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RHP 12 Regional Health Plan Overview. RHP Plan Overview CMS Initial Review 4 Phase Revision Process Updated CMS Review Status DY2 August Reporting DY2.

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Presentation on theme: "RHP 12 Regional Health Plan Overview. RHP Plan Overview CMS Initial Review 4 Phase Revision Process Updated CMS Review Status DY2 August Reporting DY2."— Presentation transcript:

1 RHP 12 Regional Health Plan Overview

2 RHP Plan Overview CMS Initial Review 4 Phase Revision Process Updated CMS Review Status DY2 August Reporting DY2 October Reporting 3 Year Project Process Prioritized List Whats Next? 2

3 3 Region 12 Anchor: UMC 47 Counties DSRIP Funding: $406 Million Participating Providers: Public Hospitals Private Hospitals TTUHSC MHMRs Local Health Departments

4 Assure residents receive high-quality, patient- centered care, in a cost-effective manner. Focus on coordinated care delivery and improved health outcomes Project focused on the Medicaid and uninsured patient populations Contain cost growth Fulfill as many urgent and critical needs identified as possible Improving quality and performance, increasing access to care, and increasing prevention and early detection activities. 4

5 Developed utilizing: Focus groups Telephone surveys Existing needs assessments throughout the region Behavioral Risk Factor Surveillance Survey (BRFSS) Census Other health and demographic data 5

6 Critical Needs: Severe primary care provider shortage, wait time, expense, lack of insurance, access to care Lack of mental health services, inability to get an appointment, lack of insurance, need to use ERs for initial contact 6

7 Urgent Needs: Poor insurance support or uninsured High incidence of obesity, diabetes mellitus and heart disease. Need for specialists to assist in the treatment of obesity, diabetes mellitus, heart disease, asthma, chronic lung disease & other chronic diseases. Need for cancer screening with mammograms, pap smears, colonoscopy, sigmoidoscopy, rectal exam Insufficient maternal and prenatal care, especially the first trimester teen pregnancy, high percentage of unmarried mothers 7

8 Important but Less Urgent: Alcohol abuse and binge drinking, substance abuse Tobacco use High Prevalence of asthma and care issues Inadequate vaccination of the population High incidence of sexually transmitted disease Shortage of dental care HIV Screening 8

9 Infrastructure Development Innovation and Redesign Quality Improvements Population-focused Improvements 9

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15 Of the 88 CAT 1 & 2 projects submitted: 48 received 100% approval 24 approved with Priority technical corrections 8 approved with proposed valuation adjustments 8 projects not approved 91% Overall Approval 15

16 94 Category 3 Projects Submitted 71 Approved 23 Not Approved 76% Approval 16

17 9 Category 4 Projects Submitted 9 Approved 100% approval 17

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19 Completed 3 of 4 Revision Phases Phase 1 – Completed (May thru June) - revised phase 1 projects – Projects with proposed valuation adjustments & Projects NOT initially approved Phase 2 – Completed (June thru July) – provided quantifiable patient impact and Medicaid/Indigent impact information for ALL projects Phase 3 – Completed (July thru September) – made necessary changes to DY2 milestones and metrics to assure DY2 payments Phase 4 – By December 2 nd - make all priority technical corrections and Category 3 changes 19

20 CAT 1&2 Update Summary 4 CAT 1 &2 Still Not Approved: 2 – Pending Phase 1 final review 2 – Replacement projects 20 CAT 1 & 2ApprovedNo Final Approval Initial808 Current Status – After Phase

21 CAT 3 Update Summary 16 CAT 3 Still Not Approved: 1 - Related Cat 1 or 2 project not initially approved 7 - Needs to define Quality of Life (QOL) tool 4 - Off-menu 4 - Different Cat 3 outcome recommended CAT 4 – No Changes -100% approved 21 ApprovedNot Approved Initial CMS Review7123 Current Status – After Phase

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23 72 of 88 Category 1 or 2 projects were eligible for August reporting 34 of the 72 eligible projects were reported on in August 18 of our 35 regional providers reported during DY2 August reporting HHSC approved $24,366,766 of DSRIP funding for Milestones/Metrics reported in August going to 17 participating providers 23

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25 REQUIRED by All Performing Providers In Progress - Due October 31 st Minimum Requirements: Overall Provider Summary tab/sheet DY2 – Project Summary section of each project Progress Update field – must be completed for each Category 1 or Category 2 metric and each Category 3 milestone. 25

26 You MUST select to carry-forward a metric if you have not 100% completed the metric: 26

27 CAT 3 Status Update – All CAT 3 projects can report a status update and ultimately receive DY2 funding regardless of achieved milestones/metrics 27

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29 Each RHP required to submit a prioritized list of 3 year projects to HHSC by October 31 st, 2013 HHSC will use the list to assess whether any DSRIP funds will be available for redistribution REQUIRED for 3 Year Project process Transparent process All Projects reviewed and scored based on community needs, gaps in service, QPI, % Medicaid/Uninsured served & compliments other projects underway in RHP Alternate IGT entity 29

30 2 Healthcare Professionals recruited to review and score 3 Year Projects All 3-Year DSRIP Projects reviewed & scored based on a scale of 1-9 (with 9 being the best) using the following weighted average domains: Alignment with Community Needs (30%), Transformational Impact (25%), QPI/Medicaid/Uninsured Impact (25%), Likelihood/Probability of Success (10%), and Sustainability After the Waiver (10%). 30

31 Northwest Texas Hospital System – DY3- DY5 Earmarked $11,840,081 WJ Mangold, Lockney, TX DY3- DY5 Earmarked $612,678 Funds from accepted Valuation Adjustments DY3 – $340,719 31

32 REQUIREMENTS of 3 Year Projects to be considered for Prioritized list Projects MUST have an identified IGT source All projects MUST be reviewed, scored & prioritized based on community needs Go through the Public Meeting Process Region 12 Customized Process 3 Tier Prioritizing Process 32

33 Tier 1 o Region 12 Earmarked 100% of remaining funds in March of Projects from providers with these earmarked funds fall into Tier 1 up to earmarked funding amounts. When and if a provider has utilized their earmarked threshold amount, any remaining lower scored projects for that provider will become Tier 3 projects. Northwest - $11,840,081 (DY3-DY5)–2 projects WJ Mangold - $612,678 (DY3-DY5)–1 project 33

34 Tier 2 o Highest scored project from any additional provider that does not currently have a DSRIP project (new provider). Only ONE project (highest scored) per new provider will be included in Tier 2. If a new provider submits more than one New 3-Year Project, then all lower scored projects will be included in Tier o Region 12 has two providers that fall in this tier Swisher Memorial Healthcare System Baptist St. Anthony's (BSA) Health System 34

35 Tier 3 Projects from providers that currently have a DSRIP project (existing providers), projects moved from Tier 1 to Tier 3 exceeding earmarked threshold amount, and lower scored projects from new providers that did not get included in Tier 2 due to the limit of one project (highest scored) per new provider. Region 12 has 16 projects in Tier 3 35

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38 October 28 th o IGT settlement date for August DY2 approved reporting October 31 st 2013 o DY2 October Reporting Due to HHSC o Prioritized List Due to HHSC o November 4 th & November 18 th o Payment issue dates for August Reporting Soon o DY 4-5 CMS Valuation Approval o Final Category 3 CMS Menu Approval Mid-November/Early December o Regional Learning Collaborative Roll out Webinar 38

39 Early December FULL 3 Year DSRIP projects Due Phase 4 (priority technical issues & Cat 3 projects) Project Plan revisions October DY2 Reporting Feedback January 4 th 2014 Estimated IGT for approved DY2 October reporting Additional information requested for non approved October reporting January 24 th 2014 Estimated Payment for approved DY2 October reporting Approval or denial of additional requested October information March 31 st 2014 Full RHP plan resubmitted as a single document 39

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41 Please submit additional comments or feedback to us at the RHP address below: 41

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