1. DSRIP Update DY7-DY8
RHP 15
January 31, 2018

2. 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

3. 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

4. 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

5. Project Level to System Level
NEW MODEL

6. 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)

7. 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%

8. 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

9. 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)

10. RHP Plan re-submission
Requirements

11. 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.

12. 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

13. Community Needs Assessment
Posted on RHP 15 Website

14. 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

15. 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

16. 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

17. Category A
Requirements

18. 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)

19. 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

21. 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)

22. Category B
Requirements

23. 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

24. System Definition(s) Menu
REQUIRED
OPTIONAL

25. System Definition(s) Menu
REQUIRED
OPTIONAL

26. System Definition(s) Menu
REQUIRED
OPTIONAL

27. System Definition(s) Menu
REQUIRED
OPTIONAL

28. Category C
Requirements

29. 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

30. 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

31. 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)

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

33. 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?

35. Category D
Requirements

36. 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

37. 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)