Region 15 Regional Healthcare Partnership 40th 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

Confirmation of Participants 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 Roll Call

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

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 ANCHOR UPDATES

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) ANCHOR UPDATES

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) ANCHOR UPDATES

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) ANCHOR UPDATES

TIMELINE January 13, 2017 January 16, 2017 January 31, 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

REGIONAL Project review

Outcome improvements – RHP 15 15 possible domains

RHP 15 Projects

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

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

DY6 MILESTONES (REVIEW) DSRIP Program Manager Oscar Perez 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 Category 3 and 4 (previous rules apply) Previous Carry Forwards

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

DY6 Sustainability Planning Beginning the process …

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

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

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?

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?

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?

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?

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?

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

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

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

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?

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

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

ROUNDTABLE

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

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

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 3. Core Component Report 4. Sustainability Plan

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

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 Carry Forward IS allowed

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

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 2.9.1 A,B,C,D,E A Identify frequent ED users and use navigators as part of a preventable ED reduction program. Train health care navigators in cultural competency. B Deploy innovative health care personnel, such as case managers/workers, community health workers and other types of health professionals as patient navigators. C Connect patients to primary and preventive care. D Increase access to care management and/or chronic care management, including education in chronic disease self‐management. E Conduct quality improvement for project using methods such as rapid cycle improvement. Activities may include, but are not limited to, identifying project impacts, identifying “lessons learned,” opportunities to scale all or part of the project to a broader patient population, and identifying key challenges associated with expansion of the project, including special considerations for safety‐net populations.