1. RHP 17 Planning Orientation May 3, 2012 9:30 a.m. to 11:00 a.m. 1:00 p.m. to 2:30 p.m.

2. Welcome & Introductions Meeting Facilitators Dr. Monica Wendel Ms. Angie Alaniz

3. Orientation Overview Update on HHSC, RHP 17 activities Presentation of Planning Process What will be included in the plan? Who should participate? What is the timeline?

4. HHSC Waiver Activities March 1 st - Uncompensated Care (UC) Protocol Finalized Submitted to Centers for Medicare and Medicaid Services March/April – Statewide Outreach Informational meetings held regarding RHP formation and DSRIP menu May 1 st - RHP Regions established

5. RHP Regions (Unofficial)

6. HHSC Timeline May 17, 2012 Public hearing on final regional boundaries August 31, 2012 Final RHP regions, DSRIP project menu, and payment protocol to CMS. September 1, 2012 RHP Plans due to HHSC. October 31, 2012 HHSC submits final RHP plans to CMS.

7. RHP Region 17

8. RHP 17 Activities March 14 th - Established RHP 17 Brazos, Burleson, Grimes, Leon, Madison, Robertson, and Washington TAMHSC named as anchor; BVCOG as fiscal agent April 9 th and 23 rd - RHP 17 expands Montgomery and Walker join RHP 17 April 18 th – IGT Meeting Focus - RHP Governance Structure

9. RHP Principles RHPs should promote transformation: Improved access Quality Cost-effectiveness Coordination

10. RHP Participants Four Primary Participants Intergovernmental Transfer Entities Private Hospitals Other Health Care Providers Anchoring Entities Participants have defined roles and responsibilities

11. IGT Entities Who are they? Cities, counties, hospital districts, hospital authorities, academic health science centers, mental health authorities, health districts, emergency management districts General duties Determines use of its IGT funding for uncompensated care (UC) and Delivery System Reform Incentive Payments (DSRIP) Participates in RHP Planning

12. IGT Entities & RHP Planning RHP Plan Selects projects and provides baseline metrics for DSRIP Must be consistent with HHSC RHP Protocol for DSRIP Estimates IGT available for each of the 4 plan years IGTs are NOT being asked to make a legal commitment beyond the first plan year.

13. IGT Entities and UC Estimates IGT for uncompensated care (UC) by plan year Provides IGT match for self or sponsored hospital

14. IGT Entities and DSRIP Estimates IGT for DSRIP by year Works with RHP, state, and CMS on valuing projects in DY 1 Provides IGT match

15. Private Hospitals Who are they? Private hospitals (without IGT) that choose to participate in waiver program and receive funding General Duties Participates in the RHP planning to receive waiver funding Coordinates with IGT providers to offer transformational services or uncompensated care as basis of receiving sponsored payments

16. Private Hospitals, UC, and DSRIP Provision of UC serves as the basis for UC waiver payments UC payment contingent upon IGT provided by IGT entities Performs transformation (DSRIP) project Must meet performance metrics as basis for IGT- funded incentive payments Provides report to anchoring entity

17. Other Health Care Providers Who are they? Non-hospital health care providers such as clinics and related service providers that a participating hospital might contract with to meet waiver objectives General Duties Coordinates with IGT providers to offer transformational services as basis for receiving payments from hospitals.

18. RHP Anchors Who are they? Any IGT entity A public hospital A hospital district or a hospital authority A county A state university with a health science center or medical school General Duties: Single point of contact between HHSC and RHP Facilitates RHP meetings with IGT entities Includes other stakeholders in RHP planning Holds public meeting prior to submission of final plan

19. Anchors and RHP Planning Ensures inclusion of key stakeholders in RHP Plan development Coordinates, develops, and provides RHP Plan to HHSC IGT contributing projects must be consistent with DSRIP Project menu and based on IGT entities’ input

20. Anchors and DSRIP Coordinates DSRIP Project Reports to HHSC Reports detail project milestones and metrics met Provides technical assistance to participating providers

21. Proposed Governance Structure RHP Executive Committee Current IGT Entities Brazos County Burleson County Hospital District Grimes County Montgomery County Hospital District Walker County Hospital District Texas A&M Health Science Center RHP Executive Committee Current IGT Entities Brazos County Burleson County Hospital District Grimes County Montgomery County Hospital District Walker County Hospital District Texas A&M Health Science Center RHP 17 Board All current and potential IGT Entities and All current and potential Participating Providers* *Non-voting members RHP 17 Board All current and potential IGT Entities and All current and potential Participating Providers* *Non-voting members Advisory Council Other Providers & Stakeholders Advisory Council Other Providers & Stakeholders Anchor Texas A&M Health Science Center Anchor Texas A&M Health Science Center Fiscal Agent BVCOG Fiscal Agent BVCOG Notes: Each IGT Entity and Participating Provider will name 1 board representative There will be 1 vote per county/hospital district Notes: Each IGT Entity and Participating Provider will name 1 board representative There will be 1 vote per county/hospital district

22. RHP Plan HHSC’s Draft Template Released April 3rd Advised RHPs NOT to complete this draft template Hosting Planning Orientation in June Plan Components RHP Organization & Executive Overview Community Needs Assessment Stakeholder Engagement DSRIP Projects Allocation of Funds & RHP Participation Certifications

23. RHP Organization & Overview RHP Sections I and II RHP Participants List e.g. IGT entity, Performing Providers, Anchor, Other Stakeholders (not directly receiving UC or DSRIP) Organization name, Lead Representative, Contact information Executive Overview Overarching RHP goals Brief summary of RHP healthcare environment Summary of how RHP will move from current status forward Identification of regional areas, e.g. RHP counties

24. Community Assessment Section III – Needs Assessment Data used cannot be more than 5 years old Demographics (e.g. race, ethnicity, income, education, employment, large employers) Insurance coverage (commercial, Medicaid, Medicare, UC) Description of region’s current health care infrastructure and environment (number/types of providers; hospital sizes, services, systems, and costs; HPSAs) Projected major changes (in first three areas) Key health challenges specific to region Assessment should be basis for selection of DSRIP projects

25. Stakeholder Engagement Section IV - Participation in RHP Performing providers – Describe how every performing provider directly eligible to receive pool payments was engaged Eligible performing providers must participate in RHP planning process in order to receive payments Public Engagement – Describe opportunities for public input into the development of the plans. Identify the stakeholders and groups that were engaged.

26. DSRIP Projects Section V – DSRIP Projects by Category Infrastructure Development Program Innovations and Redesign Quality Improvements Population Focused Improvements

27. IGT Funding & Certifications Sections VI and VII Allocation of Funds Amount of UC, DSRIP, and Estimated State Match for each RHP Performing Provider RHP Participation Certifications Signature of IGT Entities and Performing Providers

28. DSRIP Project Menu Categories Infrastructure Development Investments in technology, tools, and human resources Program Innovations and Redesign Piloting, testing, and replicating innovative care models Quality Improvements Hospitals implementing clinical improvement interventions Population Focused Improvements Patient’s experience, effectiveness of care coordination, prevention, and health outcomes of at-risk populations

29. Infrastructure Development Expand health access Primary, specialty, behavioral health, substance abuse Enhance HIE/HIT Focus: performance improvement and reporting capacity Implement/expand telehealth Develop a patient-centered Medical home model infrastructure Enhance Public Health Preventative Services Implement a Disease Management Registry

30. Program Innovation & Redesign Strategies to impact Potentially Preventable Events Mechanisms to test provider financing models Health promotion and disease prevention models Innovations in provider training and capacity Behavioral/Substance Abuse care models Telehealth Innovations Strategies to reduce inappropriate Emergency Department use Supportive care models

31. Quality Improvements Congestive Heart Failure Asthma HIV SCIP Healthcare-acquired Infections Perinatal Outcomes PPA/PPR Emergency Care MDROs/CDI Facility-acquired pressure ulcers Birth Trauma

32. Population-focused Improvements At-risk populations Preventive Health PPAs/PPRs Patient-centered health care Cost Utilization Emergency Department

33. DSRIP Project Vision Aim and Outcome Secondary Drivers Primary Drivers Care Access Care Experience Care Utilization Care Quality Human Behaviors Workforce Transformation Deliver better health and improved care At lower costs Improved access to behavioral health services through technology assisted services and enhanced service availability. Patient Engagement (HCAHPS) Patient Satisfaction (HCAPHPS) Early Intervention Services Appropriateness of Care Evidenced-based care Care Coordination Efficiency of service delivery Preventative Services Educational Services Collaborate with community partners Expand residency training slots Expand behavioral health workforce Develop training plan and curriculum Measurements 30 day readmission rates for behavioral health/substance abuse. Admission rate for behavioral health /substance abuse.

34. Proposed Process & Timeline May 14 th – June 1 st County meetings with IGT entities and health care providers to identify top 3 priorities June 11 th Community priorities consolidated and DSRIP Projects selected June 25 th Estimated cost of DSRIP projects made available July 13 th Determine IGT available and health care providers participating July 23 rd Draft RHP Plan available for local review by RHP participants August 1 st Final plan posted for public comment (due to HHSC September 1 st )

35. Who should participate? Local Government Partners Hospitals with significant Medicaid utilization Other providers with significant Medicaid utilization Academic Health Science Centers Regional Public Health Directors County Medical Associations/Societies Children’s Hospitals

36. Next Steps TAMHSC Schedule county meetings Assemble data by community Email community data, assessment summaries, and full DSRIP menu to county meeting participants Work with IGT Entities to finalize governance structure and IGT/BVCOG to define fiscal agent role/responsibilities IGT Entities/Health Care Providers Send contact information to alaniz@tamu.edualaniz@tamu.edu Review data, assessment summaries, DSRIP menu Identify top 3 health priorities by community