Hospital Transformation Performance Program (HTPP) Funding Allocation Methodology Elyssa Tran February 7, 2014

 Under Oregon’s Triple Aim, portion of the transformation savings will come from reduced utilization of hospital services  Oregon hospitals will need to pursue new models of care and business structures  OHA Budget created a new hospital incentive pool, the Hospital Transformation Performance Program (HTPP) BACKGROUND

 Funding is from the Federal equivalent value of the funds available from a 1% additional tax rate  Requires CMS approval  Available to DRG hospitals that are subjected to provider tax assessment  Must meet specific performance goals set by OHA and approved by CMS HTPP FUNDING

 Established basis for determining the level of incentive funds available to earn for each hospital  Example: Available funds is $100 million Hosp A = $40 mil Hosp B = $30 mil Hosp C = $20 mil Hosp D = $10 mil ALLOCATION METHODOLOGY

 Different from “What performance criteria and targets must a hospital meet in order to earn its share of the pie?”  Answer to this question is based on the recommendations of this OHA-led workgroup ALLOCATION METHODOLOGY

 OAHHS workgroup Drew on expertise of the Provider Tax Advisory Committee Drew on guidance from CMS expert consultants  Recommendation include: A base/minimum amount for each DRG hospital Remaining amount  50% based on share of total Medicaid discharges  50% based on share of total Medicaid inpatient days  Shared and accepted by the OHA  Hospitals must meet performance benchmarks or improvement targets to receive payment ALLOCATION METHODOLOGY

 All funds would be distributed each year (no carryover)  Data source for calculations is Hospital Inpatient Discharge Data collected by OHPR  Funds not distributed in the first round would go to a “challenge pool” ALLOCATION METHODOLOGY

Challenge Pool  Only those hospitals that received distributions in the first round are eligible  Part of the committee’s work is to recommend measures for the challenge pool  Earnings from the challenge pool could potentially be based on fewer and/or different measures from the first round ALLOCATION METHODOLOGY

Hospital Performance Potential Measures Diane Waldo February 7, 2014

 OAHHS formed a workgroup of hospital representatives to brainstorm a possible measure approach  Workgroup reviewed lists of possible measures – similar to what the Advisory Group will do today  Workgroup included multi-disciplinary representation from member hospitals  Work group met twice during April 2013 and created a measure approach for consideration BACKGROUND

 Early Elective Deliveries  Preventable Readmissions  Stage 1 Meaningful Use MEASURES FOR CONSIDERATION

 Early Elective Deliveries Description/definition Patients with elective vaginal or elective C/S at greater than or equal to 37 and less than 39 weeks completed gestation (Joint Commission definition) Alignment with CCO Important patient safety effort Cost savings MEASURES FOR CONSIDERATION

 Preventable Readmissions Description/definition Reducing preventable readmissions has value as an indicator of quality; may reflect poor coordination of services and transitions of care at discharge or in the immediate post discharge period Potentially preventable readmissions (PPR) as calculated by Apprise Health Insights, using 3M software MEASURES FOR CONSIDERATION

 Stage 1 Meaningful Use Hospitals that achieved Stage 1 meaningful use (attested and received payment) MEASURES FOR CONSIDERATION

 Falls with injury All documented patient falls with an injury level of minor or greater (NQF measure)  Catheter-Associated Urinary Tract Infection (CAUTI) Rate of patients with catheter-associated urinary tract infections per 1000 urinary catheter days-all tracked units OTHER POTENTIAL MEASURES

 Collective thinking of the hospital work group  Align with current work now being done in hospitals  Believe that this measure approach reflects transformative potential in alignment with the Triple Aim  Recognize that this is a starting point for discussion with the Advisory Committee SUMMARY