1. Region 15 Regional Healthcare Partnership 47TH Public Meeting
Wednesday, AUGUST 30, 2017
University Medical Center of El Paso
Anchor Hospital
Medical center of the americas – conference room

2. Confirmation of Participants
University Medical Center of El Paso
Texas Tech University Health Sciences Center at El Paso
El Paso Children’s Hospital
Hospitals of Providence (Tenet)
Las Palmas – Del Sol Hospital (HCA)
El Paso Health Department
Emergence Health Network
El Paso Medical Society
Visitors?
Roll Call

3. Approval of last meetings minutes.
Approval of minutes
Approval of last meetings minutes.

4. NEW WEBSITE DESIGN -- Umcelpaso.org

5. FEEDBACK/comments DSRIP Program Manager Oscar Perez
Go to your Browser or Cell Phone: OR To: Text: OSCARPEREZ394

6. 1115 Waiver Program Manager
ANCHOR UPDATES
1115 Waiver Program Manager
Oscar Perez
Myers & Stauffer Updates
Waiver Renewal Updates
Timeline
DY6 Reporting & DY7+ Preparations

7. ANCHOR UPDATES Myers & Stauffer’s Reviews (Compliance Monitoring)
Notifications of Recoupment (HHSC) – Cat 1 and 2
Postponed to allow for additional review
Category 3 Reviews
HHSC is going through Myers & Stauffer’s most recent reviews
ANCHOR UPDATES

8. ANCHOR UPDATES Waiver Renewal - Extension
Negotiations still ongoing with CMS
CMS is “informally” reviewing protocols (PFM and Bundles)
Target: September 2017 for CMS approval
Program Funding and Mechanics (PFM) changes submitted to CMS - August 4, 2017
DSRIP DY7-8 Policy will be presented:
Aug 17th – 1:30pm Hospital Payment Advisory Committee (HPAC)
Aug 24th – 9:00am Medical Care Advisory Committee (MCAC)
Sep 07th – 10:00am HHSC Executive Council
Sep 21st – 9:30am Public Hearing
Aug 25th thru Sep 25th -- Published for public comment in Texas Register
Rules to be effective December 01, 2017
ANCHOR UPDATES

9. TIMELINE ANCHOR UPDATES October 31, 2017 August 25, 2017
DY6 Reporting due to HHSC
December 31, 2017
End of new baseline period (DY7)
January 31, 2018
NEW RHP Plan due
August 25, 2017
DY7-8 DSRIP Rules posted for public Comment
September 30, 2017
End of DY6
October 01, 2017
DY7 starts
ANCHOR UPDATES

10. DY6 R2 Elements
QPI (M1) MLIU QPI (M2) SUSTAINABILITY PLANS (M3) CORE COMPONENTS (M4) * Accomplishments *CHALLENGES * LESSONS LEARNED * learning collaborative participation CATEGORY 3
QPI Template
Template NEW
Documentation
Narratives
Cat 3 Template

11. Sustainability Reporting
DY6

12. NEW Template PROVIDER LEVEL:
Section 1: Collaboration with Medicaid Managed Care
Section 2: Health Information Exchange
Project Tabs
NEW Template

13. MCOs
Provider level:

14. APM / VBP
Provider level:

15. Data Exchange
Provider level:

16. Data Exchange
Provider level:

17. PROJECT level:

18. PROJECT level:

19. PROJECT level:

20. PROJECT level:

21. Bundle assignment & Core Activities selection
DY7 +
Bundle assignment & Core Activities selection
presentation

22. Category C BUNDLES MEASURE BUNDLES
A1: Improve Chronic Disease Management: Diabetes Care
A2: Improve Chronic Disease Management: Heart Disease
B1: Care Transitions & Hospital Readmissions
B2: Patient Navigation & ED Diversion
C1: Primary Care & Prevention: Healthy Texans
C2: Primary Care & Prevention: Cancer Screening
C3: Hepatitis C
D1: Pediatric Primary Care
MEASURE BUNDLES
F1:Improve Access to Adult Dental Care
G1: Palliative Care
H1: Integration of Behavioral Health in a Primary Care Setting
H2: Behavioral Health and Appropriate Utilization
I1: Specialty Care
J1: Hospital Safety
H3: Chronic Non-Malignant Pain Management
H4: Integrated Care for People with Serious Mental Illness
E1: Improve Maternal/Perinatal Care

23. Category C BUNDLES MEASURE BUNDLES D3: Pediatric Hospital Safety
D4: Pediatric Chronic Disease Management: Asthma
E1: Improve Maternal/Perinatal Care
F1:Improve Access to Adult Dental Care
F2: Preventative Pediatric Dental
G1: Palliative Care
H1: Integration of Behavioral Health in a Primary Care Setting
H2: Behavioral Health and Appropriate Utilization
MEASURE BUNDLES
H3: Chronic Non-Malignant Pain Management
H4: Integrated Care for People with Serious Mental Illness
I1: Specialty Care
J1: Hospital Safety
K1: Rural Preventative Care
K2: Rural Emergency Care
L1: Local Health Department Measures
M1: Community Mental Health Center Measures

24. Point System

25. Point System

26. Funding Levels by Category
**If private hospital participation minimums in the region are met, then Performing Providers may increase the Statewide Reporting Measure Bundle (Cat D) funding distribution by 10%.

27. Bundle Valuation Calculate total Category C valuation
Total DY7 Valuation X (or 0.65)
Calculate MIN and MAX for each Bundle
MINIMUM = (A/B)/2 * Category C valuation
MAXIMUM = (A/B) * Category C valuation
A = Measure Bundle Point Value
B = Sum of all SELECTED Measure Bundle Points
Distribute to Bundles

28. Bundle Valuation - EXAMPLE

29. Metric Valuation EXAMPLE
TOTAL VALUATION for Category C: $11M
Metric Valuation EXAMPLE
30%
27.27%
$3,000,0000
$750,000
$750,000
$750,000
$750,000
37.5%
27.27%
$3,000,000
$600,000
$600,000
$600,000
$600,000
$600,000
Minimum Point Value : 40

30. Metric Valuation EXAMPLE
TOTAL VALUATION for Category C: $11M
Metric Valuation EXAMPLE
15%
15%
$1,650,000
$412,500
$412,500
$412,500
$412,500
17.5%
30.46%
$3,350,000
$1,116,667
$1,116,667
$1,116,667
Minimum Point Value : 40

31. DY7 REPORTING
Category A – Core Activities
Progress on core activities
Alternative payment model arrangements
Costs and savings
Collaborative activities.

32. Category A Requirements
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
Submit costs of core activities
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

33. 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

34. CORE ACTIVITY SELECTION

35. Active Patient Definition
COMBINED CARE H1: Integration of BH in a Primary and Specialty Care Setting H1-146: Screening for Clinical Depression & Follow-Up Plan System:The provider’s system definition includes primary care clinics and outpatient specialty care clinics Setting:Primary care clinics and outpatient specialty care clinics appropriate for bundle, in this case Endocrinology and Orthopedic Active Patient: In each measurement period, the provider would identify individuals that meet the active patient definition in each setting Denominator Specifications: From those individuals, the denominator would be determined following measure specifications
PRIMARY CARE
Two visits in the 12-month measurement period
One visit in the 12-month measurement period and one visit in the 12 months prior to the measurement period
Assigned to a primary care physician in your system
SPECIALTY CARE
You will propose an active patient definition for each specialty

36. REGIONAL LEARNING COLLABORATIVES
UPDATEs
DIABETES LEARNING COLLABORATIVE
Chair: Moses Priego – UMC
BEHAVIORAL HEALTH LEARNING COLLABORATIVE
Chair: Cindy Hernandez – EHN
HEALTH DATA EXCHANGE COLLABORATIVE
Chair: Rosie Sanchez – TTUHSC
REGIONAL LEARNING COLLABORATIVES

37. STAKEHOLDER’s FORUM STAKEHOLDER’S FORUM Postponed
until Waiver Renewal decision is announced
1:00pm Medical Centers of the Americas (MCA)
AGENDA will be:
Discuss Waiver Renewal
Share Successes and Challenges of the DSRIP Projects
Abbreviated Presentations of Projects
Discuss Community Health Needs Assessment
STAKEHOLDER’S FORUM

38. ROUNDTABLE
ROUNDTABLE

39. Contact Information
NEW Waiver Website:
Waiver
TXHealthcare
UMC RHP15 Website:
Region 15 - RHP

40. Medical Center of the Americas (MCA) (Cardwell Collaborative Building)
Next Meeting: Sep 27, :00pm
Medical Center of the Americas (MCA)
(Cardwell Collaborative Building)