Region 15 Regional Healthcare Partnership Fifth Public Meeting Wednesday, August 22, 2012 University Medical Center of El Paso Anchor Hospital

Confirmation of New Participants El Paso County UBH Salvation Army El Paso Child Guidance Center

New Template and Evaluation Form Revised RHP 15 Project Template Multiple changes to reflect the latest revisions by HHSC Added section for narrative to be included for each project valuation HHSC would prefer to see fairly flat valuations across the 4 years Maximum project value over the four year period is the greater of 10% of entity’s Pass 1 allocation or $10,000,000 DSRIP Proposal Evaluation Form For use by IGT Entities to evaluate outside entity project proposals

Summit Recap – UC Tool & RHP Plan Template Tool UC Protocol Approval Hospital and Physician UC Protocols Approved The tool has been uploaded 30 days from posting to due date Completion of this tool will provide UC Reimbursement UC -- DY1 Payment = late November / December 2012 UC – DY2 Payment = Early 2013 Issues with macros in the tool HHSC will publish a UC Tool Training webcast online ASAP An electronic RHP Plan Template Tool will be released after the protocols are approved by CMS (8/31/12). Webinar training will be provided for this tool

Anchor Call Recap - DSRIP Menu Changes ICD-10 Coding and ED Door to Doc Times, both removed from the Menu (Cat 1 and 2) Patient Experience moved to Category 3 (Outcome Measure) Residency Programs – Yes No longer a 3 project requirement in Category 3 Waiver Projects surrounding Jail system – patients or services must be for a Medicaid eligible patient They would like to see a listing of our projects that we considered but excluded from the Plan, i.e. No List

Anchor Call Recap - DSRIP Menu Changes Significant Changes in the entire format of the Menu! Involving Metrics and Outcomes Reporting for Categories 1, 2 & 3 All Category 1& 2 projects MUST have an associated Category 3 Outcome New Definition – Outcomes Definition = “measures that assess the results of care experienced by patients, including patients’ clinical events, patients’ recovery and health status, patients’ experiences in the health system, and efficiency/cost” Category 1&2 contain many “outcomes measures” that will be moved to Category 3. Other Improvement measures that do not meet the outcomes definition will remain in Cat 1&2. A list of Category 3 Outcomes is under development.

Anchor Call Recap – Category 3 Payments Possible Options: Cat 3 DY 2 & 3 Payments will be for preparing to report outcomes for DY 4 & 5, i.e. establishing baselines and preparing data systems Or, no funding in Cat 3 for DY 2 & 3 Cat 3 DY 4 & 5 payments will be for meeting outcome targets Can either set an estimated outcome goal in plan, or list TBD Criteria to meet the targets has not been developed yet HHSC is proposing that Cat 3 be a combination of pay for performance and pay for reporting Partial payments for Outcomes may be considered

Medicaid Waiver Timeliness Final Approval on PFM Protocol and Menu – August 31, 2012 Draft that was just sent to CMS is on our website Two weeks after approval – IGT Entities and Private Hospitals submit their final Chapter of Projects to Anchor Estimate September 14, 2012 October 31, 2012 – Submit RHP to HHSC (4 year plans) December 15, 2012 - CMS completes review RHPs returned for revisions during the 30 day period January 15th, 2013 - Revised RHP Plans to CMS February 1st, 2013 - CMS Final Decision

New Draft DSRIP Menu Category I Project Areas Expand Primary Care Capacity Increase Training of Primary Care Workforce Implement and Utilize Disease Management Registry Functionality Enhance Interpretation Services and Culturally Competent Care Collect Accurate Race, Ethnicity and Language (REAL) Data to Reduce Disparities Enhance Urgent Medical Advice Introduce Telemedicine Expand Specialty Care Capacity Enhance Performance Improvement and Reporting Capacity Expand Behavioral Health Services Expand Dental Services Expand or Enhance Emergency Medical Transportation Services

New Draft DSRIP Menu Category II Project Areas Expand Medical Homes Expand Chronic Care Management Models Redesign Primary Care Redesign for Cost Containment Establish/Expand a Patient Care Navigation Program Apply Process Improvement Methodology to Improve Quality/Efficiency Use Palliative Care Programs Conduct Medication Management Implement/Expand Care Transitions Programs Health Promotion and Disease Prevention Behavioral Health

New Draft DSRIP Menu Category III Project Areas Potentially Preventable Admissions Congestive heart failure admission rate Diabetes, short-term complications, admission rate Diabetes, uncontrolled diabetes, admission rate Behavioral health potentially preventable admissions Chronic obstructive pulmonary disease or asthma in adults admission Hypertension admission rate Diagnosis and management of asthma Potentially Preventable Readmissions All cause readmission rate Congestive heart failure readmission rate Diabetes readmission rate Behavioral health readmission COPD readmission Stroke readmission

New Draft DSRIP Menu Category III Project Areas (cont.) Potentially Preventable Complications Perinatal Outcomes Birth trauma rates Elective pre 39-week delivery Diabetes Composite Measure Hemoglobin A1c (National Quality Forum (NQF) 0059) Blood Pressure (NQF 0061) Low-Density Lipoprotein Cholesterol (NQF 0064) Retinal or dilated eye exam (NQF 0055) Foot exam (NQF 0056) Nephropathy screening (NQF 0062). Patient Experience

New Draft DSRIP Menu Category IV Project Areas Potentially Preventable Admissions Congestive heart failure admission rate Diabetes, short-term complications, admission rate Diabetes, uncontrolled diabetes, admission rate Behavioral health potentially preventable admissions Chronic obstructive pulmonary disease or asthma in adults admission Hypertension admission rate Diagnosis and Management of Asthma 30-Day Readmissions All-cause readmission rate Congestive heart failure readmission rate Diabetes readmission rate Behavioral health readmission COPD readmission Stroke readmission Pediatric asthma

New Draft DSRIP Menu Category IV Project Areas (cont.) Provider Preventable Complications Patient-centered Health Care Patient satisfaction Medication management Emergency Department Admit decision time to ED departure time for admitted patients Diabetes Composite Measures Hemoglobin A1c Blood Pressure Low-Density Lipoprotein Cholesterol Retinal or dilated eye exam Foot exam Nephropathy screening

Roundtable

Contact Information Waiver Website & Email Address: http://www.hhsc.state.tx.us/1115-waiver.shtml TXHealthcareTransformation@hhsc.state.tx.us UMC Website: http://www.umcelpaso.org Region 15 - RHP Paso del Norte Blue Ribbon Committee Needs Assessment: http://www.elpasotexas.gov/health/_documents/BRCGapBook.pdf