1. DY 7-8 CAT C Measure Bundles
Hospitals & Physician Practices

2. What Approach do you plan on taking?
Keep the Trains Running
Zero-based Bundling
Or both?
If providers select outcome measure bundles that do not align with the current DSRIP project, that doesn’t mean the project must end

3. Have you Defined your System?
System is defined by the location(s) where your patients are served and the types of services your patients are receiving.
Universe of Patients
TPI doesn’t matter
CAT C Measures naturally limit
Required vs. Optional
FAQ: CAT B – System Definition and PPP

4. RHP12 Hospitals & Physician Practices Minimum Point Thresholds (MPTs)
Performing Provider Name
DY7 Maximum Total Performing Provider Valuation
Minimum Point Threshold (MPT)
Preferred Hospital Leasing Muleshoe Inc
$250,000 1
Hemphill County Hospital District
Lynn County Hospital District
Plains Memorial Hospital DSH Acct (Castro County)
Preferred Hosp Leasing, Inc. dba Collingsworth Gen
Parmer County Community Hospital
Lockney Gen Hosp Dist (W.J. Mangold Mem Hosp)
$323,698
Hansford County Hospital District
$338,691
Ochiltree General Hospital
$373,302
Swisher Memorial Healthcare System, dba Swisher Me
$435,083
Lamb Healthcare Center
$516,472
Seminole HD of Gaines Co dba Memorial Hospital
$531,463
Moore County Hospital District dba Memorial Hospit
$628,959
Yoakum County dba Yoakum County Hospital
$832,691 2
Lubbock Heritage Hospital dba Grace Medical Center
$910,884
Dallam-Hartley Counties Hosp District dba Coon Mem
$921,373
Medical Arts Hospital
$959,477
Terry Memorial Hospital District Brownfield Region
$1,000,678
Prime Healthcare Services - Pampa, LLC dba Pampa R
$1,167,049
Childress County Hospital District dba Childress R
$1,276,649 3
Deaf Smith County Hospital District dba Hereford R
$1,353,898
Baptist St. Anthony's Health System
$1,426,984
D. M. Cogdell Memorial Hospital (Scurry County)
$1,815,289 4
Lubbock Regional MHMR Center dba Sunrise Canyon Ho
$2,439,626 5
Methodist Children's Hosp dba Covenant Children's
$3,943,820 8
Texas Tech University Health Sciences Center AMA
$5,470,479 11
Amarillo Inc dba Northwest Texas Healthcare
$5,909,771 12
GPCH LLC dba Golden Plains Community Hospital
$7,458,360 33
Texas Tech University Health Sciences Center Offic
$8,934,008 18
Covenant Health System dba Covenant Medical Center
$19,144,099 38
Lubbock County Hospital District dba University Me
$31,558,946 63
Totals
101,171,748
226
31 Providers
29 Hospitals
2 AHSC Physician Practices
22 or 71% less than 3 MPTs

5. Category C Measure Bundles
23 Total Bundle Options
2 High State Priorities
Maternal
Pain Management
8 State Priorities

6. Category C Optional & Required Measures
Some optional without points – Why Chose? Spread risk
Ones with points are not impacted by state multipliers
Limitations
K1 & K2 can only be selected by hospitals with a valuation <=2.5M
Providers >2.5M must select bundle with 3 point measure or optional 3 point selection
Optional Measures that add points cannot add points if it duplicates a measure in another selected bundle
H3 & B1
H3 & Ks
B1 & K2
C1 & K1

7. Minimum Volume Denominator Definitions
Significant - =>30 MLIU (exception can be requested to use all payer w/ good cause)
Insignificant – <30 MLIU but greater than 0 (unless an exception approved)
No Volume – MLIU = 0
Who to include in your MLIU?
Medicaid = Medicaid Fee-for-Service, Managed Care & Dual. Also include wrap-around or secondary coverage
Low Income = CHIP and any patient you have documentation of income below 200% FPL (self attestation included)
Uninsured = Self Pay

8. Minimum Volume Denominator Requirements
Significant Volume (=>30) for at least ½ of required measures
Optional can ONLY be selected if MLIU denominator has significant volume (=>30)
Required Measures
Insignificant Volume – NO “Achievement” valuation
NO Volume – Measure Removed, No Valuation

9. Eligible Denominator Population
Measure Settings
Primary Care
Urgent Care
BH IP
BH OP ED
Hospice
Hospital OB
Dental Clinic
OP Specialty Care (can be further refined for applicable measures)
Active Patient Definition
Primary Care = 2 visits in 12 month measurement period and/or 1 visit in measurement period and 1 visit in 12 months prior
OP Specialty = Defined by Performing Provider in RHP plan
All Other Settings NOT allowed to be limited by active patient
NOTE: Active Patient Definition is different for Category B

10. Selecting Outcome Measure Bundles
Choose possible Bundles depending on the approach you decide to take
Evaluate all outcome measures within the bundle
Required
Optional w/points
Optional without points
Is data available to produce a baseline for calendar year 2017? See Specs
Does the bundle ALIGN with other quality programs or strategic priorities? Organizational, Provider, Medicaid MCO or other
Is there room to improve?
What is the likelihood of achieving improvement?
*Must have at least ½ w/significant volume
*Must have significant volume to select optional
Must report All-Payer, Medicaid-Only, & LIU-Only to be eligible for reporting milestone (unless approved exemption)

11. After Measure Bundle Selection
CAT A, B & D Requirements
Valuation
Submit new RHP plan January 31st 2018

12. DSRIP Funding Distribution
Item
DY7
DY8
RHP Plan Submission
20% NA
Category A – Required Reporting 0%
Category B- MLIU PPP
10%
Category C – Measure Bundles & Measures
55 or 65%
75 or 85%
Category D – Statewide Reporting Measure Bundle
5 or 15%

13. Structure & Basis for Payment
Category B–MLIU PPP
Payment
100% w/allowable variation
100%
90-99% (or 100% less allowable variation as upper limit)
90%
75-89%
75%
50-74%
50%
<50% 0%
Category C – Measure Bundles DY
Innovative Measure (P4R)
P4P
P4P delayed baseline
DY7
100% RY1 reporting
25% baseline Reporting
25% PY1 reporting
50% DY7 goal achievement
50% goal achievement
DY8
100% RY2 reporting
25% PY2 reporting
75% DY8 goal achievement
75% DY8
goal achievement
Category C-Measure Bundles
Payment
100%
=>75%
75%
=>50%
50%
=>25%
25%
<25% 0%