1. Regional Healthcare Partnership Planning
Texas Healthcare Transformation and Quality Improvement Program
1115 Waiver Activities
And Workgroup Participation

2. Waiver Introduction
In an effort to reduce costs, the 2011 Texas Legislature directed the Texas Health and Human Services Commission to expand managed care and preserve hospital access to UPL (Upper Payment Limit) funding
In response, HHSC applied for an 1115 waiver
5 year waiver was approved by CMS in December 2011, and became effective immediately
Waiver authorizes Texas’ expansion of managed care (which took effect March 1st) and creates a new methodology for continuing UPL hospital funding

3. New Hospital Payment Methodology
Under the new waiver, trended historic UPL funds and additional new funds are distributed to hospitals through two pools:
Uncompensated Care (UC) Pool
Costs of care provided to individuals who have no third party coverage for the services provided by hospitals or other providers
Delivery System Reform Incentive Payments (DSRIP)
Support coordinated care and quality improvements through Regional Healthcare Partnerships (RHPs) to transform care delivery systems .

4. Transition Period
UPL payments have a one year transition through September 2012
Funding to hospitals remains largely the same during the first year.
Effective October 2012, payments to hospitals from the former UPL program will be made only through Uncompensated Care Pool and DSRIP Pool

5. What is DSRIP?
The Delivery System Reform Incentive Payment Pool provides “incentive” payments for health-care related projects and investments to increase or improve:
Access to health-care services
Quality of health-care and health systems
Cost/effectiveness of services and health systems
Regional collaboration and coordination

6. Qualifying for DSRIP and UC – Regional Healthcare Partnerships Development
To qualify for UC and DSRIP funds, local entities that currently receive UPL funds are required to collaborate in regions with other local entities, hospitals, and other key stakeholders to create RHPs.
The RHP anchor (Harris County Hospital District) serves as the primary point of contact for the region, coordinate RHP activities and provides administrative oversight.
RHP regions should reflect deliver systems and geographic proximity.
HHSC has developed a map with suggested regions, but final decisions have not yet been made. .

7. RHP Activities
RHPs bring participants and stakeholders together to develop an RHP Plan for public input and review
Participants with IGT matching funds (a unit of local government including a public hospital, hospital district, county, city, or local mental health authority) will make final decisions regarding the selected incentive projects included in the RHP plan
The anchor does not decide which projects other IGT entities will select

8. RHP Plan Requirements
RHP Plans are developed by each RHP, but the general requirements are determined by HHSC and CMS and will include:
Regional health needs assessments
Participating local entities
Identification of hospitals receiving incentives
Incentive projects by DSRIP categories
Yearly performance measures

9. Workgroup Activities
Based on a review of more than 30 community needs assessment documents, topical Stakeholder Workgroups have been created to assist in the development of potential DSRIP performance activities.
The primary focus is to identify innovative healthcare initiatives to improve access to care, quality of care, cost of care, and the overall health of our community population.
Each workgroup will collaborate with other members to develop specific recommendations that will be submitted to the Regional Advisory Council for review and consideration.
IGT entities will make the final determination of which DSRIP measures they will include in their program. .

10. DSRIP Plan Options
HHSC is developing a list of DSRIP initiative options from which workgroups will select projects for consideration
Group of “clinical champions” is advising HHSC on menu options
List is scheduled to be released April 1st
HHSC will select a at least limited number of projects that all hospitals will be required to include in their RHP plan
HHSC also is developing metrics for measuring progress in reaching project goals, but we do not know how specific the metrics will be or how much flexibility RHP entities will have

11. DSRIP Category 1: Infrastructure Development
Expand behavioral health care access
Provide culturally competent care
Expand primary and specialty care access
Enhance health promotion and disease prevention
Improve urgent and emergent care
Improve performance and reporting capacity

12. DSRIP Category 2: Program Innovation and Redesign
Create and implement:
Strategies to implement Potentially Preventable Events
Behavioral health delivery systems
Delivery models using telemedicine
Financing mechanisms for providers
Health promotion and disease prevention improvements
Strategies to reduce inappropriate ED use
Medical Home Model
Disease registry management

13. DSRIP Category 3: Quality Improvements
Improvements in prevention and/or management of:
Behavioral health admissions
Obesity
Congestive heart failure
Potentially preventable admissions
Asthma
Pre-39 week elective induction
Diabetes
Birth trauma rate
Healthcare-acquired infections
Central line-associated bloodstream infections
HIV
Surgical site infections
Hypertension
Stroke/chest pain
Medication management

14. DSRIP Category 4: Population-focused Improvement
Patient/care giver experience
Care coordination
Preventative health
At-risk populations

15. Timeline of Key Dates Task Responsibility Due Date
UC Protocol Due to CMS
HHSC
DSRIP Project Menus for Categories 1,2,3,4 Due to RHPs
DSRIP Payment Protocols Due to RHPs
RHP Urban Regions Due to HHSC
Urban RHPs
RHP Rural Regions Due to HHSC
Rural RHPs
RHP Regions Due to CMS
Final Urban RHP DSRIP Plans Due to HHSC
DSRIP Payment Protocols and Project Menus Due to CMS
Final Rural RHP DSRIP Plans Due to HHSC
Final DSRIP Plans Due to CMS

16. Goals for Workgroup Planning
Brainstorm project ideas in workgroup areas for each DSRIP category (preferably no more than 5-10 ideas for all 4 categories)
Identify goal of projects
Identify expected outcomes
Identify challenges/issues
Identify metrics

17. Things to keep in mind
Projects must have an IGT partner to provide the non-federal share
Projects must be something you are not currently doing today; may be projects that you planned to do
Outcomes must be measurable. Metrics will determine if you have achieved goals in each year (and payment). Make them a stretch, but doable.
Advance payments are not available, so initiatives need to be something that can be financed in the first year. Federal match payments available at the end of year one will provide some working capital in year two.

18. Ground Rules Listen actively to others
Practice meeting courtesy -- one person talks at a time; do not interrupt; no side conversations
All ideas are welcome
Express yourself completely and concisely
Participate enthusiastically and fully but do not “over-participate”
Mute cell phones and other devices; stay focused on conversation in the room

19. Project Example – Infrastructure (From California DSRIP Plan)
Implement Disease Registries
Five Year Goals:
Primary Care providers and staff of all primary care clinics will be trained in the use of disease management registry, panel management and the chronic care model
Providers will receive monthly registry reports on their patients with diabetes and hypertension
Providers at all primary care clinics will meet monthly with a panel manager and the care team to coordinate care
Process Milestones:
Year 1 - Develop curriculum and initiate training of providers and staff at facility’s primary care clinics in the use and principles of disease management registry, including training in the chronic care model and panel management
Metrics: Training logs, agendas, curricula, presentations and participant learning survey
Year 2 - Train 75% of providers and staff at all primary care clinics in the use and principles of disease management registry. Include training in the chronic care model and panel management
Metrics: Training logs, agenda, presentations and participant learning survey
Year 3 – Integrate 2-hour refresher training into annual training plans of all primary care clinic clinical staff, and achieve a minimum of 75% completion of training by clinical staff
Metrics: Document that annual competency plans for primary care clinics include chronic disease training; document attendance rate; training logs

20. Project Example –Innovation and Redesign (From California DSRIP plan)
Improve Patient Flow in the Emergency Department
Five Year Goals
Reduce overall ED length-of-stay for both low acuity patients and for patients admitted to the hospital by 20% compared to the 2010 baseline 2010.
Process Milestones:
Year 1 - Develop and disseminate monthly med-surgical ED flow report that identifies average ED length-of-stay for both low acuity patients (level 4&5) and for patients admitted to the hospital, and establish an organizational baseline for 2010.
Metrics: Average length-of-stay for the two populations as measured by electronic time stamps in ED information system
Year 2 – Identify and implement three improvement interventions and monitor and report their impact on flow
Metrics: Reports documenting interventions and results
Year 3 – Reduce overall ED length-of-stay for both low acuity patients(level 4 and 5) and for patients admitted to the hospital by 10% compared to baseline 2010
Metrics: Average length-of-stay for the two populations as measured by electronic time stamps in ED system
Year 4 – Reduce overall ED length of stay for both low acuity patients and for patients admitted to the hospital by 20% compared to baseline 2010
Metrics: Average length of stay for the two populations as measured by electronic time stamps in ED system