Region 15 Regional Healthcare Partnership 40th Public Meeting

1. Region 15Regional Healthcare Partnership40th Public Meeting Wednesday, january 25, 2017 University Medical Center of El Paso Anchor Hospital Texas tech university health sciences center – Medical Education Bldg (MEB) – Rm 1150

2. Confirmation of Participants Roll Call • University Medical Center of El Paso • Texas Tech University Health Sciences Center at El Paso • El Paso Children’s Hospital • Hospitals of Providence (Tenet) • Las Palmas – Del Sol Hospital (HCA) • El Paso Health Department • Emergence Health Network • El Paso Medical Society • Visitors • MCOs

3. ANCHOR UPDATES Cathy Gibson Anchor RHP 15 • Waiver Extension • Waiver Renewal • Cat 3 Workbook • Cat 3 Corrections • Timeline

4. ANCHOR UPDATES • Category 3 Workbook and Goal Calculator • Has been updated (Data thru DY5 reporting) • Includes Myers & Stauffer updates • Does not include NMI data just submitted

5. ANCHOR UPDATES • Category 3 Interim Corrections • DY6 R1 Cat 3 Interim Corrections Template now posted • Criteria for this is in the Category 3 Summary Documents online • Due Feb 19th (if any)

6. ANCHOR UPDATES • Waiver Extension • HHSC will be submitting to CMS soon • Requesting an additional 21 months of LEVEL FUNDING • UC and DSRIP pools • Continuation of the Managed Care Provisions in the 1115 Waiver • Initial 15-Month (thru September 30, 2019)

7. ANCHOR UPDATES • Waiver Renewal • Longer Term • HHSC working on Program Funding and Mechanics (PFM) protocol DRAFT • Specific to DY7 ONLY (at this time) • HOWEVER will lay groundwork for up to 4 additional DYs • To be proposed in May 2017; Effective: September 2017 • Anchor summit on February 6th • Encourage stakeholder feedback on DRAFT proposal (when released)

8. TIMELINE • January 13, 2017 • DY5 Oct DSRIP payments processed for hospitals • January 16, 2017 • 11:59 pm Responses due to HHSC for NMI requests. • January 31, 2017 • DY5 Oct DSRIP payments processed for all other providers • February 24, 2017 • HHSC/CMS approve or deny NMI requests

9. REGIONAL Project review

10. Outcome improvements – RHP 15 • 15 possible domains

11. RHP 15 Projects

12. NEW REGIONAL learning collaboratives • DIABETES LEARNING COLLABORATIVE • Chair: Moses Priego – UMC • mpriego@umcelpaso.org • BEHAVIORAL HEALTH LEARNING COLLABORATIVE • Chair: Cindy Hernandez – HER • chernandez@ehnelpaso.org • HEALTH DATA EXCHANGE COLLABORATIVE • Chair: Rosie Sanchez – TTUHSC • rosie.sanchez@ttuhsc.edu

13. Key Aspects of collaboratives • Focus on Closing the gap of a known problem with known solutions • Use Standard Model for this work • Must be Fast Paced with timeline for goals • Must use Standard Measures • Working Membership • Sharing of ideas and data is required • “All Teach, All Learn” philosophy

14. DY6 MILESTONES (REVIEW) Oscar Perez DSRIP Program Manager • Quantifiable Patient Impact (QPI) – Category 1 and 2 • Total QPI (Reportable in DY6 R1) • MLIU QPI (Reportable in DY6 R1) • Core Component Reporting • (Not Reportable until DY6 R2) • Sustainability Plan • (Not Reportable until DY6 R2) • Category 3 and 4 • (previous rules apply) • Previous Carry Forwards

15. Sustainability Plan • “How does the institution plan to keep this project going when the DSRIP dollars are gone?”

16. Beginning the process … DY6 Sustainability Planning

17. Levels of Evaluation • PROJECT LEVEL • Collaboration with Medicaid Managed Care • Value Based Purchasing/Alternative Payment Models • Other Funding Sources • Project Evaluation • Health Information Exchange • PROVIDER LEVEL • Collaboration with Medicaid Managed Care • Health Information Exchange

18. Assess Project’s Sustainability Potential • Collaboration with Medicaid Manage Care • Value Based Purchasing/ Alternative Payment Models • Other Funding Sources • Project Evaluation • Health Information Exchange

19. Collaboration with Medicaid Managed Care List those enrolled as a network provider • If NOT enrolled – Why NOT? APM – Alternative Payment Model VBP – Value Based Payment Methodologies APM/VBP Arrangements? • Encounter reporting? • Tracking of Services? Cost of Services? • Incentives Earned? • What is working? What is NOT working? If NOT doing APM/VBP – Why NOT?

20. Collaboration with Medicaid Managed Care • Are MCO members being referred to your project? Why? Why NOT? • Are Services of the project NOT billed to Medicaid (for MCO members)? Give Type of Service & Billing Code • Are other non-Medicaid payers billed for Services of the project?

21. APM/VBP Methodologies FFS (Fee for Service) + Incentive and/or Disincentive Component? DRG (Diagnosis Related Group) + Incentive and/or Disincentive Component? Partial Capitation? Full Capitation? Bundled Payment? Episode Payment? "Non-financial Incentive (i.e. administrative relief, preferential provider status)“? Supplemental Payments? Shared Savings/Risk?

22. Value Based Purchasing/ Alternative Payment Models • Discussing with MCO potential for payment for DSRIP services via APM/VBP methodology? • If yes, what is being discussed? If no, WHY not? • APM/VBP Arrangements with NON-Medicaid payers? • If yes, who? And what are terms?

23. Other Funding Sources • Does the project have other funding sources? • Grant funding? • Insurance Payments? • Is the project pursuing agreements with other government agencies? Why NOT? • City, County, School Districts, etc... • Foundations? • Other Organizations?

24. Project Evaluation • Cost-benefit analysis, Return-on-investment analysis or Other quality related evaluation of this project • Aspects of the Project to evaluate • Evaluation Methodology (described) • Quality Outcomes evaluated • Positive Impact (based on formal or informal evaluation) • Assets • Successes • Outcomes • Improvements

25. Project Evaluation Areas for Improvement • Barriers to success • Remaining Needs • Unmet Goals Adjustments to the project • Already implemented OR • Being considered Cost Effectiveness • How is it evaluated and explored? **In the context of CONTINUING the intervention (project) Replicable • Other states? • Other providers? Key to Project Success • Identify

26. Health Information Exchange • Does project exchange health-related information between/among individuals/ organizations? • Who is exchanging data? • What type of data is being exchanged? • Claims Data • Clinical Data • Case Notes • Other

27. Health Information Exchange Describe data being exchanged What systems are used to exchange the data? Is it “real-time” data? • If lags, what is the lag time? • Actions being made to reduce lag time? Obstacles to exchange of health related data: • Contract agreement(s) (too burdensome)? • Inadequate Technology? • Technology too costly? • Project does not require data transfer? • Other? • Are there ACTIONS to overcome these obstacles? Formal HIEs being used on this project? • Why NOT?

28. Input/comments on proposed sustainability PLANning Oscar Perez DSRIP Program Manager • Go to your Browser or Cell Phone: • http://pollev.com/oscarperez394 • OR • Text: OSCARPEREZ394 • To: 22333 • To join the session

29. STAKEHOLDER’s FORUM • To be scheduled early summer 2017 • FOCUS • Discuss Waiver Renewal • Share Successes and Challenges of the DSRIP Projects • Discuss Community Health Needs Assessment • IDEAS being solicited for format and location

30. ROUNDTABLE

31. Contact Information • NEW Waiver Website: • https://hhs.texas.gov/lawsregulations/policiesandrules/Medicaid1115waiver • Waiver E-Mail: • TXHealthcare Transformation@hhsc.state.tx.us • UMC RHP15 Website: • http://www.umcelpaso.org • Region 15 - RHP

32. Next Meeting: February 22, 2017 1:00pm Texas Tech (MEB)

33. Cat 1 and 2 Requirements (Milestones) • Standardized for ALL projects Four (4) Total Milestones 2 Quantitative 2 Qualitative • 1. Total QPI Value is 25% • 2. MLIU QPI Value is 25% • 3. Core Component Report Value is 25% • 4. Sustainability Plan Value is 25%

34. MLIU – Medicaid low income uninsured • To qualify as MLIU QPI • Enrolled in Medicaid • at the time of at least one encounter during the DY • Qualified as Low-Income or Uninsured • Below 200% of Federal Poverty Level (FPL) OR • at the time of at least on encounter during the DY • Uninsured • at the time of a separate encounter during the DY • If patient was on Medicaid and then became Low-Income or Uninsured during the DY • Counted as “Medicaid” for DSRIP purposes • Either • Individuals Served OR • Encounters Provided • Stipulated by the project

35. Milestone 1: Total QPI • HHSC will determine the target • Same as DY5 (TOTAL QPI Goal) • May request variance from HHSC (TBD)** • Grouping must be same as DY5 • No changes • Pre-DSRIP baselines remain the same • No changes • Carry Forward IS allowed

36. Milestone 2: MLIU QPI • If project had MLIU goal in DY5 • DY6 goal is same as DY5 goal • Pre-DSRIP baseline stays same • If project had no MLIU goal in DY5 • DY6 is • Pre-DSRIP QPI x %MLIU (DY3 or earliest on record) • EXAMPLE • MLIU QPI MAY BE PFP OR PFR • Projects in Project Area 1.9.* • % MLIU Not Achieved in DY3, DY4, DY5 • Identified by HHSC and notified

37. Milestone 3: Core Component Reporting • Based on Project Option • Each Core Component must be addressed • Usually 3 or more of these • ALL have a Continuous Quality Improvement (CQI) Element • EXAMPLE