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Region 12 Regional Health Partnership

Full meeting July 17, 2012. Region 12 Regional Health Partnership. Objectives. PFM Protocol Updates DSRIP RHP Planning Protocol Overview Website Resources Subcommittee Updates Schedule/Calendar. Key PFM Protocol Items Under CMS Negotiation.

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Region 12 Regional Health Partnership

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  1. Full meeting July 17, 2012 Region 12Regional Health Partnership

  2. Objectives • PFM Protocol Updates • DSRIP RHP Planning Protocol Overview • Website Resources • Subcommittee Updates • Schedule/Calendar

  3. Key PFM Protocol ItemsUnder CMS Negotiation • DSRIP requirements to be eligible for uncompensated care (UC) payments. • Minimum number of projects in each DSRIP Category • UC and DSRIP allocation methodology • Methodology for allocating funding among the four DSRIP Categories • Valuation of projects • Variation of requirements across regions

  4. UC and DSRIP Participation • Hospitals receiving UC payments must report on a subset of DSRIP Category 4 measures: • Potentially Preventable Admissions (PPAs) • Potentially Preventable Readmissions (PPRs) • Potentially Preventable Conditions (PPCs) • Failure to report on the required measures by the last quarter of the year will result in forfeiture of UC payments in that quarter. • Small and rural hospitals are exempted.

  5. DSRIP Project Requirements • Projects and DSRIP payments are documented in the RHP Plan of the Performing Provider. • A Performing Provider may only participate in the RHP Plan where it is physically located • Each project shall be implemented by one Performing Provider only. • Projects included in the RHP Plan shall be: • Selected from the RHP Planning Protocol (DSRIP Menu) • Based on community needs • Planned for implementation

  6. Performing Provider Minimum Number of Projects • DSRIP Hospital • 1 project from EITHER Category 1 or Category 2 • 1 common Category 3 intervention selected by HHSC • 1 additional Category 3 intervention selected by the hospital with an exemption for small & rural hospitals • Report on all Category 4 measures but optional for small rural hospitals. • Participate in one of the following: • Categories 1, 3, and 4 • Categories 2, 3, and 4 • Categories 1, 2, 3 and 4 • Non-hospital performing providers may not participate in Cat 3 or 4

  7. RHP UC & DSRIP Allocation Methodology • Each RHP shall be allocated UC and DSRIP funds based on low income population and Medicaid burden using the following variables: • Percent of state population with income below 200% Federal Poverty Level. • Percent of Texas Medicaid acute care payments in fiscal year 2011 (fee-for-service [FFS], primary care case management [PCCM], managed care [MCO], pharmacy). • Percent of Texas Medicaid supplemental payments in fiscal year 2011.

  8. DSRIP Allocation – RHP 12 Do you want to just show RHP 12 or just a section of the table due to space limitations? • Tier 3 • Funding Allocation Percentage – 3.56%

  9. UC Allocation – RHP 12 • Funding Allocation Percentage – 3.56%

  10. DSRIP Allocation within RHPs • Each Provider will need to make a decision on whether or not to participate in DSRIP. • Providers that will not be participating in DSRIP need to let the anchor know.

  11. DY 1 DSRIP • Anchoring Entities, IGT Entities, and Performing Providers that have a current Medicaid provider identification number are eligible for demonstration year (DY) 1 DSRIP for submission of RHP Plans. • Anchoring Entity is allocated 10%. • Performing Providers and IGT Entities are allocated the remaining 90% based on value of DSRIP Projects in Categories 1-4 for DY2 - DY5. • DY 1 DSRIP payments will be paid as follows: • 50% to the Performing Provider • 50% to the IGT Entity

  12. DYs 2-5 DSRIP Allocation within RHPs • 75% allocation to hospitals. • Each individual hospital allocation is based on its fiscal year 2011 Medicaid acute care payments (FFS, PCCM, MCO, pharmacy) and supplemental payments. • 25% allocation to non-hospital providers. • 10 %to local mental health authorities. • 10 % to physician practices associated with an academic health science center. • 5% to local health districts.

  13. “First Pass” • RHPs must meet the following: • Minimum number of project requirements for the RHP Tier level. • Broad hospital participation wherein RHPs in Tiers 1, 2, and 3 shall fund a minimum percent of the DSRIP allocated to non-profit and private hospitals. • Each Performing Provider may not exceed its DSRIP allocation.

  14. “Second Pass” • If there are unused DSRIP allocation amounts after the first pass, the RHP may redirect the unused allocations to fund additional projects. • An individual hospital provider is not limited to its DSRIP allocation in the second pass. • Physician practice groups not affiliated with academic health science centers may participate in Categories 1 and 2 DSRIP projects if they have identified a source of non-federal match.

  15. Project Valuation • •Hospital Performing Providers must comply with the funding distribution across Categories 1-4 for DY2 - DY5. • Hospitals that elect not to participate in category 4 shall allocate category 4 funding to categories 1 & 2 or 3. • HHSC will review projects valuation for face validity.

  16. Plan Modifications • Uncommitted DSRIP funding will be reallocated to RHPs with interest and funding to implement new projects in DY3. • New DSRIP projects, new Performing Providers, and/or new IGT Entities may be added in DY2 for implementation in DY3. • Other plan modifications will be allowed for: • Changes to milestones/metrics for existing projects. • Deletion of projects.

  17. Payment Based on Achievement of Milestone Bundles • Two or more metrics associated with a milestone shall have equal weighted value for the purpose of calculating incentive payments. • A Performing Provider must fully achieve a Category 1-3 metric to include it in the incentive payment calculation

  18. Payment Based on Achievement of Milestone Bundles • Based on the progress reported, each milestone will be categorized as follows to determine the total achievement value for the milestone bundle: • HHSC may determine milestones that qualify for partial achievement

  19. Sample Disbursement Calculation • A Category 1 Project in DY 2 is valued at $3 million and has 3 milestones, which make up the Milestone Bundle. • Under the payment formula, the 3 milestones represent a maximum achievement value of 3.

  20. Sample Disbursement Calculation • The hospital Performing Provider reports the following progress at 6 months: • Total achievement value at 6 months = 1.5 • Disbursement at 6 months = $3M x (1.5/3) = $1.5 million • Remaining $s payable at end of 12months given 100% of metrics are completed.

  21. DSRIP RHP Planning Protocol Overview

  22. Category 1 Infrastructure Development Project Areas The ones in blue font are ones that I identified as being new. You might verify because one of them might have fit into an old project with a totally different name. • Expand Primary Care Capacity • Increase Training of Primary Care Workforce • Implement and Utilize Disease Management Registry Functionality • Enhance Interpretation Services and Culturally Competent Care • Collect Accurate Race, Ethnicity, and Language (REAL) Data to Reduce Disparities • Enhance Urgent Medical Advice • Introduce, Expand or Enhance Telemedicine/Telehealth • Enhance Coding and Documentation for Quality Data • Expand Specialty Care Capacity • Enhance Performance Improvement and Reporting Capacity • Expand Behavioral Health Services • Expand Dental Services • Expand or Enhance Emergency Medical Transportation Services

  23. Category 2- Program Innovation and Redesign Project Areas The ones in blue font are the ones I identified as being new. You might verify because one of them might have fit into an old project with a totally different name. • Expand or Enhance Medical Homes • Expand Chronic Care Management Models • Redesign Primary Care • Redesign to Improve Patient Experience • Redesign to Cost Containment • Establish/Expand a Patient Care Navigation Program • Apply Process Improvement Methodology to Improve Quality/Efficiency • Improve Patient Flow in the Emergency Department/Rapid Medical Evaluation • Use Palliative Care Programs • Conduct Medication Management • Implement/Expand Care Transition Programs • Implement Evidence-based Health Promotion & Disease Prevention Programs

  24. Category 3 & 4 Project AreasQuality & Population Improvements Category 3 Project Areas • Severe Sepsis Resuscitation and Management • Potentially Preventable Admissions • Potentially Preventable Readmissions • Potentially Preventable Complications • Perinatal Outcomes • Diabetes Composite Measure Category 4 Project Areas • Potentially Preventable Admissions • 15-Day Readmissions • Provider Preventable Complications • Patient-centered Healthcare • Emergency Department

  25. Measure Requirements • Process Measure - Must include at least One • Although most Process Measures have one metric, several projects may be carried out by a given performing provider simultaneously, with the result that a series of related metrics will apply • Improvement Measure –Must include at least One

  26. Performing Provider Minimum Number of Projects • DSRIP Hospital • 1 project from EITHER Category 1 or Category 2 • 1 common Category 3 intervention selected by HHSC • 1 additional Category 3 intervention selected by the hospital with an exemption for small & rural hospitals • Report on all Category 4 measures but optional for small rural hospitals. • Participate in one of the following: • Categories 1, 3, and 4 • Categories 2, 3, and 4 • Categories 1, 2, 3 and 4 • Non-hospital performing providers may not participate in Cat 3 or 4

  27. DSRIP Project Template DSRIP Plans must include a narrative that includes the following subsections: • Identifying information - Category, name of the project/intervention, and Performing Provider name. • Project Goal - The goal(s) for the project, which describes the challenges or issues of the Performing Provider and brief description of the major delivery system solution identified; the starting point of the Performing Provider and the overall target goal and the significance of that goal to the Performing Provider, RHP and patients.

  28. DSRIP Project Template • Related Projects - A description of how this project supports, reinforces, enables, and is related to other projects and interventions within the RHP Plan. • Milestones and Metrics Table - Milestones and metrics adopted in accordance with the “RHP Planning Protocol.” • Should include at least one Process measure and one Improvement measure.

  29. Project Format Template

  30. Project Format Template Milestone: Description of specific process or accomplishment that will be measured. Metric: Specific goal including source for measurement and if appropriate, numerator and denominator. Estimated DSRIP Funding: Value of achieving the metric described. (Incentive Payment) Project may have multiple milestones for a single year.

  31. Project Format Template Total DSRIP Funding for all milestones for the project for the year. Total matching funds available from IGT partners for the DSRIP funds. IGT partners providing the matching funds.

  32. Electronic Template • The Electronic Template on the web-site has not been updated. We are expecting a final template from the state soon.

  33. Website Resources • Texasrhp12.com • Member Registration Register here

  34. Website Resources • Once you register you will have additional drop down selections under the members tab

  35. Website Resources • On the Documents & Downloads tab you will find resources you need to complete your plan.

  36. Website Resources

  37. Subcommittee Updates

  38. Executive Committee • Bi-weekly face to face meeting • Off week conference call • Updates from all Sub-committees • Plan Full Region Meetings • Discuss all state updates

  39. Needs Assessment Committee RURAL REPORT • Aggregate data from Jim Conditt from all RHP-12 counties except Potter, Randall and Lubbock • Health Data from the Earl Center which is BRFSS data comparable

  40. Needs Assessment Committee URBAN REPORT • Aggregate data from Jim Conditt from Potter, Randall and Lubbock counties • Executive Summary of BRFSS data obtained through surveys done by Dr. Richardson for the Amarillo area. • Covenant Health System-Covenant Medical Center Community Needs and Assets Assessments

  41. Needs Assessment Committee • Possible Additional Attachments (to support potential DSRIP Projects and give as complete information about RHP-12 as we have available to us) • The Community Data and Resources for Assessment of Needs.

  42. Finance CommitteeIGT Capacity

  43. Finance CommitteeUC Tool Update • UC Tool • July 16th – Anticipated approval by CMS • July 24th – Expected to be distributed to us for completion • August 24th – Submit completed UC tool to HHSC • November 30th – Anticipated 1st payment for DY1 (transition year) UC cap increases related to Q1-Q4.

  44. Rules & Regs • READ: Texas DSRIP Program Funding and Mechanics Protocol June 29th, 2012 Draft • VISIT: Websites provided by HHSC and REGION 12 for updates http://www.hhsc.state.tx.us/1115-waiver.shtml TXHealthcareTransformation@hhsc.state.tx.us http://www.texasrhp12.com • POST: Questions to the REGION 12 Website • PARTICIPATE IN: Meetings, webinars, and workgroups • FORWARD: Any completed plans to REGION 12 Website for review and comment • COMING SOON: HHSC to offer a “Waiver Compliance Checklist” for the entire state to assist each participant in reviewing each component of individual plans for compliance.

  45. Behavioral health

  46. Northern Rural Workgroup

  47. Southern Rural Workgroup

  48. Calendar • July 16th – UC Tool to be approved by CMS • July 24th – UC Tool released for completion • August 3rd – ALL 1st draft project plans submitted to the Anchor. • Final template and valuation to be added later • TBD – Pre-Summit Webinar • August 7-8 – RHP Planning Summit • August 13th – Full RHP 12 Region Meeting

  49. RHP Plan Submission Calendar • September 1st – RHP 4 year plan to HHSC for review • September 30th– HHSC completes initial review and notifies the RHP Anchoring Entity of any questions or concerns • October 15th– RHPs revised plan submitted to HHSC • October 31st– HHSC submits approved plans to CMS for final review and approval • December 15th– CMS will complete its review of each plan and will either: • Approve the plan; or • Notify HHSC and Anchor with questions & concerns • January 15th – HHSC shall submit revised DSRIP plans to CMS • February 1st – CMS approve or deny the revised plans

  50. Questions or Comments?

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