achieve and maintain normal weight and healthy lifestyles. Dr. Dinkevich is the director of the Downstart Healthy Lifestyles center at SUNY Downstate, which uses a team approach to evaluate children and institute healthy lifestyle, dietary and fitness interventions.

FOSTER C. GESTEN, MD, FACP

Foster Gesten is the Medical Director for the Office of Quality & Patient Safety in the New York State Department of Health. Dr. Gesten provides clinical direction and leadership for a team of professionals engaged in quality oversight, performance measurement and clinical improvement within health plans and public insurance programs in New York. Major initiatives include the development of statewide public reporting systems for commercial, Medicaid, and Child Health managed care programs on quality, access, and satisfaction, medical home demonstrations, provider based quality measurement and improvement, and patient safety. His interests include population health, health service research, and quality improvement projects directed at prevention services and chronic care. Dr. Gesten is a member of the Committee on Performance Measurement (CPM) at the National Committee for Quality Assurance (NCQA), and a member of the Measure Application Partnership Coordinating Committee of the National Quality Forum (NQF). Dr. Gesten was trained in general internal medicine at Brown University

NEELIMA NAYYAR-GUJRAL, RN Ms. Nayyar-Gujral is the Nurse Coordinator for SUNY Downstate’s Division of Child Development. She coordinates the Division’s developmental clinics as well as the Behavior & Development resident training module. Ms. Nayyar-Gujral has extensive experience in pediatric primary care nursing, and has certificate training in patient care coordination. She currently serves as a Developmental Care Manager in Downstate’s ambulatory pediatric clinic. Ms. Nayyar-Gujral is also one of the few New York developmental providers who conducts ADOS evaluations in Urdu.

HARRIS S. HUBERMAN, MD, MPH Dr. Huberman is a developmental pediatrician and the director of the SUNY Downstate Division of Child Development. He leads the Behavior & Development module of the Downstate’s pediatric residency program and is Co-Director of the Human Development course for medical students. Dr. Huberman has a background in pediatric primary care, and has served as the Medical Director of a .330 community health center in the Bronx. He also served as the Medical Director of the NYC Infant Child Health Assessment Program, at the time the Part H Child Find component of the NYC Early Intervention program which used public health approaches to identify and serve children at-risk for developmental delay. Areas of interest include public health and its intersection with child development, preventive

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parenting programs to improve developmental outcomes for children living in poverty, autism spectrum disorder and international health.

ALAN MITCHELL

Alan has 15 years of experience in the technology and non-profit sectors, and has been working with PCDC since 2008 to enhance the performance of primary care practices, particularly in medically underserved areas. Alan currently serves as a project manager on several large-scale projects. Through this work, Alan collaborates closely with hospitals and ambulatory practices to improve quality, implement health information technology, and achieve Patient Centered Medical Home recognition. In addition, he leads PCDC’s role as a Regional Extension Center implementation agent, focusing on Meaningful Use. Alan’s expertise also includes strategic planning and change management. He is an NCQA-certified PCMH Content Expert and was educated at the College of William and Mary in Virginia.

BRADLEY OLSON, MD

Dr. Olson is an Associate Professor of Pediatrics at SUNY Upstate Medical University where he serves as an Associate Program Director for Resident Education responsible for curriculum design & development. Aside from his interests in medical education, his clinical area of focus includes Pediatric International Health. He is the director of the Pediatric Global Health Clinic at SUNY Upstate Medical University where he cares for a large pediatric refugee population. In the last several years his area of focus has concentrated on medical education and curriculum development. He has worked with the School of Education from Syracuse University in the development of a novel online core curriculum for pediatric resident education. Most recently he has collaborated with the faculty from UCSF medical center to create a comprehensive shared online curriculum for pediatric resident education.

SACHIN JAIN, MD, MBA

Dedicated to harnessing the power of data, technology, medical science and collaboration to improve patient health, Sachin Jain, M.D., M.B.A., is chief medical information and innovation officer (CMIIO) at Merck. His charge includes developing strategies and global partnerships to leverage health data to improve patient health. Dr. Jain’s work emphasizes understanding of real-world patient experiences and outcomes and applying that knowledge to appropriate use of medications, medication adherence, and advancing medical discovery.

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Medicine is at the core of his efforts, and in addition to his role as CMIIO at Merck, Dr. Jain continues to serve as an attending hospitalist physician at the Boston VA-Boston Medical Center, and is a lecturer in healthcare policy at Harvard Medical School. Prior to joining Merck, Dr. Jain was senior advisor to the administrator of the Centers for Medicare and Medicaid Services (CMS), where he helped launch the Center for Medicare and Medicaid Innovation, briefly serving as its acting deputy director for policy and programs. He also served as special assistant to the National Coordinator for Health Information Technology at the Office of the National Coordinator for Health Information Technology (ONC), supporting the agency’s implementation of the HITECH Provisions of the Recovery Act, which provide incentives for physicians and hospitals to become meaningful users of health information technology. An advocate for faster translation of healthcare delivery research into practice, Dr. Jain has been drawn to the transformational relationship between a patient and caregiver, and ensuring patients’ access to both medicines and to caring, comprehensive treatment. To that end, Dr. Jain is a founder of several non-profit healthcare ventures including the Homeless Health Clinic at the Harvard Square Homeless Shelter; the Harvard Bone Marrow Initiative; and ImproveHealthCare.org. He also co-edited the book, “The Soul of a Doctor,” which has been translated into Chinese.

With expertise in the impact of reimbursement and access on patient health, Dr. Jain worked previously at WellPoint, McKinsey & Co, and the Institute for Healthcare Improvement, and served as an expert consultant to the World Health Organization. He has authored more than 50 publications on healthcare delivery innovation and healthcare reform in journals such as the New England Journal of Medicine, JAMA, and Health Affairs, and is co-editor-in-chief and co-founder of Health Care: The Journal of Delivery Science and Innovation. Dr. Jain graduated magna cum laude from Harvard College with a B.A. in government, and continued on to earn his M.D. from Harvard Medical School and M.B.A. from Harvard Business School. While completing his medical residency at Brigham and Women’s Hospital, he maintained a faculty appointment at the Harvard Business School and remains affiliated as a senior institute associate at the school’s Institute for Strategy and Competitiveness.

WILLIAM ROLLOW, MD

Dr. Rollow is Assistant Professor in Family Medicine and Director of Clinical Services at the Center for Integrative Medicine at the University of Maryland. Board-certified in family medicine, in integrative medicine, and with a master’s degree in public health, he has an extensive background in primary care practice transformation, quality improvement, healthcare technology, medical management, managed care, federal government programs, and administration, having developed and led the Emblem Health Medical Home High Value Network Project, directed the CMS group with responsibility for the Medicare Quality Improvement Organization and End Stage Renal Disease Networks programs, provided technology-based strategic and analytic consulting services at IBM, and held senior medical director positions at BlueCross BlueShield of Illinois and at Anchor HMO. Dr. Rollow seeks to promote transformation: in the lives of individuals through clinical care, in organizations through delivery system redesign resulting in improvements in outcomes and cost, and in communities through policy and practice that support health and wholeness.

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LLOYD I. SEDERER, MD

LLOYD I. SEDERER, M.D., is Medical Director of the New York State Office of Mental Health (OMH), the nation's largest state mental health system. As New York's “chief psychiatrist”, he provides medical leadership for a $3.5 billion per year mental health system which annually serves over 700,000 people and includes 24 hospitals, 90 clinics, two research institutes, and community services throughout a state of ~ 19 million people. Dr. Sederer is an Adjunct Professor at the Columbia/Mailman School of Public Health. Previously, Dr. Sederer served as the Executive Deputy Commissioner for Mental Hygiene Services in NYC, the City’s “chief psychiatrist”. He also has been Medical Director and Executive Vice President of McLean Hospital in Belmont, MA, a Harvard teaching hospital, and Director of the Division of Clinical Services for the American Psychiatric Association. In 2013, Dr. Sederer was given the Irma Bland Award for Excellence in Teaching Residents by the American Psychiatric Association, which in 2009 recognized him as the Psychiatric Administrator of the Year. He also has been awarded a Scholar-in-Residence grant by the Rockefeller Foundation and an Exemplary Psychiatrist award from the National Alliance on Mental Illness. He has published seven books for professional audiences and two books for lay audiences, as well as over 350 articles in medical journals and non-medical publications like TheAtlantic.com, The New York Times/The International Herald Tribune, The Wall Street Journal, The Washington Post.com, Commonweal Magazine, and Psychology Today. He is Medical Editor for Mental Health for the Huffington Post/AOL, where over 150 of his posts and videos have appeared. He recently became Mental Health Advisor for upwave , Turner Broadcasting’s new multi-media platform for health and wellness. His new book, The Family Guide to Mental Health Care (Foreword by Glenn Close), is for families of people with mental illness. His even newer book, co-authored with Jay Neugeboren and Michael Friedman, is The Diagnostic Manual of Mishegas (The DMOM), a parody on the DSM. Dr. Sederer’s website is www.askdrlloyd.com.

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NIRAV R. SHAH, MD, MPH

Dr. Nirav R. Shah is the 15th Commissioner of the New York State Department of Health. A native of Buffalo, he graduated with honors from Harvard College, and has an M.D. and M.P.H. in medicine and chronic disease epidemiology from Yale University. He is board certified in internal medicine and is an elected member of the Institute of Medicine (IOM) of the National Academy of Sciences. Before becoming Commissioner, he was Attending Physician at Bellevue Hospital Center in Manhattan, Associate Investigator at the Geisinger Center for Health Research in central Pennsylvania, and Assistant Professor of Medicine in the Section of Value and Comparative Effectiveness at NYU Langone Medical Center. His interests as a researcher include using large-scale clinical laboratories and electronic health records to improve the effectiveness and efficiency of care. He is a nationally recognized thought leader in patient safety and quality, health information technology, and the strategies required to transition to lower-cost, patient-centered health care for the 21st century. As commissioner, Dr. Shah heads one of the world's leading public health agencies with an annual budget of more than $58 billion. The Department regulates more than 200 hospitals and hundreds of other health care facilities, administers the state's public health insurance programs for over 5 million New Yorkers, oversees more than 80,000 NY state licensed doctors, administers the state health benefit exchange, runs a premier biomedical laboratory, and supports public health and prevention initiatives. During Dr. Shah’s tenure, the Department led the transformation of the state’s Medicaid program, which resulted in more than $4 billion in savings in just the first year while improving population health and quality of care. The Department also spearheaded the creation of a health benefit exchange that will give 1.1 million New Yorkers health insurance coverage; and drafted an evidence-based Prevention Agenda for improving the health of all New Yorkers.

JONATHAN SWARTZ, MD

Jonathan Swartz MD, MBA is a Regional Medical Director for Montefiore Medical Group, where he oversees a network of 11 primary care practices performing 450,000 visits annually. He has had a clinical practice and leadership roles in underserved New York area communities for over 25 years in the areas of practice management, residency education, and managed care. At Montefiore Jon championed Diabetes improvement efforts in the Medical Group over the past decade, culminating recently in a Bridges to Excellence Award for 122 Medical Group physicians. He recently led the Patient Centered Medical Home Pilot program at two Montefiore Medical Practices, and is now working with other MMG leadership to extend PCMH transformation across the Medical Group.

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Jon completed Medical School at the University of Connecticut School of Medicine and residency at Montefiore Medical Center. He is Board Certified in Family Medicine and holds a Masters in Business Administration from the Physician Executive MBA Program of the University of Tennessee. He has worked as a clinician and leader for New York City Health and Hospitals Corporation, St. Joseph’s Medical Center in Yonkers, NY, and The Institute for Urban Family Health. Jon was the founding Medical Director of The Bronx Health Plan (now Affinity Health Plan) and returned to Montefiore in 2000 as the Vice Chair of the Department of Family Medicine before taking on his current MMG role in 2006.

JUDY TUNG, MD

Dr. Judy Tung is an Associate Professor of Clinical Medicine at the Weil Cornell Medical College/ New York Presbyterian Hospital. She obtained her M.D. at the Albert Einstein College of Medicine and completed her Internal Medicine Residency at the University of California, San Francisco. She completed a chief residency at Bellevue Hospital/ New York University prior to joining the faculty at Cornell. Dr. Tung was the Director of the Primary Care Residency training program and an Associate Program Director of the Internal Medicine Residency training program at New York Presbyterian Hospital for seven years. She is currently the Director of the Weill Cornell Internal Medicine Associates (WCIMA), a blended faculty resident practice certified as a level 3 Patient Centered Medical Home. She is also the Interim Chief of the Division of General Internal Medicine. Dr. Tung is a respected educator who has presented nationally on various aspects of outpatient medicine and resident education, including transitions of care, ambulatory practice teams and year end panel handoffs.

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POSTER SESSION - FACILITATED BY ANU ASHOK, MPH & CARLA NELSON, MBA - GREATER NEW YORK HOSPITAL

ASSOCIATION

1. Improvements in Quality and Care Coordination: A Demonstration-Wide Look at HMH Outcomes

Kate Bliss, MSW, Research Scientist – NYS Department of Health

2. A Combined Quality Improvement and PCMH Curriculum – Improving Practice and Engaging Residents

Amanda S. Carmel, MD, Fred N. Pelzman, MD, and Judy Tung, MD – Weill Cornell Medical College

3. Implementing Best Practices in Pediatric Sepsis: Use of Simulation and House Staff-Driven Education

ML Quintos-Alagheband, MD, and Arsenia Asuncion, MD – Winthrop University Hospital

4. Development of a Multidisciplinary Pediatric Home Visiting Program in an Underserved Community

Joseph Truglio, MD, MPH – Mount Sinai Medical Center

5. Improving Resident Continuity in a PCMH

Jacqueline Weber and Ulka Kothari, MD – Winthrop University Hospital

6. Rapid Cycling: Implementing a Resident-Driven Quality Improvement Project in the Outpatient Setting

Tamara Goldberg, MD, Michael Wiener, MD, and Claudia Levine, MD – St. Luke’s Roosevelt Hospital

7. Improving Continuity of Care in a Teaching Community Hospital

Guiseppe Annunziata,MD – St. Barnabas Hospital

8. From Inpatient to Outpatient – Easing the Transition for Our Patients

Jessica Glaser, PCMH Coordinator – Kaleida Health

9. Reducing Hospital Admissions Among Pediatric Asthma Patients

Steven Gelman, MD, Debbie Cleveland, NP, Kathy Garrett-Syzmanski and Pramod Narula, MD – New York Methodist

Hospital

10. Specialty Care Referrals in a Pediatric PCMH

Robyn Rosenblum, MD, Theresa Lang, and Laurie Gordon, MD – The New York Hospital Medical Center of Queens

11. Integration of a PCMH Rotation into the Family Medicine Curriculum

Andreas Cohrssen, MD – Beth Israel Medical Center

12. Transitions in Care – Targeting High Risk Patients Across the Continuum of Care

Jason Hyde, AVP Community Case Management – Lutheran Medical Center & Family Health Centers

13. Quality Improvement: Is Rapid Plan-Do-Study-Act Cycle feasible in a Residency Ambulatory Setting?

Yar Pye, MD, Juana Hernandez, MD, and Concetta Rizzo, RN – Lutheran Medical Center & Family Health Centers

14. Evaluating the Effectiveness of a Coordination of Care Program in a Resident Run Clinic

Joanne Gottridge, MD – North Shore Long Island Jewish School of Medicine

15. No Referrals Left Behind: Improving Specialty Care Coordination

TingTing Wong, MD, Sabiha Friedrich, MD, Khalid Amin, MD, Parag Mehta, MD, and Christina Santos – New York

Methodist Hospital

16. Steps to Transition

Tiffany Bacchus, FNP, Sabiha Friedrich, MD, Khalid Amin, MD, and Parag Mehta, MD – New York Methodist Hospital

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POSTER SESSION - FACILITATED BY ANU ASHOK, MPH & CARLA NELSON, MBA - GREATER NEW YORK HOSPITAL

ASSOCIATION (CONTINUED)

17. Learners Participation in PCMH Implementation

Sonia Velez, MD, JD, Michelle Vaca, MD, Laurie Sullivan, PhD, and Maryam Salehpour, MD – St. Joseph’s Medical Center

18. The Role of the PCMH Nurse in Facilitating Team Based Care in a Family Medicine Residency Practice

Teresa Semalulu, MPH, Merdith Snyder, CHES, MPH, and Angela Bosinski, PhD – University of Buffalo Primary Care

Research Institute

19. Reducing Readmissions Through the Creation of an Interdisciplinary, High-Risk Patient Working Group Janina Morrison, MD, MPH, Inga Bell, RN, Carol Lau, FPN, Joanna White, RN, Marta Rico, MD – Montefiore Medical Center

20. Multidisciplinary Development of an Institutional Sepsis Program Davis Tompkins, MD – Lutheran Medical Centered & Family Health Centers

21. Teaching Clinic Redesign: A Collaborative Effort to Improve Care Coordination and Resident Learning

Anu Ashok, Senior Director Graduate Medical Education – Greater NY Hospital Association

22. Preparing Residents for Future Practice by Implementing a Quality Curriculum in the 2nd

Year of Residency Using Longitudinal Rotation Mathew J. Devine, DO – University of Rochester Medical Center

23. Resident Quality Improvement – Increasing Continuity of Care in a Pediatric Primary Care Setting

Melanie Wilson-Taylor, MD – NY Presbyterian Hospital

24. The Post-Hospital Discharge Clinic in the Transition of Care From the Hospital to the Outpatient Setting

Jonna O. Mercado, MD, Oleyumisi Ariyibi, MD, Archie Bella, MD, Ranjita Pallavi, MD, Ethan Jacobi, Nora V. Bergasa, MD –

Metropolitan Hospital Center

25. Engaging Residents in Analyzing System Errors in a PCMH

Jennifer Rockfeld, MD, Kendrick Lopez, MD, and Barbara Porter, MD, MPH – NYU School of Medicine & Bellevue Hospital

26. Internal Medicine Residents Attitudes About a Change in Training Schedules That Gives Emphasis to Primary

Care

Anastasia Asanov, MD, Susan Grossman, MD, Say Salomon, MD, Yanely Pineiro-Puebla, MD, and Thierry Mallet, MD –

Woodhull Medical Center

27. The July Problem: Hand-off of Graduating Residents’ Continuity Clinic Panels

Barbara Porter, MD, and Jennifer Rockfeld, MD – Bellevue Hospital

28. Poor Competency in Screening Practices May Explain Lower Than Expected Depression Rates in Inner City

Catchment Clinics

Gutnick, DN, and Landolt J – Bellevue Hospital

29. Building an Engaged and Skilled Work-force for Collaborative Care Implementation in a Public Hospital

System

Marianne Howard-Siewers, Damara Gutnick, Elizabeth Lagone, David Stevens, Mary-Ann Etiebet, and Gary Belkin – NYC

HHC Hospitals

30. Integrating House Staff into the Ambulatory Quality Improvement Infrastructure/What’s Your QI IQ?

Resident Physicians as Quality Improvement Leaders

David Eshak, MD – Jacobi Medical Center

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HOSPITALS AND RESIDENCIES PARTICIPATING IN THE HOSPITAL MEDICAL HOME DEMONSTRATION ALBANY MEDICAL CENTER HOSPITAL INTERNAL MEDICINE RAYMOND SMITH, MD ALBANY MEDICAL COLLEGE

ALBANY MEDICAL CENTER HOSPITAL INTERNAL MEDICINE-PEDIATRICS IVELISSE VERRICO, MD ALBANY MEDICAL COLLEGE

ALBANY MEDICAL CENTER HOSPITAL PEDIATRICS KATHERINE DOUGHERTY, MD ALBANY MEDICAL COLLEGE

BELLEVUE HOSPITAL CENTER INTERNAL MEDICINE PATRICK COCKS NYU MEDICAL CENTER

BELLEVUE HOSPITAL CENTER PEDIATRICS RHONDA GRAVES-ACHOLONU NYU MEDICAL CENTER

BETH ISRAEL MEDICAL CENTER - PETRIE CAMPUS INTERNAL MEDICINE DAN STEINBERG, MD BETH ISRAEL MEDICAL CENTER

BETH ISRAEL MEDICAL CENTER - PETRIE CAMPUS FAMILY MEDICINE ANDREAS COHRSSEN, MD BETH ISRAEL MEDICAL CENTER

BRONX-LEBANON HOSPITAL CENTER INTERNAL MEDICINE SRIDHAR S. CHILIMURI, MD BRONX-LEBANON HOSPITAL CENTER

BRONX-LEBANON HOSPITAL CENTER FAMILY MEDICINE DOUGLAS J. REICH, MD BRONX-LEBANON HOSPITAL CENTER

BRONX-LEBANON HOSPITAL CENTER PEDIATRICS AYOADE O. ADENIYI MD, MBA BRONX-LEBANON HOSPITAL CENTER

BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER FAMILY MEDICINE JOHN TSIALIS, D.O. BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER FAMILY MEDICINE TROY DICKINSON, D.O. BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER&#039;S FAMILY MEDICI

BROOKLYN HOSPITAL CENTER - DOWNTOWN CAMPUS INTERNAL MEDICINE KENNETH ONG, MD THE BROOKLYN HOSPITAL CENTER, OUTPATIENT SERVICES BUILDING

BROOKLYN HOSPITAL CENTER - DOWNTOWN CAMPUS INTERNAL MEDICINE KENNETH ONG, MD THE BROOKLYN HOSPITAL CENTER, PATH CENTER

BROOKLYN HOSPITAL CENTER - DOWNTOWN CAMPUS INTERNAL MEDICINE KENNETH ONG, MD THE BROOKLYN HOSPITAL CENTER, PATH EXT. CLINIC

BROOKLYN HOSPITAL CENTER - DOWNTOWN CAMPUS FAMILY MEDICINE SHERLY ABRAHAM, MD THE BROOKLYN HOSPITAL CENTER, FAMILY MEDICINE CENTER

BROOKLYN HOSPITAL CENTER - DOWNTOWN CAMPUS FAMILY MEDICINE SHERLY ABRAHAM, MD THE BROOKLYN HOSPITAL CENTER, LA PROVIDENCIA FAMILY HEALTH CT

BROOKLYN HOSPITAL CENTER - DOWNTOWN CAMPUS PEDIATRICS SARA RAWSLON, MD THE BROOKLYN HOSPITAL CENTER, THE CHILDREN&#039;S CENTER

CITY HOSPITAL CENTER AT ELMHURST INTERNAL MEDICINE LAWRENCE REICH ELMHURST HOSPITAL CENTER/MOUNT SINAI SCHOOL OF MEDICINE

CITY HOSPITAL CENTER AT ELMHURST PEDIATRICS MELVIN GERTNER ELMHURST HOSPITAL CENTER

CONEY ISLAND HOSPITAL INTERNAL MEDICINE ROBERT CUCCO CONEY ISLAND HOSPITAL

CONEY ISLAND HOSPITAL PEDIATRICS [email protected] CONEY ISLAND HOSPITAL

ELLIS HOSPITAL FAMILY MEDICINE GARY DUNKERLEY, MD ELLIS HOSPITAL

ERIE COUNTY MEDICAL CENTER INTERNAL MEDICINE CHRISTOPHER P. SCHAEFFER SUNY BUFFALO DEPARTMENT OF INTERNAL MEDICINE

ERIE COUNTY MEDICAL CENTER FAMILY MEDICINE MICHAEL E. ZIONTS SUNY BUFFALO DEPARTMENT OF FAMILY MEDICINE

FLUSHING HOSPITAL MEDICAL CENTER INTERNAL MEDICINE KAREN BEEKMAN, M.D. FLUSHING HOSPITAL MEDICAL CENTER

FLUSHING HOSPITAL MEDICAL CENTER PEDIATRICS SUSANA RAPAPORT, M.D. FLUSHING HOSPITAL MEDICAL CENTER

GLEN COVE HOSPITAL FAMILY MEDICINE WILLIAM BENNETT MD GLEN COVE HOSPITAL

GOOD SAMARITAN HOSPITAL MEDICAL CENTER FAMILY MEDICINE STEVEN GOLINOWSKI, DO GOOD SAMARITAN HOSPITAL MEDICAL CENTER

GOOD SAMARITAN HOSPITAL MEDICAL CENTER PEDIATRICS RONALD MARINO, DO GOOD SAMARITAN HOSPITAL MEDICAL CENTER

HARLEM HOSPITAL CENTER INTERNAL MEDICINE RAJI AYINLA, MD, FCCP, FACP COLUMBIA UNIVERSITY

HARLEM HOSPITAL CENTER PEDIATRICS DIANE FERRAN COLUMBIA UNIVERSITY

HIGHLAND HOSPITAL FAMILY MEDICINE STEPHEN SCHULTZ, MD HIGHLAND HOSPITAL, UNIVERSITY OF ROCHESTER MEDICAL CENTER

INTERFAITH MEDICAL CENTER INTERNAL MEDICINE MARK ADLER INTERFAITH MEDICAL CENTER

JACOBI MEDICAL CENTER INTERNAL MEDICINE ANDREW GUTWEIN JACOBI MEDICAL CENTER

JACOBI MEDICAL CENTER PEDIATRICS J. AUXFORD BURKS JACOBI MEDICAL CENTER

JAMAICA HOSPITAL MEDICAL CENTER FAMILY MEDICINE GINA BASELLO, DO JAMAICA HOSPITAL MEDICAL CENTER

JAMAICA HOSPITAL MEDICAL CENTER INTERNAL MEDICINE RICHARD PINSKER, MD JAMAICA HOSPITAL MEDICAL CENTER

KALEIDA HEALTH - BUFFALO GENERAL MEDICAL CENTER FAMILY MEDICINE DR. MICHAEL ZIONTS UNIVERSITY AT BUFFALO

KALEIDA HEALTH - BUFFALO GENERAL MEDICAL CENTER INTERNAL MEDICINE DR. CHRISTOPHER SCHAEFFER UNIVERSITY AT BUFFALO

KALEIDA HEALTH - MILLARD FILLMORE SUBURBAN HOSPITAL FAMILY MEDICINE DR. MICHAEL ZIONTS UNIVERSITY AT BUFFALO

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KALEIDA HEALTH - WOMEN AND CHILDREN’S HOSPITAL OF BUFFALO PEDIATRICS DR. LORNA FITZPATRICK KALEIDA HEALTH - WOMEN AND CHILDREN&#039;S HOSPITAL OF BUFFALO

KALEIDA HEALTH - WOMEN AND CHILDREN’S HOSPITAL OF BUFFALO INTERNAL MEDICINE-PEDIATRICS DR. MICHAEL ARONICA UNIVERSITY AT BUFFALO

KINGS COUNTY HOSPITAL CENTER INTERNAL MEDICINE STEVEN WEISS KINGS COUNTY HOSPITAL CENTER

KINGS COUNTY HOSPITAL CENTER PEDIATRICS HENRY SCHAEFFER KINGS COUNTY HOSPITAL CENTER

KINGS COUNTY HOSPITAL CENTER FAMILY MEDICINE MARGARET DONAT KINGS COUNTY HOSPITAL CENTER

KINGSBROOK JEWISH MEDICAL CENTER INTERNAL MEDICINE MOHAMMAD ZAHIR, M.D. KINGSBROOK JEWISH MEDICAL CENTER

KINGSTON HOSPITAL FAMILY MEDICINE MARK JOSEFSKI INSTITUTE FOR FAMILY HEALTH

KINGSTON HOSPITAL/INSTITUTE FOR FAMILY HEALTH FAMILY MEDICINE MARK JOSEFESKI, M.D. INSTITUTE FOR FAMILY

LINCOLN MEDICAL &AMP; MENTAL HEALTH CENTER INTERNAL MEDICINE VIHREN DIMITROV LINCOLN MEDICAL AND MENTAL HEALTH CENTER

LINCOLN MEDICAL &AMP; MENTAL HEALTH CENTER PEDIATRICS MAGDA MENDEZ LINCOLN MEDICAL AND MENTAL HEALTH CENTER

LONG BEACH MEDICAL CENTER FAMILY MEDICINE NANCY BONO, DO LONG BEACH MEDICAL CENTER

LUTHERAN MEDICAL CENTER FAMILY MEDICINE CLAUDIA LYON, D.O. LUTHERAN MEDICAL CENTER

LUTHERAN MEDICAL CENTER INTERNAL MEDICINE DANIEL GIACCIO, M.D. LUTHERAN MEDICAL CENTER

MAIMONIDES MEDICAL CENTER INTERNAL MEDICINE EDWARD CHAPNICK MAIMONIDES MEDICAL CENTER

MERCY HOSPITAL OF BUFFALO INTERNAL MEDICINE KHALID QAZI, MD MERCY HOSPITAL OF BUFFALO

METROPOLITAN HOSPITAL CENTER INTERNAL MEDICINE SHOBHANA CHAUDHARI METROPOLITAN HOSPITAL CENTER

METROPOLITAN HOSPITAL CENTER PEDIATRICS ANDRE BROUSSARD METROPOLITAN HOSPITAL CENTER

MONTEFIORE MEDICAL CENTER FAMILY MEDICINE MARY DUGGAN, MD MONTEFIORE, DEPARTMENT OF FAMILY &AMP; SOCIAL MEDICINE

MONTEFIORE MEDICAL CENTER INTERNAL MEDICINE ROSEMARIE CONIGLIARO, MD MONTEFIORE, DEPARTMENT OF MEDICINE

MONTEFIORE MEDICAL CENTER PEDIATRICS SARA ROSS, MD MONTEFIORE, DEPARTMENT OF PEDIATRICS

MOUNT VERNON HOSPITAL INTERNAL MEDICINE ZEV CARREY, MD MOUNT VERNON HOSPITAL

NASSAU UNIVERSITY MEDICAL CENTER PEDIATRICS DAVID FAGAN MD NASSAU UNIVERSITY MEDICAL CENTER

NASSAU UNIVERSITY MEDICAL CENTER INTERNAL MEDICINE PRACHI ANAND MD NASSAU UNIVERSITY MEDICAL CENTER

NASSAU UNIVERSITY MEDICAL CENTER PEDIATRICS DA NUMC

NEW YORK METHODIST HOSPITAL INTERNAL MEDICINE DR. HARVEY DOSIK NEW YORK METHODIST HOSPITAL

NEW YORK METHODIST HOSPITAL PEDIATRICS PRAMOD NARULA, M.D. NEW YORK METHODIST HOSPITAL

NIAGARA FALLS MEMORIAL MEDICAL CENTER FAMILY MEDICINE TIMOTHY G. MURPHY, D.O. NIAGARA FALLS MEMORIAL MEDICAL CENTER

NORTH CENTRAL BRONX HOSPITAL INTERNAL MEDICINE MARK KORSTEN MT. SINAI/VA

NORTH SHORE UNIVERSITY HOSPITAL INTERNAL MEDICINE SAIMA CHAUDHRY, M.D. NORTH SHORE LIJ HEALTH SYSTEM

PECONIC BAY MEDICAL CENTER FAMILY MEDICINE GEORGE RUGGIERO, D.O. NYCOMEC

PHELPS MEMORIAL HOSPITAL ASSOCIATION FAMILY MEDICINE SHANTIE HARKISOON PHELPS MEMORIAL HOSPITAL ASSOCIATION

QUEENS HOSPITAL CENTER INTERNAL MEDICINE DEBRA BRENNESSEL NYC HHC

RICHMOND UNIVERSITY MEDICAL CENTER INTERNAL MEDICINE JAY NFONOYIM, MD RICHMOND UNIVERSITY MEDICAL CENTER

RICHMOND UNIVERSITY MEDICAL CENTER PEDIATRICS RENE CHALOM, MD RICHMOND UNIVERSITY MEDICAL CENTER

ROCHESTER GENERAL HOSPITAL INTERNAL MEDICINE PAUL BERNSTEIN, MD ROCHESTER GENERAL HOSPITAL

ROCHESTER GENERAL HOSPITAL PEDIATRICS LYNN GARFUNKEL, MD ROCHESTER GENERAL HOSPITAL

SAMARITAN MEDICAL CENTER INTERNAL MEDICINE DAVID P. RECHLIN, D.O., F.C.C.P., F.A.C.O.I. SAMARITAN MEDICAL CENTER

SAMARITAN MEDICAL CENTER FAMILY MEDICINE BENJAMIN RUDD, M.D. SAMARITAN MEDICAL CENTER

SISTERS OF CHARITY HOSPITAL INTERNAL MEDICINE KHALID QAZI, MD SISTERS OF CHARITY HOSPITAL

SISTERS OF CHARITY HOSPITAL FAMILY MEDICINE ANDREW HARBISON SISTERS OF CHARITY HOSPITAL

SOUND SHORE MEDICAL CENTER OF WESTCHESTER INTERNAL MEDICINE STEPHEN JESMAJIAN, MD SOUND SHORE MEDICAL CENTER OF WESTCHESTER

SOUND SHORE MEDICAL CENTER OF WESTCHESTER PEDIATRICS MATTHEW KAPKLEIN, MD WESTCHESTER MEDICAL CENTER - MARIA FERRERI CHILDREN&#039;S HOSPI

SOUTH NASSAU COMMUNITIES HOSPITAL FAMILY MEDICINE SAMUEL SANDOWSKI, MD SOUTH NASSAU COMMUNITIES HOSPITAL

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ST BARNABAS HOSPITAL INTERNAL MEDICINE VICTORIA BENGUALID, MD ST. BARNABAS HOSPITAL

ST BARNABAS HOSPITAL FAMILY MEDICINE NELSON ENG, DO UNION COMMUNITY HEALTH CENTER

ST BARNABAS HOSPITAL PEDIATRICS DAVID H. RUBIN, MD ST. BARNABAS HOSPITAL

ST JOSEPH’S HOSPITAL HEALTH CENTER FAMILY MEDICINE ANNE K. LOUISE ST. JOSEPHS HOSPITAL HEALTH CENTER

ST. JOSEPH’S MEDICAL CENTER FAMILY MEDICINE SONIA VELEZ, M.D.J.D. ST. JOSEPH&#039;S MEDICAL CENTER

ST. LUKE’S- ROOSEVELT HOSPITAL CENTER INTERNAL MEDICINE ETHAN FRIED, MD ST. LUKE&#039;S - ROOSEVELT HOSPITAL CENTER

STATE UNIVERSITY OF NEW YORK DOWNSTATE MEDICAL CENTER INTERNAL MEDICINE JEANNE MACRAE, MD SUNY DOWNSTATE MEDICAL CENTER

STATE UNIVERSITY OF NEW YORK DOWNSTATE MEDICAL CENTER FAMILY MEDICINE MARGARET DONAT, MD SUNY DOWNSTATE MEDICAL CENTER

STATE UNIVERSITY OF NEW YORK DOWNSTATE MEDICAL CENTER PEDIATRICS HENRY SCHAEFFER, MD SUNY DOWNSTATE MEDICAL CENTER

STONY BROOK UNIVERSITY HOSPITAL FAMILY MEDICINE DONNA MELTZER STONY BROOK UNIVERSITY HOSPITAL

STONY BROOK UNIVERSITY HOSPITAL PEDIATRICS ROBYN BLAIR STONY BROOK UNIVERSITY HOSPITAL

STONY BROOK UNIVERSITY HOSPITAL INTERNAL MEDICINE-PEDIATRICS KIMBERLY FENTON STONY BROOK UNIVERSITY HOSPITAL

STONY BROOK UNIVERSITY HOSPITAL INTERNAL MEDICINE ROBERT REILLY STONY BROOK UNIVERSITY HOSPITAL

STRONG MEMORIAL HOSPITAL INTERNAL MEDICINE DONALD R. BORDLEY, MD STRONG MEMORIAL HOSPITAL

STRONG MEMORIAL HOSPITAL PEDIATRICS WILLIAM S VARADE, MD STRONG MEMORIAL HOSPITAL STRONG MEMORIAL HOSPITAL INTERNAL MEDICINE-PEDIATRICS BRETT W ROBBINS, MD STRONG MEMORIAL HOSPITAL - UNIVERSITY OF ROCHESTER MEDICAL CENTE

THE MOUNT SINAI MEDICAL CENTER INTERNAL MEDICINE DAVID THOMAS MOUNT SINAI SCHOOL OF MEDICINE

THE MOUNT SINAI MEDICAL CENTER PEDIATRICS LISA BOGUSKI MOUNT SINAI SCHOOL OF MEDICINE

THE MOUNT SINAI MEDICAL CENTER FAMILY MEDICINE FRANCESCO LEANZA MOUNT SINAI SCHOOL OF MEDICINE

THE NEW YORK AND PRESBYTERIAN HOSPITAL INTERNAL MEDICINE JOSEPH TENEBAUM, MD COLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS AND SURGEONS

THE NEW YORK AND PRESBYTERIAN HOSPITAL FAMILY MEDICINE HEATHER LYNN PALADINE, MD COLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS AND SURGEONS

THE NEW YORK AND PRESBYTERIAN HOSPITAL PEDIATRICS ELIZABETH A. WEDEMEYER, MD COLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS AND SURGEONS

THE NEW YORK AND PRESBYTERIAN HOSPITAL INTERNAL MEDICINE LIA S. LOGIO, MD WEILL CORNELL MEDICAL COLLEGE

THE NEW YORK AND PRESBYTERIAN HOSPITAL PEDIATRICS JENNIFER I. DIPACE, MD WEILL CORNELL MEDICAL COLLEGE

THE NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS INTERNAL MEDICINE STEVEN REICHERT, M.D. THE NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS

THE NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS PEDIATRICS LAURIE GORDON, M.D. THE NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS

UNITY HOSPITAL INTERNAL MEDICINE RUTH KOUIDES, MD MPH UNITY HEALTH SYSTEM

UNIVERSITY HOSPITAL SUNY HEALTH SCIENCE CENTER PEDIATRICS GLORIA A KENNEDY, MD DEPARTMENT OF PEDIATRICS, SUNY UPSTATE MEDICAL UNIVERSITY

UNIVERSITY HOSPITAL SUNY HEALTH SCIENCE CENTER PEDIATRICS GLORIA A KENNEDY, MD DEPARTMENT OF PEDIATRICS, SUNY UPSTATE MEDICAL UNIVERSITY

WESTCHESTER MEDICAL CENTER INTERNAL MEDICINE SACHIN SULE, M.D. WESTCHESTER MEDICAL CENTER

WESTCHESTER MEDICAL CENTER PEDIATRICS MATTHEW KAPKLEIN WESTCHESTER MEDICAL CENTER

WINTHROP-UNIVERSITY HOSPITAL PEDIATRICS JILL LEAVENS-MAURER, MD WINTHROP-UNIVERSITY HOSPITAL

WOODHULL MEDICAL &AMP; MENTAL HEALTH CENTER INTERNAL MEDICINE SUSAN GROSSMAN WOODHULL MEDICAL AND MENTAL HEALTH CENTER

WOODHULL MEDICAL &AMP; MENTAL HEALTH CENTER PEDIATRICS RAYMOL VARGHESE WOODHULL MEDICAL AND MENTAL HEALTH CENTER

WYCKOFF HEIGHTS MEDICAL CENTER INTERNAL MEDICINE FRANTZ DUFFOO, M.D. WYCKOFF HEIGHTS MEDICAL CENTER

WYCKOFF HEIGHTS MEDICAL CENTER PEDIATRICS MOHAMMAD MIR, M.D. WYCKOFF HEIGHTS MEDICAL CENTER