DY 7-8 CAT C Measure Bundles Hospitals & Physician Practices

What Approach do you plan on taking? Keep the Trains Running Zero-based Bundling Or both? If providers select outcome measure bundles that do not align with the current DSRIP project, that doesn’t mean the project must end

Have you Defined your System? System is defined by the location(s) where your patients are served and the types of services your patients are receiving. Universe of Patients TPI doesn’t matter CAT C Measures naturally limit Required vs. Optional FAQ: CAT B – System Definition and PPP

RHP12 Hospitals & Physician Practices Minimum Point Thresholds (MPTs) Performing Provider Name DY7 Maximum Total Performing Provider Valuation Minimum Point Threshold (MPT) Preferred Hospital Leasing Muleshoe Inc $250,000 1 Hemphill County Hospital District Lynn County Hospital District Plains Memorial Hospital DSH Acct (Castro County) Preferred Hosp Leasing, Inc. dba Collingsworth Gen Parmer County Community Hospital Lockney Gen Hosp Dist (W.J. Mangold Mem Hosp) $323,698 Hansford County Hospital District $338,691 Ochiltree General Hospital $373,302 Swisher Memorial Healthcare System, dba Swisher Me $435,083 Lamb Healthcare Center $516,472 Seminole HD of Gaines Co dba Memorial Hospital $531,463 Moore County Hospital District dba Memorial Hospit $628,959 Yoakum County dba Yoakum County Hospital $832,691 2 Lubbock Heritage Hospital dba Grace Medical Center $910,884 Dallam-Hartley Counties Hosp District dba Coon Mem $921,373 Medical Arts Hospital $959,477 Terry Memorial Hospital District Brownfield Region $1,000,678 Prime Healthcare Services - Pampa, LLC dba Pampa R $1,167,049 Childress County Hospital District dba Childress R $1,276,649 3 Deaf Smith County Hospital District dba Hereford R $1,353,898 Baptist St. Anthony's Health System $1,426,984 D. M. Cogdell Memorial Hospital (Scurry County) $1,815,289 4 Lubbock Regional MHMR Center dba Sunrise Canyon Ho $2,439,626 5 Methodist Children's Hosp dba Covenant Children's $3,943,820 8 Texas Tech University Health Sciences Center AMA $5,470,479 11 UHS @ Amarillo Inc dba Northwest Texas Healthcare $5,909,771 12 GPCH LLC dba Golden Plains Community Hospital $7,458,360 33 Texas Tech University Health Sciences Center Offic $8,934,008 18 Covenant Health System dba Covenant Medical Center $19,144,099 38 Lubbock County Hospital District dba University Me $31,558,946 63 Totals 101,171,748 226 31 Providers 29 Hospitals 2 AHSC Physician Practices 22 or 71% less than 3 MPTs

Category C Measure Bundles 23 Total Bundle Options 2 High State Priorities Maternal Pain Management 8 State Priorities

Category C Optional & Required Measures Some optional without points – Why Chose? Spread risk Ones with points are not impacted by state multipliers Limitations K1 & K2 can only be selected by hospitals with a valuation <=2.5M Providers >2.5M must select bundle with 3 point measure or optional 3 point selection Optional Measures that add points cannot add points if it duplicates a measure in another selected bundle H3 & B1 H3 & Ks B1 & K2 C1 & K1

Minimum Volume Denominator Definitions Significant - =>30 MLIU (exception can be requested to use all payer w/ good cause) Insignificant – <30 MLIU but greater than 0 (unless an exception approved) No Volume – MLIU = 0 Who to include in your MLIU? Medicaid = Medicaid Fee-for-Service, Managed Care & Dual. Also include wrap-around or secondary coverage Low Income = CHIP and any patient you have documentation of income below 200% FPL (self attestation included) Uninsured = Self Pay

Minimum Volume Denominator Requirements Significant Volume (=>30) for at least ½ of required measures Optional can ONLY be selected if MLIU denominator has significant volume (=>30) Required Measures Insignificant Volume – NO “Achievement” valuation NO Volume – Measure Removed, No Valuation

Eligible Denominator Population Measure Settings Primary Care Urgent Care BH IP BH OP ED Hospice Hospital OB Dental Clinic OP Specialty Care (can be further refined for applicable measures) Active Patient Definition Primary Care = 2 visits in 12 month measurement period and/or 1 visit in measurement period and 1 visit in 12 months prior OP Specialty = Defined by Performing Provider in RHP plan All Other Settings NOT allowed to be limited by active patient NOTE: Active Patient Definition is different for Category B

Selecting Outcome Measure Bundles Choose possible Bundles depending on the approach you decide to take Evaluate all outcome measures within the bundle Required Optional w/points Optional without points Is data available to produce a baseline for calendar year 2017? See Specs Does the bundle ALIGN with other quality programs or strategic priorities? Organizational, Provider, Medicaid MCO or other Is there room to improve? What is the likelihood of achieving improvement? *Must have at least ½ w/significant volume *Must have significant volume to select optional Must report All-Payer, Medicaid-Only, & LIU-Only to be eligible for reporting milestone (unless approved exemption)

After Measure Bundle Selection CAT A, B & D Requirements Valuation Submit new RHP plan January 31st 2018

DSRIP Funding Distribution Item DY7 DY8 RHP Plan Submission 20% NA Category A – Required Reporting 0% Category B- MLIU PPP 10% Category C – Measure Bundles & Measures 55 or 65% 75 or 85% Category D – Statewide Reporting Measure Bundle 5 or 15%

Structure & Basis for Payment Category B–MLIU PPP Payment 100% w/allowable variation 100% 90-99% (or 100% less allowable variation as upper limit) 90% 75-89% 75% 50-74% 50% <50% 0% Category C – Measure Bundles DY Innovative Measure (P4R) P4P P4P delayed baseline DY7 100% RY1 reporting 25% baseline Reporting 25% PY1 reporting 50% DY7 goal achievement 50% goal achievement DY8 100% RY2 reporting 25% PY2 reporting 75% DY8 goal achievement 75% DY8 goal achievement Category C-Measure Bundles Payment 100% =>75% 75% =>50% 50% =>25% 25% <25% 0%