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

2. Confirmation of Participants
Roll Call

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

4. 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

5. 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

6. 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)

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.

14. DSRIP Project Discussions
Roundtable
DSRIP Project Discussions

15. Contact Information
Waiver Website & Address:
TXHealthcare
UMC Website:
Region 15 - RHP
Paso del Norte Blue Ribbon Committee Needs Assessment: