1. RHP12 Regional Meeting & Stakeholder Forum
1115 Waiver: Transitioning to DY 7-8
Process and Updated RHP Plan
March 23, 2018
1:00pm – 5:00pm
McInturff Conference Center

2. Medicaid 1115 Waiver Overview
11/8/2018
Medicaid 1115 Waiver Overview
5 years
2011 – 2016
DYs 1-5
15 months
Through Dec 2017
DY 6
2017 – 2022
(4 years for DSRIP)
DY 7-11
Approved
$24.8 billion (+)
Approved
$7.75 billion
Approved $29 billion
Extensions continue programs and focus on:
Outcomes
Sustainability
Transition to quality- based payment systems across managed care and providers
Expanded Medicaid managed care statewide and created incentive pools:
Uncompensated Care (UC)
Delivery System Reform Incentive Payment (DSRIP)
Dollars shown as “All Funds”
(42% Local / 58% Federal)

3. Uncompensated Care (UC) Pool
Significant changes to data source and calculation methodology of UC Pool incentives.
Key Dates – Failure to meet any of these deadlines will result in 20% reduction in expenditure authority from the UC pool for the program year. Reductions are cumulative.
Draft UC protocol due to CMS by March 30, 2018
Draft TAC rule to be published by July 31, 2018
Revised draft UC applications due to CMS by May 1, 2019
Final TAC rule to be published by January 30, 2019 and effective by September 30, 2019
Revised UC protocol to be implemented by October 1, 2019
Draft Protocol: payments-protocol
For more information, contact HHSC at or

4. Address Community Needs
11/8/2018
We picked Cat 1 or 2 “projects”
We implemented projects
60% upon completion
We selected outcome measures related to the projects
30% upon achievement
Original Waiver DY 2-6
Address Community Needs
HHSC approves selections and plan mods
Rapid Cycle Improvement
Outcome measure bundles
55-85% upon achievement
Implement
“core activities” 0%
Invest system-wide
DY 7-8+
Address Community Needs

5. Hospital Example DSRIP DY 5-6 DSRIP DY 8 $1,464,687 per year
Cats 1 & 2 $849,021(58%)
Gestational diabetes program
Cardiovascular screening program
Cat 3 $491,540 (34%)
% LBW births
Controlling high blood pressure
Cat 4 $124,126 (8%)
DSRIP DY 8
$1,464,687 per year
Cat A (0%)
Cat B 146,469 (10%)
MLIU PPP
Cat C 1,098,515 (75%)
1 Bundle (2-11 measures)
Cat D 219,703 (15%)
Minimum Point Threshold (MPT) = 3

6. Achievement Targets Category A Category B Category C Category D
Implement Core Activities
Progress on APM/VBP
Conduct cost benefit analysis
Category B
Maintain number MLIU served
Category C
“Gap closure” improvement over baseline
IOS: 2.5% (DY7), 10% (DY8)
QSMIC: 5% (DY7), 20% (DY8)
Category D
Reporting on population- based measures

7. Evolution from Project to System Approach
Updated protocol approved for DY7-8, October 1, 2017 to September 30, 2019 (DY9-11 TBD)
Builds upon current DSRIP structure
Individual projects evolve into larger, system-level initiatives and targeted clinical outcomes
Focus remains on target population: Medicaid recipients and low-income uninsured individuals
Continues advancing the Triple Aim of Healthcare
Clinical outcomes and quality standards remain priorities
Promotes collaboration for organizations who share patients

8. Regional Healthcare Partnership (RHP) Structure
47 counties
36 Performing Providers
$119.4M per DY7 and DY8 for DSRIP
20 RHPs
254 Counties
>300 Performing Providers
$3.1B per DY7 and DY8 for DSRIP

9. Regional Healthcare Partnership 12 DY 2-6 vs. DY7-8
Provider Type
Number of Providers
DY 2-6
Projects
DY 7-8 Minimum Point Thresholds
DRAFT RHP Plan Update
Rural Hospitals 22 48 66
128
Urban Hospitals 6 20
126
152
Community Mental Health Centers 4 15 30 34
Health Science Centers 2 13 29 35
Local Health Department 1
Psychiatric Hospital 5
Totals 36 99
262
355

10. Status of RHP 12 Plan Update
FINAL
Performing Provider Eligibility
Maximum $ allocations
Minimum Point Thresholds
Community Needs Assessment
Not Final/Subject to Change
System Definitions
MLIU & Total PPP Goals & Percentages
Measure/bundle & Core Activity selections
Learning Collaborative Plan
Operational guidance from HHSC
Collaborating Stakeholders

11. DRAFT RHP12 Plan Update Two Sections: Section I Section II
Anchor Template Tabs
Anchor Entry
RHP Organization
Regional Valuation
Regional Category B
Regional Category C Summary
Community Needs Assessment
Stakeholder Engagement
Learning Collaborative Plan
Section II
Proposed Core Activities by Outcome Measure Bundle/Theme

12. RHP 12 DSRIP Performing Providers (DY7-8) 29 Hospitals
Baptist St. Anthony Health System
Brownfield Regional Medical Center
Childress Regional Medical Center
Collingsworth General Hospital
Coon Memorial Hospital
Covenant Children’s Hospital
Covenant Medical Center
D.M. Cogdell Memorial Hospital
Golden Plains Community Hospital
Grace Medical Center
Hansford County Hospital District
Hemphill County Hospital District
Hereford Regional Medical Center
Lamb Healthcare Center
Lynn County Hospital District
Medical Arts Hospital
Memorial Hospital (Gaines County)
Memorial Hospital (Moore County)
Muleshoe Area Medical Center
Northwest Texas Healthcare System
Ochiltree General Hospital
Plains Memorial Hospital
Pampa Regional Medical Center
Parmer County Community Hospital
Sunrise Canyon Hospital
Swisher Memorial Hospital
University Medical Center
W.J. Mangold Memorial Hospital
Yoakum County Hospital
DRAFT - Expected to Change - 3/23/18

13. RHP 12 DSRIP Performing Providers (DY7-8) 4 CMHCs, 1 LHD & 2 HSCs
Central Plains Centers
StarCare Specialty
Texas Panhandle Centers
West Texas Centers
City of Amarillo Health Dept.
Texas Tech Health Sciences Center - Amarillo
Texas Tech Health Sciences Center - Lubbock
5 UC only Providers:
Cochran Memorial Covenant – Levelland
Covenant – Plainview Crosbyton Clinic Hospital
Parkview Hospital
DRAFT - Expected to Change - 3/23/18

14. Regional Valuation By Performing Provider Type
By Category also included in Draft plan
Type
DY7
DY8
Total Valuation
Hospitals
86,767,261
173,534,523
Physician Practices
14,404,487
28,808,973
CMHCs
15,096,348
30,192,697
LHDs
3,124,788
6,249,575
TOTAL
119,392,884
238,785,768

15. Regional CAT B – System Definition
System Components by Performing Provider Type
Type IP ED
OP Clinics
Maternal
Urgent Care
Optional
Hospitals 29 28 17 7 1
Type
Primary Care
Specialty Care
Physician Practices 2
Type
Home-Based Services
Office/Clinic
CMHC 3 4
Type
Clinics
Immunization Locations
LHD 1

16. MLIU by PPP
TBD – Majority of the data used in the DRAFT RHP Plan update is generic data. Updates will occur in April

17. Hospital & Physician Practice Measure Bundles
A1: Chronic Disease Mgmt. – Diabetes
A2: Chronic Disease Mgmt. – Heart Disease
B1: Care Transitions & Hospital Readmission
B2: Patient Navigation & ED Diversion
C1: Primary Care Prevention – Healthy Texas
C2: Primary Care Prevention - Cancer Screening
C3: Hepatitis C
D1: Pediatric Primary Care
D3: Pediatric Hospital Safety
D4: Pediatric Chronic Disease Mgmt. - Asthma
D5: Pediatric Chronic Disease Mgmt. - Diabetes
E1: Improved Maternal Care
E2: Maternal Safety
F1: Improved Access to Adult Dental Care
F2: Preventive Pediatric Dental
G1: Palliative Care
H1: Integration of Behavioral Health in a Primary or Specialty Care Setting
H2: Behavioral Health and Appropriate Utilization
H3: Chronic
Non-Malignant Pain
H4: Integrated Care for People with Serious Mental Illness
I1: Specialty Care
J1: Specialty Care
K1: Rural Preventive Care
K2: Rural Emergency Care

18. Measure Bundles Selected in RHP 12 DRAFT
A1: Chronic Disease Mgmt. – Diabetes
A2: Chronic Disease Mgmt. – Heart Disease
B1: Care Transitions & Hospital Readmission
B2: Patient Navigation & ED Diversion
C1: Primary Care Prevention – Healthy Texas
C2: Primary Care Prevention - Cancer Screening
C3: Hepatitis C
D1: Pediatric Primary Care
D3: Pediatric Hospital Safety
D4: Pediatric Chronic Disease Mgmt. - Asthma
D5: Pediatric Chronic Disease Mgmt. - Diabetes
E1: Improved Maternal Care
E2: Maternal Safety
F1: Improved Access to Adult Dental Care
F2: Preventive Pediatric Dental
G1: Palliative Care
H1: Integration of Behavioral Health in a Primary or Specialty Care Setting
H2: Behavioral Health and Appropriate Utilization
H3: Chronic
Non-Malignant Pain
H4: Integrated Care for People with Serious Mental Illness
I1: Specialty Care
J1: Specialty Care
K1: Rural Preventive Care
K2: Rural Emergency Care

19. Measure Bundles Selected in RHP 12 DRAFT
A2: Chronic Disease Mgmt. – Heart Disease
C1: Primary Care Prevention – Healthy Texas
D1: Pediatric Primary Care
H2: Behavioral Health and Appropriate Utilization
H4: Integrated Care for People with Serious Mental Illness
K1: Rural Preventive Care

20. MPT Summary Performing Provider Name MPT
Total Points in Selected Measure Bundles / Measures
Baptist St. Anthony's Health System 3 6
Central Plains Center for Mental Health Mental Ret
Childress County Hospital District dba Childress R
City of Amarillo
Preferred Hosp Leasing, Inc. dba Collingsworth Gen 1
Dallam-Hartley Counties Hosp District dba Coon Mem 2
Methodist Children's Hosp dba Covenant Children's 8 18
Covenant Health System dba Covenant Medical Center 38 39
D. M. Cogdell Memorial Hospital (Scurry County) 4
GPCH LLC dba Golden Plains Community Hospital 33 35
Lubbock Heritage Hospital dba Grace Medical Center
Hansford County Hospital District
Hemphill County Hospital District
Deaf Smith County Hospital District dba Hereford R
Lamb Healthcare Center
Lockney Gen Hosp Dist (W.J. Mangold Mem Hosp)
Lynn County Hospital District
Medical Arts Hospital 9
Moore County Hospital District dba Memorial Hospit
Preferred Hospital Leasing Muleshoe Inc
Amarillo Inc dba Northwest Texas Healthcare 12 20
Ochiltree General Hospital
Prime Healthcare Services - Pampa, LLC dba Pampa R
Parmer County Community Hospital
Plains Memorial Hospital
Seminole HD of Gaines Co dba Memorial Hospital
Lubbock Regional MHMR dba StarCare Specialty 10
Lubbock Regional MHMR dba Sunrise Canyon Hospital 5
Swisher Memorial Healthcare System dba Swisher Memorial
Terry Memorial Hospital District Brownfield Regional
Texas Panhandle Mental Health Retardation 11 13
Texas Tech Health Sciences Center Amarillo 16
Texas Tech Health Sciences Center Lubbock 19
Lubbock County Hospital dba University Medical Center 63
West Texas Centers for MHMR 7
Yoakum County dba Yoakum County Hospital
TOTAL RHP 12
262
355

21. Anchor Input Community Needs Assessment Stakeholder Engagment
Summarized process for updating our region’s community needs assessment
Stakeholder Engagment
Extension Stakeholder engagement forum
Learning Collaborative Plan
Describing opportunities and requirements for shared learning among DSRIP providers in the region

22. RHP 12 Community Needs TIER 1 – CRITICAL NEED TIER 2 – URGENT NEED
CN.1 – Severe primary care provider shortage, wait time, expense, lack of insurance, access to care
CN.2 – Lack of mental health services, inability to get an appointment, lack of insurance, need to use ERs for initial contact
CN.3 – Insufficient maternal and prenatal care, especially the first trimester teen pregnancy, high percentage of unmarried mothers
CN.4 – Poor insurance support or uninsured
CN.5 – High incidence of obesity, diabetes mellitus, and heart disease
CN.6 – Need for specialist to assist in treatment of obesity, diabetes mellitus, heart disease, asthma, chronic lung disease & other chronic disease
CN.7 – Need for cancer screening with mammograms, pap smears, colonoscopy, sigmoidoscopy, rectal exam
CN.8 – Alcohol abuse and binge drinking, substance abuse
TIER 3 – IMPORTANT BUT LESS URGENT
CN.9 – High incidence of sexually transmitted disease
CN.10 – Tobacco Use
CN.11 – High Prevalence of asthma and care issues
CN.12 – Inadequate vaccination of the population
CN.13 – Shortage of dental care
CN.14 – HIV screening

23. Timeline for Completion, Submission, Review and Approval of RHP 12 Plan Update
Event
March 22, 2018
RHP 12 DRAFT RHP Plan Update posted to Website
March 23, 2018
RHP 12 Regional Meeting & Stakeholder Forum
March 23-April 15
Stakeholder Comment Period
March 30, 2018
RHP12 deadline for Providers to submit Final RHP Plan Update Templates to Anchor
April 24, 2018
Last chance for providers to make changes
April 27, 2018
Anchor sumbits final RHP Plan Update to HHSC
April 30, 2018
HHSC deadline for Anchor to submit completed RHP Plan Update
May TBD
Webinar to review final plan
May-June 2018
HHSC reviews RHP Plan submissions and may request additional information
June 30, 2018
HHSC approves RHP Plans

24. Thank you for attending
RHP12 Plan Update is on our website:
For more information & comment submission:
Bobbye Hrncirik
VP and Anchor RHP12