1. Region 15 Regional Healthcare Partnership 40th Public Meeting
Wednesday, january 25, 2017
University Medical Center of El Paso
Anchor Hospital
Texas tech university health sciences center – Medical Education Bldg (MEB) – Rm 1150

2. Confirmation of Participants
University Medical Center of El Paso
Texas Tech University Health Sciences Center at El Paso
El Paso Children’s Hospital
Hospitals of Providence (Tenet)
Las Palmas – Del Sol Hospital (HCA)
El Paso Health Department
Emergence Health Network
El Paso Medical Society
Visitors
MCOs
Roll Call

3. ANCHOR UPDATES Cathy Gibson Anchor RHP 15 Waiver Extension
Waiver Renewal
Cat 3 Workbook
Cat 3 Corrections
Timeline

4. ANCHOR UPDATES Category 3 Workbook and Goal Calculator
Has been updated (Data thru DY5 reporting)
Includes Myers & Stauffer updates
Does not include NMI data just submitted
ANCHOR UPDATES

5. ANCHOR UPDATES Category 3 Interim Corrections
DY6 R1 Cat 3 Interim Corrections Template now posted
Criteria for this is in the Category 3 Summary Documents online
Due Feb 19th (if any)
ANCHOR UPDATES

6. ANCHOR UPDATES Waiver Extension HHSC will be submitting to CMS soon
Requesting an additional 21 months of LEVEL FUNDING
UC and DSRIP pools
Continuation of the Managed Care Provisions in the Waiver
Initial 15-Month (thru September 30, 2019)
ANCHOR UPDATES

7. ANCHOR UPDATES Waiver Renewal Longer Term
HHSC working on Program Funding and Mechanics (PFM) protocol DRAFT
Specific to DY7 ONLY (at this time)
HOWEVER will lay groundwork for up to 4 additional DYs
To be proposed in May 2017; Effective: September 2017
Anchor summit on February 6th
Encourage stakeholder feedback on DRAFT proposal (when released)
ANCHOR UPDATES

8. TIMELINE January 13, 2017 January 16, 2017 January 31, 2017
DY5 Oct DSRIP payments processed for hospitals
January 16, 2017
11:59 pm Responses due to HHSC for NMI requests.
January 31, 2017
DY5 Oct DSRIP payments processed for all other providers
February 24, 2017
HHSC/CMS approve or deny NMI requests

9. REGIONAL Project review

10. Outcome improvements – RHP 15
15 possible domains

11. RHP 15 Projects

12. NEW REGIONAL learning collaboratives
DIABETES LEARNING COLLABORATIVE
Chair: Moses Priego – UMC
BEHAVIORAL HEALTH LEARNING COLLABORATIVE
Chair: Cindy Hernandez – HER
HEALTH DATA EXCHANGE COLLABORATIVE
Chair: Rosie Sanchez – TTUHSC

13. Key Aspects of collaboratives
Focus on Closing the gap of a known problem with known solutions
Use Standard Model for this work
Must be Fast Paced with timeline for goals
Must use Standard Measures
Working Membership
Sharing of ideas and data is required
“All Teach, All Learn” philosophy

14. DY6 MILESTONES (REVIEW)
DSRIP Program Manager
Oscar Perez
Quantifiable Patient Impact (QPI) – Category 1 and 2
Total QPI (Reportable in DY6 R1)
MLIU QPI (Reportable in DY6 R1)
Core Component Reporting
(Not Reportable until DY6 R2)
Sustainability Plan
Category 3 and 4
(previous rules apply)
Previous Carry Forwards

15. Sustainability Plan
“How does the institution plan to keep this project going when the DSRIP dollars are gone?”

16. DY6 Sustainability Planning
Beginning the process …

17. Levels of Evaluation PROVIDER LEVEL PROJECT LEVEL
Collaboration with Medicaid Managed Care
Health Information Exchange
PROJECT LEVEL
Collaboration with Medicaid Managed Care
Value Based Purchasing/Alternativ e Payment Models
Other Funding Sources
Project Evaluation
Health Information Exchange

18. Assess Project’s Sustainability Potential
Collaboration with Medicaid Manage Care
Value Based Purchasing/ Alternative Payment Models
Other Funding Sources
Project Evaluation
Health Information Exchange

19. Collaboration with Medicaid Managed Care
List those enrolled as a network provider
If NOT enrolled – Why NOT?
APM – Alternative Payment Model
VBP – Value Based Payment Methodologies
APM/VBP Arrangements?
Encounter reporting?
Tracking of Services? Cost of Services?
Incentives Earned?
What is working? What is NOT working?
If NOT doing APM/VBP – Why NOT?

20. Collaboration with Medicaid Managed Care
Are MCO members being referred to your project? Why? Why NOT? Are Services of the project NOT billed to Medicaid (for MCO members)? Give Type of Service & Billing Code Are other non-Medicaid payers billed for Services of the project?

21. APM/VBP Methodologies
FFS (Fee for Service) + Incentive and/or Disincentive Component? DRG (Diagnosis Related Group) + Incentive and/or Disincentive Component? Partial Capitation? Full Capitation? Bundled Payment? Episode Payment? "Non-financial Incentive (i.e. administrative relief, preferential provider status)“? Supplemental Payments? Shared Savings/Risk?

22. Value Based Purchasing/ Alternative Payment Models
Discussing with MCO potential for payment for DSRIP services via APM/VBP methodology?
If yes, what is being discussed? If no, WHY not?
APM/VBP Arrangements with NON-Medicaid payers?
If yes, who? And what are terms?

23. Other Funding Sources Does the project have other funding sources?
Grant funding?
Insurance Payments?
Is the project pursuing agreements with other government agencies? Why NOT?
City, County, School Districts, etc...
Foundations?
Other Organizations?

24. Project Evaluation
Cost-benefit analysis, Return-on-investment analysis or Other quality related evaluation of this project
Aspects of the Project to evaluate
Evaluation Methodology (described)
Quality Outcomes evaluated
Positive Impact (based on formal or informal evaluation)
Assets
Successes
Outcomes
Improvements

25. Project Evaluation Areas for Improvement Barriers to success
Remaining Needs
Unmet Goals
Adjustments to the project
Already implemented OR
Being considered
Cost Effectiveness
How is it evaluated and explored? **In the context of CONTINUING the intervention (project)
Replicable
Other states?
Other providers?
Key to Project Success
Identify

26. Health Information Exchange
Does project exchange health-related information between/among individuals/ organizations?
Who is exchanging data?
What type of data is being exchanged?
Claims Data
Clinical Data
Case Notes
Other

27. Health Information Exchange
Describe data being exchanged
What systems are used to exchange the data?
Is it “real-time” data?
If lags, what is the lag time?
Actions being made to reduce lag time?
Obstacles to exchange of health related data:
Contract agreement(s) (too burdensome)?
Inadequate Technology?
Technology too costly?
Project does not require data transfer?
Other?
Are there ACTIONS to overcome these obstacles?
Formal HIEs being used on this project?
Why NOT?

28. Input/comments on proposed sustainability PLANning
DSRIP Program Manager
Oscar Perez
Go to your Browser or Cell Phone: OR Text: OSCARPEREZ394 To: To join the session

29. STAKEHOLDER’s FORUM To be scheduled early summer 2017 FOCUS
Discuss Waiver Renewal
Share Successes and Challenges of the DSRIP Projects
Discuss Community Health Needs Assessment
IDEAS being solicited for format and location

30. ROUNDTABLE

31. Contact Information
NEW Waiver Website:
Waiver
TXHealthcare
UMC RHP15 Website:
Region 15 - RHP

32. Next Meeting: February 22, 2017 1:00pm
Texas Tech (MEB)

33. Cat 1 and 2 Requirements (Milestones)
Standardized for ALL projects
Four (4) Total Milestones
2 Quantitative
2 Qualitative
1. Total QPI
Value is 25%
2. MLIU QPI
3. Core Component Report
4. Sustainability Plan

34. MLIU – Medicaid low income uninsured
To qualify as MLIU QPI
Enrolled in Medicaid
at the time of at least one encounter during the DY
Qualified as Low-Income or Uninsured
Below 200% of Federal Poverty Level (FPL) OR
at the time of at least on encounter during the DY
Uninsured
at the time of a separate encounter during the DY
If patient was on Medicaid and then became Low-Income or Uninsured during the DY
Counted as “Medicaid” for DSRIP purposes
Either
Individuals Served OR
Encounters Provided
Stipulated by the project

35. Milestone 1: Total QPI HHSC will determine the target
Same as DY5 (TOTAL QPI Goal)
May request variance from HHSC (TBD)**
Grouping must be same as DY5
No changes
Pre-DSRIP baselines remain the same
Carry Forward IS allowed

36. Milestone 2: MLIU QPI If project had MLIU goal in DY5
DY6 goal is same as DY5 goal
Pre-DSRIP baseline stays same
If project had no MLIU goal in DY5
DY6 is
Pre-DSRIP QPI x %MLIU (DY3 or earliest on record)
EXAMPLE
MLIU QPI MAY BE PFP OR PFR
Projects in Project Area 1.9.*
% MLIU Not Achieved in DY3, DY4, DY5
Identified by HHSC and notified

37. Milestone 3: Core Component Reporting
Based on Project Option
Each Core Component must be addressed
Usually 3 or more of these
ALL have a Continuous Quality Improvement (CQI) Element
EXAMPLE
2.9.1
A,B,C,D,E A
Identify frequent ED users and use navigators as part of a preventable ED reduction program. Train health care navigators in cultural competency. B
Deploy innovative health care personnel, such as case managers/workers, community health workers and other types of health professionals as patient navigators. C
Connect patients to primary and preventive care. D
Increase access to care management and/or chronic care management, including education in chronic disease self‐management. E
Conduct quality improvement for project using methods such as rapid cycle improvement. Activities may include, but are not limited to, identifying project impacts, identifying “lessons learned,” opportunities to scale all or part of the project to a broader patient population, and identifying key challenges associated with expansion of the project, including special considerations for safety‐net populations.