Region 15 Regional Healthcare Partnership 20th Public Meeting Wednesday, February 26, 2014 University Medical Center of El Paso Anchor Hospital

Confirmation of Participants Roll Call

3 Year Projects $23 Million to redistribute to all regions in left over funds for 3 year projects

Category 3 New Payment Methodology Assign New Values to all Category 3 Total amount for Category 3 Outcomes will be provided and Providers must re-allocate percentages to each measure There will be a minimum percentage assigned by Provider There may also be exceptions to using certain percentages This will be performed in the spreadsheet tool

Category 3 New Payment Methodology DY3 April, 2014 – payment based on status narrative report of establishing baseline October, 2014 – payment based on submitting baseline A signed certification will be required with submission of baseline rates by an executive of your entity

Category 3 Measure Type – You must review the new measures and if you can find a P4P measure to fit, use it. HHSC will be sending measures back where the choice is P4R and they find a P4P that fits. P4P P4R Stretch Activities or Population Focused Activities in DY5 Standalone (SA) or Non-Standalone (NSA) Measure Specifications Setting – Inpatient, Ambulatory, ED, Both Prior Authorization (PA)

Benchmark Measurements Category 3 Benchmark Measurements QSMIC – Quality Improvement System for Managed Care High Performance Levels (HPL) – 90th Percentile If your baseline is above the HPL, you cannot use the measure Minimum Performance Levels (MPL) – 10th Percentile If baseline is at MPL or above: DY4 – 10% gap reduction to HPL DY5 – 20% Improvement Over Self (IOS) 5% improvement in DY4 10% improvement in DY5

Category 3 Measurements Numerator / Denominator New materials list detailed elements required Subsets – Can measure based on: Payor Race Gender Facility Age You cannot choose to measure only the patients enrolled in your project CMS wants broader results

Category 3 New Payment Methodology P4P OUTCOME MEASURES P4r Outcome Measures (requires Prior Authorization DY4 50% P4R 50% P4P If improvement goal is not achieved, then partial payments can apply DY5 100% P4P DY4 100% P4R DY5 50% P4R 50% P4P on Population-focused priority measure or stretch activity

Additional Activities for P4R Priority Population Focused Measures Spreadsheet posted on website Stretch Activities SA1- Validation of P4R measure SA2- Apply for National Quality Forum (NQF) Endorsement SA3- Alternative Approaches to Program and Outcome Linkages SA4- Emergency Department Improvements SA5- Regional exchange of public health surveillance data SA6- Community surveillance for at-risk and disparity groups SA7- Texas HIE participation SA-8- Data Governance Structure

Helpful Resources Selection Tool – Partial Data Sent 2/26/14 Companion – not posted yet Compendium – not posted yet Decision Tree – HHSC PPT Risk Adjusting Document – not posted yet Denominator One Pager – ?? Reporting Templates for DY3 – not posted yet

Questions for HHSC Inbox Title by: Category 3 – Selection tool Category 3 – Select measures to fit cat 1 or 2 Category 3 – population-focused priority measures Category 3 – stretch activities Category 3 – achievement methodology Category 3 – data collection processes Category 3 – tools/surveys Category 3 - other

Timelines February 28, 2014 (delayed since Feb. 7) – October Reporting NMI Eligible for April Reporting Soon – Replacement Projects March 10, 2014 –Category 3 measures due to HHSC Providers send to HHSC and cc Anchor By March 14, 2014 – HHSC submits New 3-Year Projects to CMS Late April, 2014 – Results from CMS on New 3-Year Projects April 2014, probably later – Full RHP Plan submission to HHSC April 30, 2014 – April DY3 Reporting and Semi-Annual Progress Reports due from providers Early June 2014 – HHSC approves April reports or NMI July 9, 2014 – Estimate IGT due date for April DY3 milestone/metric achievement Mid-July 2014 – Providers supply additional information if necessary following April DY3 reporting July 31, 2014 – HHSC reviews and approves or disapproves additional information submitted by providers following April DY3 reporting. July 31, 2014 – Estimated payment date for April DY3 reporting June 30, 2014 – Plan Modifications for DY4-5.

DSRIP Project Discussions Roundtable DSRIP Project Discussions

Contact Information Waiver Website & Email Address: http://www.hhsc.state.tx.us/1115-waiver.shtml TXHealthcare Transformation@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