RHP 17 Planning Orientation

1. RHP 17Planning Orientation May 3, 2012 9:30 a.m. to 11:00 a.m. 1:00 p.m. to 2:30 p.m.

2. Welcome & Introductions • Meeting Facilitators • Dr. Monica Wendel • Ms. Angie Alaniz

3. Orientation Overview • Update on HHSC, RHP 17 activities • Presentation of Planning Process • What will be included in the plan? • Who should participate? • What is the timeline?

4. HHSC Waiver Activities • March 1st - Uncompensated Care (UC) Protocol Finalized • Submitted to Centers for Medicare and Medicaid Services • March/April – Statewide Outreach • Informational meetings held regarding RHP formation and DSRIP menu • May 1st - RHP Regions established

5. RHP Regions (Unofficial)

6. HHSC Timeline • May 17, 2012 • Public hearing on final regional boundaries • August 31, 2012 • Final RHP regions, DSRIP project menu, and payment protocol to CMS. • September 1, 2012 • RHP Plans due to HHSC. • October 31, 2012 • HHSC submits final RHP plans to CMS.

7. RHP Region 17

8. RHP 17 Activities • March 14th - Established RHP 17 • Brazos, Burleson, Grimes, Leon, Madison, Robertson, and Washington • TAMHSC named as anchor; BVCOG as fiscal agent • April 9th and 23rd - RHP 17 expands • Montgomery and Walker join RHP 17 • April 18th – IGT Meeting • Focus - RHP Governance Structure

9. RHP Principles • RHPs should promote transformation: • Improved access • Quality • Cost-effectiveness • Coordination

10. RHP Participants • Four Primary Participants • Intergovernmental Transfer Entities • Private Hospitals • Other Health Care Providers • Anchoring Entities • Participants have defined roles and responsibilities

11. IGT Entities • Who are they? • Cities, counties, hospital districts, hospital authorities, academic health science centers, mental health authorities, health districts, emergency management districts • General duties • Determines use of its IGT funding for uncompensated care (UC) and Delivery System Reform Incentive Payments (DSRIP) • Participates in RHP Planning

12. IGT Entities & RHP Planning • RHP Plan • Selects projects and provides baseline metrics for DSRIP • Must be consistent with HHSC RHP Protocol for DSRIP • Estimates IGT available for each of the 4 plan years • IGTs are NOT being asked to make a legal commitment beyond the first plan year.

13. IGT Entities and UC • Estimates IGT for uncompensated care (UC) by plan year • Provides IGT match for self or sponsored hospital

14. IGT Entities and DSRIP • Estimates IGT for DSRIP by year • Works with RHP, state, and CMS on valuing projects in DY 1 • Provides IGT match

15. Private Hospitals • Who are they? • Private hospitals (without IGT) that choose to participate in waiver program and receive funding • General Duties • Participates in the RHP planning to receive waiver funding • Coordinates with IGT providers to offer transformational services or uncompensated care as basis of receiving sponsored payments

16. Private Hospitals, UC, and DSRIP • Provision of UC serves as the basis for UC waiver payments • UC payment contingent upon IGT provided by IGT entities • Performs transformation (DSRIP) project • Must meet performance metrics as basis for IGT-funded incentive payments • Provides report to anchoring entity

17. Other Health Care Providers • Who are they? • Non-hospital health care providers such as clinics and related service providers that a participating hospital might contract with to meet waiver objectives • General Duties • Coordinates with IGT providers to offer transformational services as basis for receiving payments from hospitals.

18. RHP Anchors • Who are they? • Any IGT entity • A public hospital • A hospital district or a hospital authority • A county • A state university with a health science center or medical school • General Duties: • Single point of contact between HHSC and RHP • Facilitates RHP meetings with IGT entities • Includes other stakeholders in RHP planning • Holds public meeting prior to submission of final plan

19. Anchors and RHP Planning • Ensures inclusion of key stakeholders in RHP Plan development • Coordinates, develops, and provides RHP Plan to HHSC • IGT contributing projects must be consistent with DSRIP Project menu and based on IGT entities’ input

20. Anchors and DSRIP • Coordinates DSRIP Project Reports to HHSC • Reports detail project milestones and metrics met • Provides technical assistance to participating providers

21. Proposed Governance Structure RHP Executive Committee Current IGT Entities Brazos County Burleson County Hospital District Grimes County Montgomery County Hospital District Walker County Hospital District Texas A&M Health Science Center Anchor Texas A&M Health Science Center Fiscal Agent BVCOG Advisory Council Other Providers & Stakeholders RHP 17 Board All current and potential IGT Entities and All current and potential Participating Providers* *Non-voting members • Notes: • Each IGT Entity and Participating Provider will name 1 board representative • There will be 1 vote per county/hospital district

22. RHP Plan • HHSC’s Draft Template • Released April 3rd • Advised RHPs NOT to complete this draft template • Hosting Planning Orientation in June • Plan Components • RHP Organization & Executive Overview • Community Needs Assessment • Stakeholder Engagement • DSRIP Projects • Allocation of Funds & RHP Participation Certifications

23. RHP Organization & Overview • RHP Sections I and II • RHP Participants List • e.g. IGT entity, Performing Providers, Anchor, Other Stakeholders (not directly receiving UC or DSRIP) • Organization name, Lead Representative, Contact information • Executive Overview • Overarching RHP goals • Brief summary of RHP healthcare environment • Summary of how RHP will move from current status forward • Identification of regional areas, e.g. RHP counties

24. Community Assessment • Section III – Needs Assessment • Data used cannot be more than 5 years old • Demographics (e.g. race, ethnicity, income, education, employment, large employers) • Insurance coverage (commercial, Medicaid, Medicare, UC) • Description of region’s current health care infrastructure and environment (number/types of providers; hospital sizes, services, systems, and costs; HPSAs) • Projected major changes (in first three areas) • Key health challenges specific to region • Assessment should be basis for selection of DSRIP projects

25. Stakeholder Engagement • Section IV - Participation in RHP • Performing providers – Describe how every performing provider directly eligible to receive pool payments was engaged • Eligible performing providers must participate in RHP planning process in order to receive payments • Public Engagement – Describe opportunities for public input into the development of the plans. Identify the stakeholders and groups that were engaged.

26. DSRIP Projects • Section V – DSRIP Projects by Category • Infrastructure Development • Program Innovations and Redesign • Quality Improvements • Population Focused Improvements

27. IGT Funding & Certifications • Sections VI and VII • Allocation of Funds • Amount of UC, DSRIP, and Estimated State Match for each RHP Performing Provider • RHP Participation Certifications • Signature of IGT Entities and Performing Providers

28. DSRIP Project Menu • Categories • Infrastructure Development • Investments in technology, tools, and human resources • Program Innovations and Redesign • Piloting, testing, and replicating innovative care models • Quality Improvements • Hospitals implementing clinical improvement interventions • Population Focused Improvements • Patient’s experience, effectiveness of care coordination, prevention, and health outcomes of at-risk populations

29. Infrastructure Development • Expand health access • Primary, specialty, behavioral health, substance abuse • Enhance HIE/HIT • Focus: performance improvement and reporting capacity • Implement/expand telehealth • Develop a patient-centered Medical home model infrastructure • Enhance Public Health Preventative Services • Implement a Disease Management Registry

30. Program Innovation & Redesign • Strategies to impact Potentially Preventable Events • Mechanisms to test provider financing models • Health promotion and disease prevention models • Innovations in provider training and capacity • Behavioral/Substance Abuse care models • Telehealth Innovations • Strategies to reduce inappropriate Emergency Department use • Supportive care models

31. Quality Improvements • Congestive Heart Failure • Asthma • HIV • SCIP • Healthcare-acquired Infections • Perinatal Outcomes • PPA/PPR • Emergency Care • MDROs/CDI • Facility-acquired pressure ulcers • Birth Trauma

32. Population-focused Improvements • At-risk populations • Preventive Health • PPAs/PPRs • Patient-centered health care • Cost Utilization • Emergency Department

33. DSRIP Project Vision Aim and Outcome Secondary Drivers Primary Drivers Improved access to behavioral health services through technology assisted services and enhanced service availability. Care Access Patient Engagement (HCAHPS) Patient Satisfaction (HCAPHPS) Care Experience Deliver better health and improved care At lower costs Early Intervention Services Appropriateness of Care Care Utilization Evidenced-based care Care Coordination Efficiency of service delivery Care Quality Preventative Services Educational Services Human Behaviors Collaborate with community partners Expand residency training slots Expand behavioral health workforce Develop training plan and curriculum Workforce Transformation Measurements • 30 day readmission rates for behavioral health/substance abuse. • Admission rate for behavioral health /substance abuse.

34. Proposed Process & Timeline • May 14th – June 1st • County meetings with IGT entities and health care providers to identify top 3 priorities • June 11th • Community priorities consolidated and DSRIP Projects selected • June 25th • Estimated cost of DSRIP projects made available • July 13th • Determine IGT available and health care providers participating • July 23rd • Draft RHP Plan available for local review by RHP participants • August 1st • Final plan posted for public comment (due to HHSC September 1st)

35. Who should participate? • Local Government Partners • Hospitals with significant Medicaid utilization • Other providers with significant Medicaid utilization • Academic Health Science Centers • Regional Public Health Directors • County Medical Associations/Societies • Children’s Hospitals

36. Next Steps • TAMHSC • Schedule county meetings • Assemble data by community • Email community data, assessment summaries, and full DSRIP menu to county meeting participants • Work with IGT Entities to finalize governance structure and IGT/BVCOG to define fiscal agent role/responsibilities • IGT Entities/Health Care Providers • Send contact information to alaniz@tamu.edu • Review data, assessment summaries, DSRIP menu • Identify top 3 health priorities by community