RHP 12 DY 7-8 Planning Session

Agenda Update on RHP Updated Plan & Submission Update on DY7-8 APPROVED Protocols Strengthen the measure sets Define & Incorporate an attribution model Proportional distribution of Category C Accountable performance measurement and payment methodology for providers with high baselines Link core Activities to Selected Measure Bundles & Cat C

Submission of RHP Plan Update February 8, 2018 – HHSC releases RHP Plan Update Template & Hosts a webinar February 28, 2018 20% of DY7 funding payment in July Submission of CAT C baselines in April, payment in July (if approved) April 30th, 2018 Submission of CAT C baselines in October, payment in January (if approved)

RHP Plan Update – Performing Provider Requirements Definition of the Performer’s system Description of performer’s core activities for DY 7-8 – Drivers & Change Ideas (driver diagrams) Performer’s Category B MLIU Patient Population by Provider (PPP) baseline Selected Category C Measure Bundles or Measures Requests for allowable changes to those measure bundles and measures as described in PFM Description of the transition of the performer’s DY 2-6 projects to its selected Category C Measure Bundles or measures. Performer’s Category D Statewide Reporting Measure Bundle Performer’s DSRIP valuation amounts IGT details by DY & Category

5 Areas of CMS Concerns Addressed 1. Strengthen the Measurement Set Population Based Clinical Outcomes Maternal Care Bundle split into two bundles 2. Define and Incorporate an attribution model All Measures based on DSRIP attributed population No More Measure Settings – Now each Measure has a target population your provider system is accountable for improvement of 3. Proportional distribution of Category C Limited Range updated to .75-1.25 of Category C valuation No 3 Point Clinical Outcome or 4 Point Population Based Clinic Outcome can not be increased Innovated measures limited to 50% of other measure valuation Valuation changes greater than 1% will require justification

5 Areas of CMS Concerns Addressed 4. Accountable performance measurement and payment methodology for providers with high baselines Continued Improvement for high baselines – NO option for maintenance IOS – No New HPLs – Goal remains at perfect (0 or 100%) 5. Link Core Activities to Selected Measure Bundles and Category C Narrative fields of drivers and change ideas as part of description

Strengthen the Measure set Measure Bundle Menu – pg. 24 LHD & CMHC’s did not change Review – A1, C1, K1 & K2 As a Reminder, standard baseline is CY2017 with some allowable exceptions for shortened and delayed baselines. For measures where provider does not have six or twelve months of data that align with CY2017, providers should consider the following in order of preference: A Baseline numerator of 0 for measures that are eligible Manual chart review and sampling (Sampling instructions in Spec Introduction) Approximate specifications for measures that require specific kind of assessment (ex: foot Exam, use comparable exam for baseline only) Delayed Baseline

Define and Incorporate an Attribution Model Measure Bundle Protocol – pg. 20 Eligible Denominator Population Steps 1-4 Step 1 – Determine the DSRIP attributed population – the target population (or pool) for accountability under the DSRIP incentive program – using the prescribed attribution methodology (pg.22 measure bundle protocol) Step 2 – Determine the individuals from step one that are included in the measure bundle or measure target population (Refer to Appendix A - Measure Bundle Target Population and Measure Specifications) Step 3 – Determine the individuals from the measure bundle target population that meet the measure specific denominator inclusion criteria (Refer to Appendix A - Measure Bundle Target Population and Measure Specifications) Step 4 – Determine payer type for individuals or encounters in the denominator following standardized specifications to determine the all payer, Medicaid, and uninsured rate for each measure Population Based Clinical Outcomes = Step 1 ONLY Clinical Outcomes and Process Measures = Step 1-4

Proportional distribution of Category C Attachment J – Program Funding & Mechanics (PFM) pg. 16-20 Measure Bundle Example: Total CAT C valuation = 500,000 3 Pt Measure Total Points % of Total Points Base Valuation Max Valuation (1.25) Min Valuation (.75) Yes 20 .5263 263,158 328,947 197,368 12 .3157 157,895 118,421 No 6 .1578 78,947 59,211 Total 38 1.00 500,000

Proportional distribution of Category C Measure Example: 20 Points from previous example Max valuation (requires justification)=328,947 4 Measures, 1 innovative Innovative = 328,947/(4-.5) divided by 2 Standard = 328,947/(4-.5) NOTE: This is example for Significant Volume ONLY Measure Valuation 1 93,985 2 3 4 46,992 Total 328,947

Accountable performance measurement and payment methodology for providers with high baselines Attachment J – Program Funding & Mechanics (PFM) pg. 24

Link Core Activities to Selected Measure Bundles and Category C More to come when we receive the HHSC RHP Plan Update template

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