 Regional LC Summary & Feedback  Focused Cohorts  DSRIP in Action Update  Reporting Sessions  Waiver Updates

 A big “Thank You” to all who attended our May 4 th LC Event  We had 83 Participants  28 Provider Partners Represented

 Takeaway: Overall Event was a success EvaluationsSatisfied – Very satisfied Neutral- Dissatisfied Total Surveys Overall Satisfaction with LC 97%3%39 Overall satisfaction with format of event 90%10%39 Overall satisfaction with provider project presentations 100%0%39 Overall satisfaction with speakers97%3%39 Overall Satisfaction with poster presentations 97%3%39 Overall satisfaction with content of LC event 97%3%39

 We truly appreciate your Feedback. ◦ 40 comments received  This is what we heard from you: ◦ TOO Noisy – Peer to Peer will be separated out at future events. ◦ You like hearing from HHSC ◦ You learned everyone has similar barriers and obstacles. ◦ Keep providing direction of program, support, and requirement…..

1 st place: StarCare- Lubbock “Psychiatric Crisis Center”

2 nd place: Poster winner! 2 nd place: Poster winner! University Medical Center “Conduct Medication Management”

 Lisa Barrington, MSN, RN, Process Excellence Manager, UMC Health System kicked off the Behavioral Health and Potentially Preventable Readmissions  Presentation: ◦ Objectives: The Why behind Quality Improvement ◦ Systems: Every system is perfectly designed to achieve exactly the results it gets. ◦ Quality and Cost ◦ Timeline of Cohorts ◦ Performance Improvement Methodologies: ◦ Goals Plan, Do, Check, Act A3 Problem Solving Plan/Analyze Problem/Identify Causes SMART Goals Specific Measureable Agreed Upon Realistic Time Phased

RHP12 Celebration For those who could not attend you were missed! Lot’s of fun, food and laughter were enjoyed by all!

DSRIP in Action DSRIP in Action On March 30 th West Texas Centers MHMR in Big Spring hosted a DSRIP in Action event for our region. We had16 attendees from 10 different regional provider locations join us for the event.  Project Highlights:  Tele-Medicine project was presented by Landon Sturdivant, MPA, LBSW, Chief Operating Officer, West Texas Centers.  BH & Primary Care Integration was presented by David Gutierrez, Director of Administrative Programs, West Texas Centers.

 Service Area:  23 counties/ 25,034 square miles/ 217,135 population/11% of the land mass of TX/ 1% of population of TX /8.7 persons per square mile Regional Health Care Partnerships regions include RHP12, RHP14, RHP13 and RHP11  Challenges: Large Geographical Service Area/Limited or no local provider/Limited or no public transportation/Limited tele-communications technology  Solutions: Develop a Tele-Psychiatry System of Care Purchased first Telemedicine equipment in March 2000 Purchased new hardware technology which included laptops, switches, routers and camera Purchased Software-Lifesize-ClearSea Expanded Network IT Connections Contracted Additional Providers Increased Access to Care Have providers throughout the US from coast to coast Benefits: Eliminated Waiting list/Expanded Services within the local jails/Expanded system of Providers Across the Nation/Increased access to Psychiatric Care Next Steps: Expand Tele-Psychiatry into Local Emergency Rooms/Expand tele-Psychiatry Services with Community Partners/Expand Contracts with MCS’s for Tele-Psychiatry, Expand Tele-Psychiatry Sevices in Jails/Expand Primary/BehavioralHealthcare integration through Tele Psychiatry

 Goal: To provide on-site access at Scenic Mountain Medical Center to behavioral health care while facilitating more opportunities to address both the physical and mental needs of the consumer. This will result in behavioral health providers sharing the same facility, having some systems in common, participating in regular fact-to-face communication and functioning with primary care providers in team approaches to patient care.  Project Goals: DY4: of the 425 persons served by Howard County Mental Health Clinic/Center, 72 of persons will be receiving care at the new location utilizing this project’s integrated health care processes and model to include treatment plans developed and implemented with primary and behavioral health care expertise. DY5: Of the 425 persons served by Howard County Mental Health Clinic/ Center, an increase from 72 to 144 persons will be receiving care at the new location utilizing this project’s integrated healthcare processes and model to include treatment plans developed and implemented with primary and behavioral healthcare expertise.  Challenges: Lease agreement/Hospital-Community Health Systems(TN)/Clinic-City of Big Spring/Construction/Stigma/Shared Spaces Successes: Doors opened July 2014/both Behavioral Health and Physical Health Care occur at the same location and in some cases the same day. Increased diversion from emergency department and potential incarceration/law enforcement involvement. Better communication between providers with enhance coordination of care, Increased consumer satisfaction

Looking forward…… DSRIP in Action: June 29 th - Plains Memorial Hospital –Castro County, Dimmitt, TX Cohorts: June 21 st - Touch Point Conference Call July 14 th - Mid Project Meeting- Face to Face (location to be determined) Aug. 18 th - Touch Point Conference Call Sept.28 th Update at Learning Collaborative RHP12 Regional Learning Collaborative: Sept. 28 th - University Medical Center

Bobbye Hrncirik

 June 8 – HHSC will complete the initial reporting review and distribute reporting results including NMI metrics  June 17 - Updated IGT file sent to UMC/anchor  July 1 – IGT settlement date for April reporting DSRIP payments.  July 6, 11:59pm –April NMI Responses to HHSC  July 29 - April reporting DY4 DSRIP payments processed for all providers and DY5 DSRIP payments processed  August 5 – HHSC will complete NMI Reporting Review and distribute reporting results.

 Preliminary results of Cat 1 & 2 validation audits are currently being reviewed by HHSC  Communication regarding possible recoupments will come from HHSC (in June) and providers will have an opportunity to respond prior to the initiation of a recoupment.  Cat 3 performance reviews are forthcoming

 Last week Myers & Stauffer sent out another round of request for CAT 1 & 2 Validation audits.  Below is a list of RHP 12 providers who received M&S request: Sunrise CanyonNorthwest Central PlainsUMC WJ MangoldCovenant Texas PanhandleStar Care City of Amarillo

 As you know, CMS approved a 15-month extension of the waiver (Oct 2016-Dec 2017)  The 15-month extension does not equal a 15-month year  10/1/2016-9/30/2017 – Report Annual Metrics  10/1/ /31/2017 – Prorated (method is WIP)  CMS prefers to maintain current Cat 1-4 structure  CAT 3 will remain Pay for Performance – gap closure structure to follow  No Performance Bonus Pool at this time  No required Medicaid IDs

 Planned Next Steps proposal to CMS: ◦ MLIU QPI metric for all projects in DY6. P4P or P4R depending on current project requirements or notification by HHSC. ◦ Sustainability plans in DY6 using a template  Proposed elements include working with MCOs, collaborating with other community partners, participating in local HIE, project evaluations, etc.  HHSC continues to work with CMS on DY7 plans.

 HHSC Plans to: ◦ Submit a proposal for Transition Year (DY6) Protocol to CMS in early summer 2016 ◦ Submit the revised DSRIP protocols for DY7 replacement projects in the fall 2016; and ◦ Complete protocols and metrics for DY7 continuing projects by January 2017  HHSC will submit high-level proposals to CMS for consideration on an ongoing basis

 CMS is requiring us to submit a report related to the UC & DSRIP pools and how they interact with the Medicaid shortfall and what UC would be if Texas opted to expand Medicaid ◦ Health Management Associates is completing the study ◦ Draft due July 15 th, 2016 ◦ Final due August 31 st, 2016  CMS & HHSC must agree on the size of the UC pool & DSRIP structure by the end of No Agreement equals ◦ DSRIP phase down process of 25% each year beginning in 2018 ◦ UC renewed but reduced

 Registration is now open and will close on August 8, 2016  As in previous years, all performing providers in our region have 1 designated in person slot allocated for their organization. ◦ Please let us know who will be attending from your organization or if no one will be attending  HHSC will reallocate additional slots later in the summer. ◦ Please let us know if you would like more than you 1 slot.  For those of you unable to attend in person the summit will be broadcast on the internet