Region 15 Regional Healthcare Partnership 6th Public Meeting Wednesday, September 26, 2012 University Medical Center of El Paso Anchor Hospital

Confirmation of Participants Role Call

UMC Projects Refer to RHP Website DSRIP Projects Parallel Universe Projects Questions Next Steps

HHSC Webinar Updates RHP Planning Protocol Webinar 9/25/12 Project options Continuous Quality Improvement QI Milestones are included with each project that requires QI under Process Milestones. For example, for Project 1.3 Implement a Chronic Disease Management Registry you can find these process milestones on pg 35 starting with P-12 – P-14 Category 3 – 13 Outcome Domains (OD) 1 stand alone measure 1 stand alone measure and 1 non-stand alone measure 3 non-stand alone measures Or create a measure that meets the definition of ‘outcomes measure’ Or To Be Determined TBD We will report on Category 3 Measures on an annual basis Category 4 – 5 Required Reporting Measures One was just added as optional – Adult or Child Core Measures for CHIP/Medicaid Population Non-Hospital Performing Providers – No Category 4 Reporting Requirements

HHSC Webinar Updates RHP Plan Template Webinar 9/26/12

Final DSRIP Menu Category I Project Areas Expand Primary Care Capacity Increase Training of Primary Care Workforce Implement a Chronic Disease Management Registry Enhance Interpretation Services and Culturally Competent Care Collect Valid and Reliable Race, Ethnicity and Language (REAL) Data to Reduce Disparities Expand Access to Urgent Care and Enhance Urgent Medical Advice Introduce, Expand, or Enhance Telemedicine / Telehealth Increase, Expand, and Enhance Dental Services

Final DSRIP Menu Category I Project Areas (cont.) Expand Specialty Care Capacity Enhance Performance Improvement and Reporting Capacity Implement technology-assisted services (telehealth, telemonitoring, telementoring, or telemedicine) to support, coordinate, or deliver behavioral health services Enhance service availability (i.e., hours, locations, transportation, mobile clinics) to appropriate levels of behavioral health care Development of behavioral health crisis stabilization services as alternatives to hospitalization. Develop Workforce enhancement initiatives to support access to behavioral health providers in underserved markets and areas (e.g., psychiatrists, psychologists, LMSWs, LPCs and LMFTs)

Final DSRIP Menu Category II Project Areas Enhance / Expand Medical Homes Expand Chronic Care Management Models Redesign Primary Care Redesign to Improve Patient Experience Redesign for Cost Containment Implement Evidence-based Health Promotion Programs Implement Evidence-based Disease Prevention Programs Apply Process Improvement Methodology to Improve Quality / Efficiency Establish / Expand a Patient Care Navigation Program Use of Palliative Care Programs Conduct Medication Management

Final DSRIP Menu Category II Project Areas (cont.) Implement / Expand Care Transitions Programs Provide an intervention for a targeted behavioral health population to prevent unnecessary use of services in a specified setting (i.e., the criminal justice system, ER, urgent care etc.) Implement person-centered wellness self-management strategies and self directed financing models that empower consumers to take charge of their own health care Integrate Primary and Behavioral Health Care Services Provide virtual psychiatric and clinical guidance to all participating primary care providers delivering services to behavioral patients regionally Establish improvements in care transition from the inpatient setting for individuals with mental health and / or substance abuse disorders Recruit, train and support consumers of mental health services to provide peer support services Develop Care Management Function that integrates primary and behavioral health needs of individuals

Sample Project Milestones and Metrics Choose Category 1 or 2 Choose Project within that Category Choose Project Option Include all elements from RHP Plan DSRIP Narrative Section (pg 7-15)

Category 1 and 2 Process Milestones Choose minimum of One Process Milestone for the first two years (you can choose more) P-1, etc. You must choose the metric associated with the chosen process milestone to assess or implement within the first two years. P-1.1, etc. You can also keep process milestones through the 4 years if you want (not sure if that’s beneficial)

Category 1 and 2 Improvement Milestones Choose minimum of One Improvement Milestone for the last two years (you can choose more) I-1, etc. You must choose the metric associated with the chosen improvement milestone to assess or improve upon in the last two years. I-1.1, etc. You can choose the same measure and metric to improve more upon in the last year.

Category 3 Process Measures to fit with Category 1 and 2 Projects In years DY 2 and DY3, we must choose a Category 3 Process Milestone for each project and provide a narrative of goals and rationale: Category 3 Process Milestones: P-1 Project Planning – engage stakeholders, identify current capacity and needed resources, determine timelines and document implementation plans P-2 Establish Baseline Rates P-3 Develop and Test Data Systems P-4 Conduct PDSA Cycles to Improve Data Collection and Intervention Activities P-5 Disseminate Findings, including Lessons Learned and Best Practices, to Stakeholders P-7 Other activities not described above These Milestones may be redundant / complimentary to Category 1 and 2 Milestones

Category 3 Improvement Measures or Outcomes Domains to fit with Category 1 and 2 Projects Outcome Improvement Targets DY4 and DY5 Outcomes/Improvement Targets: OD-1 Primary Care and Chronic Disease Management OD-2 Potentially Preventable Admissions OD-3 Potentially Preventable Readmissions (30 Day Readmission Rates) OD-4 Potentially Preventable Complications and Health Care Acquired Conditions OD-5 Cost of Care OD-6 Patient Satisfaction OD-7 Oral Health OD-8 Perinatal Care OD-9 Right Care in Right Setting and Patient Centeredness OD-10 Functional Status OD-11 Health Disparities OD-12 Primary Care and Primary Prevention OD-13 Palliative Care Can also Propose Outcomes not included in the list, i.e. outcomes that fit the ‘outcomes definition’ Improvement Targets can also start in earlier years

Category 4 Reporting Measures Hospital Performing Providers Only Pay for Reporting 5 Required Domains: RD-1 Potentially Preventable Admissions (PPA) RD-2 30 Day Readmissions RD-3 Potentially Preventable Complications (PPC) RD-4 Patient Centered Healthcare RD-5 Emergency Department 1 Optional Domain Initial Core Set of Health Care Quality Measures for Children (CHIP) or Adults (Medicaid) eligible

Performing Provider Workbooks Walk-through Questions

UC Tool Due 10/26/12 to HHSC Walk-through Questions

Medicaid Waiver Timelines As of 9/24/12, HHSC has formal approval from CMS for: PFM Protocol RHP Planning Protocol RHP Plan Template As of 9/25/12, the final UC Tool was released for Provider Input Due to HHSC 10/26/12 Two weeks after approval – IGT Entities and Private Hospitals submit their final Chapter of Projects to Anchor – Due to Anchor 10/12/12 October 31, 2012 – Submit RHP to HHSC (4 year plans) December 15, 2012 - CMS completes review RHPs returned for revisions during the 30 day period January 15, 2013 - Revised RHP Plans to CMS February 1, 2013 - CMS Final Decision

Roundtable

Contact Information Waiver Website & Email Address: http://www.hhsc.state.tx.us/1115-waiver.shtml TXHealthcareTransformation@hhsc.state.tx.us UMC Website: http://www.umcelpaso.org Region 15 - RHP Paso del Norte Blue Ribbon Committee Needs Assessment: http://www.elpasotexas.gov/health/_documents/BRCGapBook.pdf