1. RHP 12 DY 7-8 Planning Session

2. 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

3. 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)

4. 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. 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 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

6. 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

7. 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

8. 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

9. Proportional distribution of Category C
Attachment J – Program Funding & Mechanics (PFM) pg
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

10. 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

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

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

13. Comments/Questions?