Regional Healthcare Partnership 18 October 23, 2012

Texas Healthcare Transformation and Quality Improvement Program  1115 Medicaid Waiver ○ Creates Regional Healthcare Partnerships (RHP) ○ Expands and enhances healthcare services not currently available or allowable ○ Changes the way hospitals are paid for uncompensated care ○ Encourages expanded coverage under Medicaid

Regional Healthcare Partnership 18 The RHP Anchor – Collin County Government Is inclusive, reaching out to the community Provides technical assistance to, organizes, convenes, plans, coordinates, leads, and facilitates healthcare providers and other stakeholders in the RHP Reviews, consults on and compiles the plan Ensures plan meets requirements Holds public hearings on the plan Oversees and performs monitoring and reporting functions

RHP Activities Since July 2012  Held 50 group and individual meetings with potential providers  Conducted four workshop events for technical assistance and consensus  Ensured continuous communications with the Medicaid Transformation Waiver Team at the Texas Health and Human Services Commission  Provided continuous flow of information to potential providers  Produced a community needs assessment  Conducted RHP Plan Development

Community Needs Assessment CollinGraysonRockwallTexas Population (2011 estimate)812,226121,41981,29025,674,681 % Medicaid Enrolled5%13%6%13% % below Poverty Level7%14%6%17% % Uninsured17%25%19%26% Preventable Admissions Rate per 1,000 (National 49) % under 18 on Medicaid11%28%12%32% Sources: U.S. Census Bureau ; University of Wisconsin Population Health Institute.

Community Needs Assessment Identified Priorities for Waiver Projects Primary CarePrenatal Care Urgent and Emergency CareCo-morbid medical and behavioral health conditions Health ProfessionsAcute Care Admissions DiabetesCardiovascular Disease Elderly at home and in care facilitiesOther special populations Communicable DiseasesObesity and co-morbid risk factors Source: U.S. Census Bureau for each county and Texas

Community Needs Assessment Consistent with U.S. Center for Disease Control: Healthy People 2020 Access to HealthcareClinical Preventive Services Injury and ViolenceMaternal, Infant, and Child Health Nutrition, Physical Activity and Obesity Social Determinants of Medical and Behavioral Health Problems Source: U.S. Census Bureau for each county and Texas

Provider Participation Based On  Voluntary submission of a DSRIP project  Intergovernmental Transfer (IGT) funds Counties or cities Community Mental Health Centers Academic Health Science Centers

RHP 18 Allocations  DY 2: $28 million  DY 3: $32.5 million  DY 4: $34.8 million  DY 5: $37.8 million

Center for Medicaid and Medicare Services (CMS) Pass 1 Requirements  Minimum of 4 projects At least 2 in Category 2  5% must be from private hospital DSRIP projects  A safety net hospital must submit a DSRIP project RHP 18 has one safety net hospital ○ Texoma Medical Center At Least 4 Projects 5% Private Hospital Participation DSRIP Project from Safety Net Hospital

Pass 1 Potential Participants CollinGraysonRockwall 4 Hospital Networks2 Hospital Networks Behavioral Health Clinic Health Department Health Science Center (Dallas County based)

Current Proposed Projects Texoma Community Center in Grayson County Enhance performance improvement and reporting capacity Implement technology-assisted behavioral health services Increase services availability for substance abuse programs Expand counseling services Care management functions integrating primary and behavioral healthcare programs

Current Proposed Projects UT Southwestern – in Collin County Primary Care (Family, Internal, OBGYN) Specialty Care (Orthopedics, Behavioral Health, Cancer Care) Texas Health Presbyterian Hospital – Rockwall County Emergency Department Navigation LifePath Systems – in Collin County Integrate primary care with behavioral healthcare Lakes Regional MHMR Center – in Rockwall County Telemedicine services

Pass 2  Provides opportunities for clinics, physician- owned offices and hospitals that did not qualify for Pass 1

DSRIP Funding  HHSC will re-assess RHP allocation amounts in DY 2 Uncommitted amounts will be redistributed to RHPs that implement new projects in DYs 3-5

Project Information  Available online Collin, Grayson and Rockwall county websites