DSRIP Update DY7-DY8 RHP 15 January 31, 2018

1115 Waiver Renewal December 21, 2017 Letter from CMS approving extension of 1115 Waiver Thru September 30, 2022 (DY7 – DY11) Two years (DY7 and DY8) “level funding” (same as DY6) DY9 – 6% reduction DY10 – additional 14% reduction DY11 – zero funding STATEWIDE DY7 DY8 DY9 DY10 DY11 UC Pool $3.1B $2.33B DSRIP Pool $2.91B $2.49B $0

CMS Concerns Measurement Sets Provider Attribution Model Add More Outcome Measures and Bundles Remove bundles and measures that are not specified Provider Attribution Model Assure all providers are included in the denominators Funding within bundles Assure it is distributed proportionally (Changes – PFM 17.o) High Performing (Maximized) Baselines Assure that it is “suitable and accountable” Core Activities and Bundles/Measures Require that providers clearly specify, link and report on these linkages

Protocol Changes DSRIP Protocols Approved - January 19, 2018 Attachment J – Program Funding and Mechanics Protocol (PFM) Attachment R – Measure Bundle Protocol (MBP) On RHP15 Website https://www.umcelpaso.org/about-us/region-15-rhp/documents

Project Level to System Level NEW MODEL

RHP 15 – MPTs and Total Valuations DY7 MINIMUM POINT THRESHOLDS (scale = 1 to 75) El Paso Children's Hospital 1 pt ($541,438) Providence Memorial Hospital 15 pts ($7,554,569) City of El Paso Department of Health 16 pts ($8,229,731) Sierra Providence East Medical Center 17 pts ($8,460,787) Emergence Health Network 31 pts ($15,394,778) Texas Tech University Health Sciences Center El Paso 31 pts ($15,718,716) Las Palmas – Del Sol Medical Center 46 pts ($22,934,877) University Medical Center of El Paso 75 pts ($64,018,220)

Funding Levels by Category DY7 DY8 RHP Plan Update Submission 20% NA Category A - Required Reporting 0% Category B - MLIU PPP 10% Category C- Measure Bundles and Measures 55% 75% Category D - Statewide Reporting Measure Bundle 15%

DSRIP Opportunities for Payment YEAR Category A Category B Category C Category D DY7 Apr BASELINE PPP BASELINE CY17 DY7 P4R DY7 Oct DY7 Core Activities Status DY8 Apr DY7 PPP CY18 P4P Achievement DY8 P4R DY8 Oct DY8 Core Activities DY8 P4R Status DY9 Apr DY8 CY19 P4P Achievement DY9 P4R DY9 Oct DY9 Core Activities DY9 P4R Status DY10 Apr DY9 CY20 P4P Achievement DY10 P4R DY10 Oct DY10 Core Activities DY10 P4R Status

Proposed Timeline February 2nd or 5th February 8th February 23rd RHP Plan Templates Released February 8th Webinar Training on Templates February 23rd Cat A - Core Activities Definition DUE Cat B – System Definition DUE PPP Baselines DUE Cat C - Bundle/Metric Definitions & Valuations DUE February 27th Stakeholder Forum/ RHP Meeting February 28th Submit appropriate templates to HHSC March 2018 Review HHSC Comments Corrections (if needed) April 30th Cat C Baselines DUE to HHSC July 2018 Payment: CF’s from DY6 20% for RHP Plan re-submission 55% for Cat C Baselines 15% Cat D (potential)

RHP Plan re-submission Requirements

RHP Plan Updates “RHP Plan Updates …. will reflect the evolution of the DSRIP program from project-level reporting to provider Core Activities supporting Performing Provider-level outcomes that measure continued transformation of the Texas healthcare system.” Attachment J – Program Funding and Mechanics Protocol Section I.1.

RHP Plan Re-submission RHP Plan Update Organization of RHP including collaborating organizations Updated Community Needs Assessment Stakeholder Engagement Event System Definition(s) Category A Transition of DY2-6 projects to Cat C selections Planned Core Activities for DY7-8 Linkages between Core Activities and Bundles/Metrics Category B Population by Provider (PPP) Baselines Category C Measure Bundle and Metric Selections Learning Collaborative Plan Bundle/Metric Valuation Amounts Signed Certifications from Leadership & IGT entities Templates Providers (YOU) Anchor (ME) Submitted by February 28, 2018

Community Needs Assessment Posted on RHP 15 Website

Stakeholder Forum Include Solicit Stakeholder and Public Input Hospitals and Providers in the Region Public Stakeholders Solicit Stakeholder and Public Input Process for input should be posted on website Held in different parts of the region Post updated Plan on website AGENDA: Discuss Waiver Renewal Share Successes and Challenges of the previous DSRIP Projects Project Portfolios (Project Evaluations) Discuss New Community Health Needs Assessment Review New Bundle/Metric Selections Solicit Comments and Feedback

Measure Specifications System Definition(s) Part of Category B Should incorporate ALL aspects of the organization that serve patients Include contracted partners (if applicable) Incarcerated populations served by Hospitals under contract with a Government entity may be excluded. To be used for all Cat C and PPP reporting. (Hierarchy) System Definition Setting of Services Measure Specifications

Patient Population by Provider (PPP) Baselines Individuals Served (Unique Patients) DY5 – DY6 Average PPP Total DY5 - DY6 Average MLIU PPP Total HHSC will calculate goals for DY7 and DY8

Category A Requirements

Category A Selections Core Activities Based on foundation of DY2-6 projects Menu Connected to the Transformational Extensions Menu (TEM) Developed in 2015 – 2016 Clinical Champions identified as “most transformational” May also propose activities from MACRA MIPS All selections will be reported every R2 Additions and deletions may occur every year (no approvals necessary)

CORE ACTIVITY SELECTION Access to Primary Care Services Access to Specialty Care Services Availability of Appropriate Levels of Behavioral Health Care Services Chronic Care Management Expansion of Patient Care Navigation and Transition Services Expansion or Enhancement of Oral Health Services Maternal and Infant Health Care Palliative Care Patient Centered Medical Home Prevention and Wellness Substance Use Disorder

Category A Reporting No incentive payments for Category A Report to include: Core Activities Progress and updates on all activities Alternative Payment Methodology (APM) Progress toward OR implementation of APM arrangements with: Medicaid Managed Care Organizations (MCOs) Other Payors Costs and Savings For providers receiving $1M or more per DY in DSRIP incentive $ Submit costs of one core activity per year Forecasted/generated savings experienced from the activities Collaborative Activities Required to attend (each DY) Learning Collaborative (at least one) Stakeholder Forum Or other Stakeholder Meeting(s)

Category B Requirements

Category B Requirements YOU will define your “system” System definition is intended to reflect the “universe of patients served by a performing provider” Should incorporate ALL components of the organization that serve patients There are REQUIRED and OPTIONAL components REQUIRED are considered the essential or “base unit” functions (or departments) of the provider If the provider system has that business component it must be REQUIRED TOTAL PPP TOTAL MLIU PPP

System Definition(s) Menu REQUIRED OPTIONAL

System Definition(s) Menu REQUIRED OPTIONAL

System Definition(s) Menu REQUIRED OPTIONAL

System Definition(s) Menu REQUIRED OPTIONAL

Category C Requirements

Measure Bundles A1: Chronic Disease Management: Diabetes Care A2: Chronic Disease Management: Heart Disease B1: Care Transitions & Hospital Readmissions B2: Patient Navigation & Emergency Department Diversion C1: Primary Care Prevention - Healthy Texans C2: Primary Care Prevention - Cancer Screening C3: Hepatitis C D1: Pediatric Primary Care D3: Pediatric Hospital Safety D4: Pediatric Chronic Disease Management: Asthma D5: Pediatric Chronic Disease Management: Diabetes E1: Improved Maternal Care E2: Maternal Safety F1: Improved Access to Adult Dental Care F2: Preventive Pediatric Dental G1: Palliative Care H1: Integration of Behavioral Health in a Primary or Specialty Care Setting H2: Behavioral Health and Appropriate Utilization H3: Chronic Non-Malignant Pain Management H4: Integrated Care for People with Serious Mental Illness I1: Specialty Care J1: Hospital Safety K1: Rural Preventive Care K2: Rural Emergency Care *** Many Changes in “Required” metrics and point values

Bundle/Metric Valuations No update to OLD tool; NEW calculations will be embedded in the RHP Plan template MINIMUM Bundle Valuation ($) (Bundle point value/all selected bundles point value) *0.75 * Total Category C Valuation MAXIMUM Bundle Valuation ($) (Bundle point value/all selected bundles point value) *1.25 * Total Category C Valuation MAXIMUM Bundle Valuation ($) ** for bundles without any required or selected optional 3-point measures (Bundle point value/all selected bundles point value)* Total Category C Valuation

Cat C Improvement Methodologies Baseline DY7 DY8 IOS (reported) 2.5% Gap Closure 10% Gap Closure QISMC Below MPL MPL 10% Gap Closure (HPL - MPL) Between MPL & HPL 5% Gap Closure (towards HPL) OR 2% Gap Closure (HPL – MPL) whichever is GREATER 20% Gap Closure (towards HPL) OR 8% Gap Closure At HPL or higher (HPL - MPL)

Category C Eligible Denominator Population HOSPITALs – PHYSICIAN PRACTICES COMMUNITY MENTAL HEALTH CENTERS LOCAL HEALTH DEPARTMENTS *** REFER TO MEASURE BUNDLE PROTOCOL page 21-22

Participating Provider Certifications Each participating entity must have a new certification signed Name of Organization TPI Type of Organization Local Health Department (LHD) Physician Practice affiliated with an Academic Health Science Center (AHSC) Hospital-Private Hospital-Public Community Mental Health Center (CMHC) Providing IGT?

Category D Requirements

Category D Pay for Reporting (P4R) Population focused measures PHYSICIAN PRACTICES Diabetes Complications Admission Rate Long Term Short Term Perforated Appendix Admission Rate COPD or Asthma Admission Rate Hypertension Admission Rate Heart Failure Admission Rate Low Birth Weight Rate Dehydration Admission Rate Bacterial Pneumonia Admission Rate UTI Admission Rate Uncontrolled Diabetes Admission Rate Asthma in Younger Adults Admission Rate Lower-Extremity Amputation among Diabetes Patients Rate Pay for Reporting (P4R) Population focused measures HHSC may provide the data HOSPITALS PPAs PPRs (30-day) PPCs PPVs (ED visits) Patient Satisfaction COMMUNITY MENTAL HEALTH CENTERS Effective Crisis Response Crisis Follow Up Community Tenure Juvenile Justice Avoidance Adult Jail Diversion

Category D (continued) Immunization Status Flu Pneumonia Tetanus MMR HPV STDs HIV Test LOCAL HEALTH DEPARTMENTs Time Since Routine Check Up High Blood Pressure Status Diabetes Status Overweight or Obese (BRFSS)