Regional Healthcare Partnership Plan Updated May 2018

Regional Healthcare Partnership Plan Updated May 2018
Interactive Tool This interactive tool is designed for providers and community stakeholders to better understand the transformation projects being implemented in RHP 6 as part of the Texas Medicaid 1115 Waiver. This tool provides information about the projects, including project descriptions, incentive-based milestones, and current status. Contact information for the performing providers is also included. Users are encouraged to contact the providers to learn more about the projects and identify opportunities for collaborating with one another. Questions may also be directed to What is the Texas 1115 Waiver? Continue

What is the Texas 1115 Waiver?
In December 2011, the Texas Health and Human Services Commission (HHSC) received federal approval of a five- year waiver that allows the state to expand Medicaid managed care while preserving hospital funding, provides incentive payments for health care improvements, and directs more funding to hospitals that serve large numbers of uninsured patients. HHSC established geographic boundaries for new Regional Healthcare Partnerships (RHP). Each RHP developed a plan that identifies the participating partners, community needs, proposed projects and funding distribution. RHP 6 includes the following counties: Atascosa, Bandera, Bexar, Comal, Dimmit, Edwards, Frio, Gillespie, Guadalupe, Kendall, Kerr, Kinney, La Salle, McMullen, Medina, Real, Uvalde, Val Verde, Wilson, and Zavala. Each region is “anchored” by a public hospital or other governmental entity. University Health System is the anchor for RHP 6. Through the 1115 Healthcare Transformation waiver, supplemental payment funding, managed care savings, and negotiated funding goes into two statewide pools worth $29 billion (all funds) over five years. Funding from the pools is being distributed to hospitals and other providers to support the following objectives: (1) an uncompensated care (UC) pool to reimburse for uncompensated care costs as reported in the annual waiver application/UC cost report; and (2) a Delivery System Reform Incentive Payment (DSRIP) pool to incentivize hospitals and other providers to transform their service delivery practices to improve quality, health status, patient experience, coordination, and cost-effectiveness. Uncompensated Care Pool Payments are designed to help offset the costs of uncompensated care provided by the hospital or other providers. DSRIP Pool Payments are incentive payments to hospitals and other providers that develop programs or strategies to enhance access to health care, increase the quality of care, the cost-effectiveness of care provided and the health of the patients and families served. CMS approved a request to extend the waiver through December Sept. 30, 2022. Continue

Instructions for Using this Interactive Tool
The originally submitted Regional Healthcare Partnership Plan for RHP 6 included an 1800-page document approved in March 2013 plus an overwhelming collection of revised narratives and complex spreadsheets. The purpose of this interactive tool is to improve the user’s experience in navigating through the 112 DSRIP projects. With this tool, you can navigate projects by provider name, county, project focus, and the outcomes by which each project is working to improve. If you identify a project of interest, please note the unique project identification (ID) number. Regardless of how you begin your search, all avenues will lead you to the list of projects by provider. You will need this ID number to obtain the related files for each project. Please note: At the Outcome Measure detail, individual measures are highlighted to reflect their achievement status. Measures highlighted in green reflect full achievement of the target. Measures highlighted in yellow were either not met or partially met. Remaining progress is “carried forward” to the next demonstration year. At the final level which shows projects by provider, the project ID is color coded to reflect the project’s current status. Green indicates the project is on track and all current milestones have been achieved. Yellow indicates one or more of the sixth year milestones have been “carried forward” for achievement in year seven, which concludes September 30, 2018. Below each project’s title are the Quantifiable Patient Impact (QPI) targets for each project. These often represent the number of additional individuals served or encounters delivered as a result of the DSRIP project. The target “MLIU” percentage is also provided. This represents the percentage of the target population that is considered low-income uninsured or covered by Medicaid. Projects or outcome measures highlighted in red or grey have been withdrawn. All project values and incentives earned are shown as “all funds.” The waiver is jointly funded with state and federal dollars. The “state” portion (roughly 42%) is actually funded by local providers and government entities through Intergovernmental Transfers (IGT). All projects were selected to address six critical needs identified in the RHP 6 Community Needs Assessment. These include improving health care quality, preventing and managing chronic conditions, improving access to medical and dental care, expanding behavioral health care and integrating it with physical health care, improving maternal and pediatric preventive care, and preventing communicable disease. If you have questions regarding the tool or the Medicaid waiver, please contact Continue

Provider County Project Focus Outcome Measure Exit
Hint: These four navigation buttons are found on each page of the tool Exit RHP 6’s 112 DSRIP projects are organized by provider, county, project focus, and outcome measure. Select an option by clicking one of the boxes below. To return to your previous slide To return to this menu To exit To learn more about the waiver There are 25 providers with active DSRIP projects, including: Hospitals Community Mental Health Centers Physician practices Local public health An additional five providers are participating in the Uncompensated Care (UC) pool. RHP 6 Quick Facts: 20 counties 24,734 square miles 2.3 million residents 54% Hispanic / 37% Anglo 16% live below poverty line 24% without health coverage $36,000 per capita income 20% did not complete high school Providers selected project areas from a menu called the RHP Planning Protocol For this tool, the 33 project areas have been organized into 12 focus areas. All proposed projects were reviewed and approved by HHSC and CMS. Incentives are paid for achieving approved milestones and metrics. 190 outcome measures were selected by RHP 6 providers and approved by HHSC in Demonstration Year (DY) 3. Baselines were set in DY3. DY4 incentives will be paid for reporting and performance. DY5 incentives will be paid for performance only. DY6 measures will be paid for performance only. Provider County Project Focus Outcome Measure View incentives earned by providers for Years 1-6 Back to Instructions Back to Start

Exit Val Verde Uvalde Kerr Dimmit Frio Bexar Medina Gillespie Edwards
Wilson Guadalupe Gillespie Edwards Kinney Real Zavala La Salle Bandera Atascosa McMullen Comal Kendall Use this map to view DSRIP transformation projects by county. The counties labeled in blue have active DSRIP projects being performed by hospitals or other providers based in those counties. Community Mental Health Centers (CMHC), with the exception of Center for Health Care Services, serve multiple counties. Click here to view the counties in RHP 6 served by CMHCs.

Community Mental Health Centers (CMHC)
Exit Community Mental Health Centers (CMHC) Click on the CMHC’s logo to view their associated DSRIP projects. Return to RHP6 County map Hill Country MHDD Centers

Physician Practices (2)
Select a Performing Provider beginning with provider type: Exit Hospitals (18) Physician Practices (2) Community Mental Health Centers (4) Local Public Health (1)

Hospitals Baptist Health System Clarity Child Guidance Center
Exit Baptist Health System Clarity Child Guidance Center Children’s Hospital of San Antonio CHRISTUS Santa Rosa Health System Connally Memorial Medical Center Dimmit Regional Hospital Frio Regional Hospital Guadalupe Regional Hospital Hill Country Memorial Hospital Medina Healthcare System Methodist Healthcare System Nix Health Peterson Regional Medical Center Southwest General Hospital Texas Center for Infectious Disease University Health System Uvalde Memorial Hospital Val Verde Regional Medical Center

Community Mental Health Centers
Exit Bluebonnet Trails Community Services Camino Real Community Services Hill Country Mental Health & Developmental Disabilities Center The Center for Health Care Services

University Medicine Associates
Physician Practices Exit University Medicine Associates UT Health San Antonio

San Antonio Metropolitan
Local Public Health Exit San Antonio Metropolitan Health District

Select by Outcome Measure Domain (OD)
Exit Select by Outcome Measure Domain (OD) OD1 – Primary Care and Chronic Disease Management OD2 – Potentially Preventable Admissions OD3 – Potentially Preventable Readmissions OD4 – Potentially Preventable Complications OD5 – Cost of Care OD6 – Patient Satisfaction OD7 – Oral Health OD8 – Perinatal Outcomes and Maternal & Child Health OD9 – Right Care, Right Setting OD10 – Quality of Life / Functional Status OD11 – Behavioral Health / Substance Abuse Care OD12 – Primary Prevention ADD INFORMATION ADD HYPERLINKS OD13 – Palliative Care OD14 – Healthcare Workforce OD15 – Infectious Disease Management Withdrawn project Achievement on individual measures for each Performance Year (PY) is noted by color and symbol: Achieved target  = Reported 100% of goal = Reported <100% of goal  = Reported 0% of goal B=DY 4 baseline data counted as achievement for PY1 R = Reported a Pay for Reporting measure CF = reporting of measure Carried Forward Carry Forward due to partial achievement Milestone not met or partially met; no longer eligible

OD1 – Primary Care and Chronic Disease Management
Exit Provider Project ID IT-reference number Measure Title PY1 PY2 PY3 UT Health San Antonio IT-1.1 Third next available appointment   Val Verde Regional Medical Center CHRISTUS Santa Rosa Health System IT-1.10 Diabetes care: HbA1c poor control (>9.0%) CF Connally Memorial Medical Center Guadalupe Regional Medical Center University Health System Uvalde Memorial Hospital IT-1.11 Diabetes care: BP control (<140/90mm Hg)  University Medicine Associates View page: 1 2

OD1 – Primary Care and Chronic Disease Management
Exit Provider Project ID IT-reference number Measure Title PY1 PY2 PY3 Frio Regional Hospital IT-1.12 Diabetes care: Retinal eye exam   IT-1.13 Diabetes care: Foot exam Methodist Healthcare System B  CF Nix Health University Health System IT-1.14 Diabetes care: Nephropathy IT-1.18 Follow-Up After Hospitalization for Mental Illness UT Health San Antonio IT-1.22 Asthma Percent of Opportunity Achieved IT-1.26 Seizure type(s) and current seizure frequency(ies) Connally Memorial Medical Center IT-1.6 Cholesterol management for patients with cardiovascular conditions Southwest General Hospital IT-1.7 Controlling high blood pressure View page: 1 2

OD2 – Potentially Preventable Admissions
Exit Provider Project ID IT-reference number Measure Title PY1 PY2 PY3 Clarity Child Guidance Center IT-2.7 (P4R) Behavioral Health/Substance Abuse (BH/SA) Admission Rate R

OD3 – Potentially Preventable Readmissions
Exit Provider Project ID IT-reference number Measure Title PY1 PY2 PY3 CHRISTUS Santa Rosa Health System IT-3.3 Risk Adjusted Congestive Heart Failure (CHF) 30-day Readmission Rate  IT-3.9 Risk Adjusted Acute Myocardial Infarction (AMI) 30-day Readmission Rate Peterson Regional Medical Center IT-3.4 (P4R) Diabetes 30-day Readmission Rate DY6 (PY3): PPR.11 Risk Adjusted Sepsis PPRs R Nix Health IT-3.5 Risk Adjusted Diabetes 30-day Readmission Rate DY6 (PY3): Pressure Ulcer Rate UT Health San Antonio IT-3.14 (P4R) Behavioral Health /Substance Abuse 30-day Readmission Rate IT-3.14 Val Verde Regional Medical Center CF IT-3.22 Risk Adjusted All-Cause Readmission Bluebonnet Trails Community Services DY6 (PY3): IT-1.18 Follow up After Hospitalization for Mental Illness Guadalupe Regional Medical Center  Uvalde Memorial Hospital University Health System DY6 (PY3): IT-3.17 Risk Adjusted COPD 30-day Readmission Rate Baptist Health System

OD4 – Potentially Preventable Complications
Exit Provider Project ID IT-reference number Measure Title PY1 PY2 PY3 Dimmit Regional Hospital IT-4.4 Surgical Site Infection (SSI) rate  Nix Health IT-4.3 Catheter-associated Urinary Tract Infections (CAUTI) rates Methodist Healthcare System IT-4.17 Stroke - Thrombolytic Therapy IT-4.2 Central line-associated bloodstream infections (CLABSI) rates IT-4.5 Patient Fall Rate University Health System

OD5 – Cost of Care Exit  Provider Project ID IT-reference number
Measure Title PY1 PY2 PY3 UT Health San Antonio IT-5.1.c Improved Cost Savings: Demonstrate cost savings in care delivery - Cost Effectiveness Analysis IT-5.2 Per Episode Cost of Care University Health System IT-5.1.d Improved Cost Savings: Demonstrate cost savings in care delivery - Cost Utility Analysis 

OD6 – Patient Satisfaction
Exit Provider Project ID IT-reference number Measure Title PY1 PY2 PY3 UT Health San Antonio IT-6.1.b.ii CG-CAHPS 12-month: Provider Communication   IT-6.1.d.i CG-CAHPS Visit Survey 2.0: Timeliness of Appointments, Care, & Information  IT-6.2.b Visit-Specific Satisfaction Instrument (VSQ-9) WD IT-6.1.d.iv CG-CAHPS Visit Survey 2.0: Overall Provider Rating Val Verde Regional Medical Center IT-6.1.b.i CG-CAHPS 12-month: Timeliness of Appointments, Care, & Information Camino Real Community Services IT-6.2.a Client Satisfaction Questionnaire 8 (CSQ-8) R The Center for Healthcare Services CF B University Health System IT-6.1.a.v HCAHPS Communication about Medicine Nix Health

OD7 – Oral Health Exit   CF Provider Project ID IT-reference number
Measure Title PY1 PY2 PY3 UT Health San Antonio IT-7.10 Cavities: Adults   San Antonio Metropolitan Health District IT-7.6 Urgent Dental Care Needs in Children: Percentage of children with urgent dental care needs University Health System IT-7.9 Dental Treatment Needs Among Chronic Disease Patients CF

OD8 – Perinatal Outcomes and Maternal Child Health
Exit Provider Project ID IT-reference number Measure Title PY1 PY2 PY3 San Antonio Metropolitan Health District IT-8.14 (P4R) Exclusive Breastfeeding at 3 Months R IT-8.15 (P4R) Exclusive Breastfeeding at 6 Months IT-8.16 (P4R) Any Breastfeeding at 6 Months IT-8.9 Youth Pregnancy Rate Southwest General Hospital IT-8.2 Percentage of Low Birth- weight births  University Health System IT-8.22 Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life  Children's Hospital of San Antonio (CHOSA) IT-8.20 Developmental Screening in the First Three Years of Life IT-8.21 Well-Child Visits in the First 15 Months of Life (6 or more visits) IT-8.24 Adolescent Well-Care Visits (AWC)

OD9 – Right Care, Right Setting
Exit Provider Project ID ref number Measure Title PY1 PY2 PY3 UT Health San Antonio IT-9.1 Decrease in mental health admissions and readmissions to criminal justice settings such as jails or prisons  IT-9.2 Reduce Emergency Department (ED) visits for Ambulatory Care Sensitive Conditions (ACSC) per 100,000 Medina Regional Hospital IT-9.10 ED throughput Measure bundle Bluebonnet Trails Community Services  Methodist Healthcare System IT-9.6 Emergency department (ED) visits where patients left without being seen IT-9.10.a Median Time from ED Arrival to ED Departure for Discharged ED Patients Dimmit Regional Hospital University Medicine Associates IT-9.4.b Reduce Emergency Department visits for Diabetes Guadalupe Regional Medical Center IT-9.4.e Reduce Emergency Department visits for Behavioral Health/Substance Abuse Uvalde Memorial Hospital The Center for Health Care Services University Health System Baptist Health System  Children's Hospital of San Antonio (CHOSA) IT-9.4.h Pediatric/Young Adult Asthma Emergency Department Visits IT-9.10.b Median time from admit decision time to time of departure from the ED for ED patients admitted to inpatient status IT-9.10.c Median time from ED arrival to time of departure from the emergency room for patients admitted to the facility from the ED

OD10 – Quality of Life / Functional Status
Exit Provider Project ID IT-reference number Measure Title PY1 PY2 PY3 Hill Country MHDD Centers IT-10.2.a Supports Intensity Scale (SIS) DY6 (PY3): CMHC.5 Adherence to Antipsychotic Medications R  UT Health San Antonio IT-10.1.a.v Pediatric Quality of Life Inventory (PedsQL) San Antonio Metropolitan Health District IT-10.1.h CDC Health-Related Quality of Life (HRQoL) Measures   The Center for Health Care Services IT-10.1.b.iii RAND Short Form 36[1] (SF-36) Health Survey

OD11 – Behavioral Health / Substance Abuse Care
Exit Provider Project ID IT-reference number Measure Title PY1 PY2 PY3 Hill Country MHDD Centers IT (P4R) Daily Living Activities (DLA-20) DY6 (PY3): CMHC.5 Adherence to Antipsychotic Medications R  IT-11.16 Assessment for Substance Abuse Problems of Psychiatric Patients W IT-11.19 Assessment for Psychosocial Issues of Psychiatric Patients IT (P4R) Assessment of Major Depressive Symptoms UT Health San Antonio IT-11.6 Follow-up Care for Children Prescribed ADHD Medication (ADD) CF IT-11.8 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment B Bluebonnet Trails Community Services IT c (P4R) Adult Needs and Strength Assessment (ANSA) Camino Real Community Services IT-11.17 Assessment of Risk to Self/Others IT e.i Patient Health Questionnaire 9 (PHQ-9) University Health System IT-11.12 Cardiovascular monitoring for people with cardiovascular disease and schizophrenia (SMC) IT d (P4R) Children and Adolescent Needs and Strengths Assessment (CANS-MH) DY6 (PY3): CMHC.6 Depression Management: Screening and Treatment Plan for Clinical Depression The Center for Health Care Services

OD12 – Primary Prevention
Exit Provider Project ID IT-reference number Measure Title PY1 PY2 PY3 Nix Health IT-12.1 Breast Cancer Screening  IT-12.3 Colorectal Cancer Screening IT-12.4 Pneumonia vaccination status for older adults UT Health San Antonio W Medina Regional Hospital  Val Verde Regional Medical Center IT-12.2 Cervical Cancer Screening University Health System IT-12.8 Immunization for Adolescents- Tdap/TD and MCV IT-12.6 Influenza Immunization -- Ambulatory CF Hill Country Memorial Hospital B IT (P4R) Intensive behavioral dietary counseling for adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease R IT (P4R) ABI Screening for Peripheral Arterial Disease

OD13 – Palliative Care Exit  R Provider Project ID
IT-reference number Measure Title PY1 PY2 PY3 Guadalupe Regional Medical Center IT-13.6 Palliative Care: Percent of patients who have documentation in the medical record that an interdisciplinary family meeting was conducted on or before day five of ICU admission  IT-13.2 Hospice and Palliative Care – Treatment Preferences IT-13.5 Hospice and Palliative Care – Percentage of patients receiving hospice or palliative care services with documentation in the clinical record of a discussion of spiritual/religions concerns or documentation that the patient/caregiver did not want to discuss Uvalde Memorial Hospital IT-13.4 (P4R) Hospice and Palliative Care – Proportion admitted to the ICU in the last 30 days of life R University Health System IT-13.1 Hospice and Palliative Care – Pain assessment

OD 14 – Healthcare Workforce
Exit Provider Project ID IT-reference number Measure Title PY1 PY2 PY3 UT Health San Antonio IT-14.9 (P4R) Number of practicing specialty care practitioners per 1000 individuals in HPSA or MUA R

OD 15 – Infectious Disease Management
Exit Provider Project ID IT-reference number Measure Title PY1 PY2 PY3 Texas Center for Infectious Disease IT-15.17 Latent Tuberculosis Infection (LTBI) treatment rate  UT Health San Antonio IT-15.18 Hepatitis C Cure Rate R San Antonio Metropolitan Health District IT-15.11 Follow-up after Treatment for Primary or Secondary Syphilis

View DSRIP projects by Project Area
Exit View DSRIP projects by Project Area Behavioral Health 1.11, 1.12, 1.13, 1.14, 2.13, 2.14, 2.15, 2.16, 2.17, 2.18, 2.19 Care Management 1.3, 2.2, 2.1 Health Promotion / Disease Prevention 2.6, 2.7 Interpretation Services 1.4 Oral Health 1.8 Palliative Care 2.10 Patient-Centered Medical Homes 2.1 Patient Navigation / Care Coordination 1.6, 2,9, 2.12 Primary Care Expansion / Redesign 1.1, 1.2, 2.3 Process Improvement / Patient Experience 1.5, 1.10, 2.4, 2.5, 2.8 Specialty Care 1.9 Telemedicine 1.7 ADD INFORMATION ADD HYPERLINKS

Behavioral Health Project Areas: 1. 11, 1. 12, 1. 13, 1. 14, 2. 13, 2
Behavioral Health Project Areas: 1.11, , , , , 2.14, , , 2.17, , Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Unique Project ID Project Option Provider Name Project Description Withdrawn 1.14.1 UT Health San Antonio Establish the Sustained Treatment is an Outpatient Priority (STOP) program, a substance use disorder (SUD) treatment training program, to improve access to evidence-based specialty care for medically-indigent patients in RHP 6 by: 1) increasing the breadth and depth of evidence-based treatment services in RHP 6; 2) providing evidence-based training to future specialty care professionals and mid-level care providers in HPSA-designated areas of RHP 6 in such a way as to promote the likelihood that trainees will serve those areas; and 3) going to community clinics of non-behavioral medical providers in RHP 6 and training those providers in the SBIRT practice of SUD screening, brief intervention, and referral to specialty care as necessary. 2.15.1 Place master’s level behavioral care managers (BCM) in primary pediatric clinics to work with children with ADHD and comorbid psychiatric conditions (depression, aggression), providing behavioral and family therapy. The BCM will consult with child psychiatrists who in turn will assist pediatricians with psychopharmacology when needed. 2.13.1 Provide evidence-based transitional care for individuals discharged from psychiatric units or diverted from emergency rooms. Interventions to be delivered include cognitive behavior therapy ; cognitive adaptation training (a home based treatment using environmental supports such as signs, alarms, checklists, pill containers to promote medication adherence and improve community functioning); family psychoeducation and care coordination (designed to link patients to appropriate options for care in the community for longer term follow up). Novel treatment program designed to reduce recidivism for alcohol-related driving offenses. 1.13.1 Camino Real Community Services Establish a minimum of a 10 bed Crisis Residential Facility 1.12.3 Establish 2 Mobile Crisis Outreach Teams (MCOT) in a service area that is extremely rural and where there is limited access to community based options that provide readily accessible crisis interventions Bluebonnet Trails Community Services Implement Treatment Foster Care (TFC) sites in Guadalupe County to provide crisis respite services to youth in psychiatric crisis. Youth will be assessed, and if eligible, placed in foster homes long enough to to resolve the crisis and initiate therapeutic services for youth and family (an average of 45 days). Admission to TFC will be accessible 24 hours a day. 1.12.2 Establish services that are new to BTCS and the community by opening and staffing substance abuse services within a current clinic site in Seguin that has space and is suitable for the service without renovation or capital expenditure Implement a peer-led transitional services program through which individuals will receive behavioral health services in a transitional housing setting to improve community living skills with the goal of acheiving permanent supportive housing. View page: 1 2 3 4

Behavioral Health Project Areas: 1. 11, 1. 12, 1. 13, 1. 14, 2. 13, 2
Behavioral Health Project Areas: 1.11, , , , , 2.14, , , 2.17, , Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Unique Project ID Project Option Provider Name Project Description 2.13.1 Hill Country MHDD Centers Implement two Mobile Crisis Outreach Teams (one for Kerr and Gillespie counties and one for Val Verde County) to provide 24 hour a day, 7 day a week behavioral health crisis intervention and crisis follow up services within the community setting in order to reduce emergency department utilization, incarceration and hospitalizations. 2.16.1 Implement psychiatric and clinical guidance 24 hours a day, 7 days a week for primary care physicians and hospitals within the 11 counties served by Hill Country in RHP6 in order to help physicians identify and treat behavioral health symptoms earlier in order to avoid exacerbation of symptoms into a behavioral health crisis. Implement Co-occurring Psychiatric and Substance Use Disorder Services within the 11 counties served by Hill Country in RHP6 in order to meet the needs of individuals with psychiatric and substance use issues within the community setting in order to reduce emergency department utilization, inpatient utilization, and incarceration. Implement Trauma Informed Care Services within the 11 counties served by Hill Country in RHP6 in order to meet the needs of individuals who have experienced trauma that is impacting their behavioral health. 2.18.1 Implement Whole Health Peer Support services within the 11 counties served by Hill Country in RHP6 in order to meet the overall health needs of individuals who have behavioral health issues. Expand peer support services in an effort to identify veterans and their family members who need comprehensive community based wrap around behavioral health services, such as psychiatric rehabilitation, skills training, crisis intervention, supported housing and supported employment, that would complement, but not duplicate, potential services through the Veterans Administration and provide the community based wrap around behavioral health services for these veterans in order to treat symptoms prior to the need forutilization of emergency departments, inpatient hospitalization or incarceration Implement Mental Health Courts within the Comal, Medina, and Uvalde counties served by Hill Country in RHP6 in order to meet the overall health needs of individuals dealing with behavioral health issues who frequently utilize the emergency departments or criminal justice system. The project will have dedicated case workers to provide wraparound services for the identified individuals and will have dedicated courts to monitor the patient’s treatment compliance. 1.13.1 University Health System Create a 20-bed crisis intervention unit that can provide care in a safe environment for those patients who do not require acute care admissions. By providing them with case management service in the least restrictive environment acute inpatient beds are preserved for more appropriate admissions. updated to 2.15.1 Increase access to behavioral health specialty care by adding/increasing behavioral health providers at primary care clinics and having patients receive behavioral health services through integrated patient-centered medical home/neighborhood clinics (PCMH) Develop and expand a psychiatric emergency service with capacity to accommodate voluntary and involuntary patients with mental illness and in acute crisis. It offers an alternative to medical emergency rooms for those patients not requiring emergent/urgent evaluation and stabilization of physical medical conditions. View page: 1 2 3 4

The Center For Health Care Services
Behavioral Health Project Areas: 1.11, , , , , 2.14, , , 2.17, , Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Unique Project ID Project Option Provider Name Project Description 1.13.1 The Center For Health Care Services Establish a residential crisis and respite center for children with severe emotional disturbance that will include a total of 16 beds, 8 reserved for children in crisis and 8 for children whose families require a brief respite from the overwhelming responsibilities of delivering care 1.12.1 Expand access to MH services through new clinic locations, extended service hours; utilization of a BH care manager model to align case management and wellness education with treatment services; and increased training opportunities. Telemedicine will augment the BH workforce until the number of skilled clinicians increases. A Psychiatric Urgent Care Clinic will be opened to dispense medications and connect consumers in crisis to community-based care. Clinic services will include psychiatry, labs and medication, mental health treatment ancillary to psychiatric care, peer recovery services, and substance abuse counseling and treatment for individuals with co-occurring disorders Establish crisis transitional residential options, up to 32 beds, for adults. Available service will include: 1) crisis respite and a continuum of care for individuals with complex treatment issues, including those who are chronically mentally ill, homeless and alcohol or drug dependent and have chronic medical conditions; and, 2) transitional residential services, including medication \assistance, support for activities of daily living and connection to supported housing and employment services. 1.12.2 Establish a centralized, accessible campus from which systems or families can obtain care for children and adolescents with a serious emotional and/ or behavioral problem or developmental delay. Services will include comprehensive treatment planning, wraparound care, mental health interventions, coordination of care among all interested systems (schools, juvenile justice, child protective services), substance abuse counseling, group counseling for children, parents, siblings, and caregivers, recreational therapy, ROPES course, connection to in-home services (occupational therapy, physical therapy, nutritional counseling, medication education, in-home nursing care), therapeutic foster care, and diversion services for youth involved with the juvenile justice system. An on-site model classroom and learning lab will assist children with the transition to school environments and support their academic achievement. Safe rooms and relaxation areas will be available for all ages. Staff from all childserving systems (schools, juvenile probation, child protective services, Medicaid, sexual abuse services) will have on-site representatives. Establish a centralized, accessible clinic to provide a comprehensive continuum of services across the life span for individuals with co-occurring intellectual developmental disability (IDD), mental illness and substance use disorders, including medication management, comprehensive treatment planning, mental health interventions, skills development through in-home or clinic based services for occupational therapy, physical therapy, speech therapy, recreational therapy, and primary care access for routine medical services, and support services for caregivers. Telemedicine may be used to deliver medication management services to individuals with transportation challenges or whose disabilities prevent them from participating in clinic activities. Wraparound care will be coordinated with staff from other systems serving the IDD population (schools, Child and Adult Protective Services, Juvenile and Adult Probation, the local authority for IDD, service providers). An on-site primary health care provider will give consumers access to integrated behavioral and primary health care. View page: 1 2 3 4

The Center For Health Care Services
Behavioral Health Project Areas: 1.11, , , , , 2.14, , , 2.17, , Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Unique Project ID Project Option Provider Name Project Description 2.13.1 The Center For Health Care Services Expand a therapeutic justice model for persons with serious mental illness as a means of diverting them from being placed in the criminal justice system whether through institutionalization or adjudication. 2.15.1 Establish a comprehensive, integrated care management center offering primary and behavioral health care to homeless adults living at Prospects Courtyard (PCY) within the Haven for Hope campus. The great majority will have co-occurring mental health and/or substance use and chronic physical disorders. Embed and integrate primary care services at the Restoration Center, a comprehensive substance abuse treatment facility. Adults served at the Restoration Center will experience enhanced access to primary care, including health promotion, disease prevention, health maintenance, counseling, patient education, and diagnosis and treatment of acute and chronic illnesses. Collaborative effort with area hospitals. CHCS is developing protocols and a shared cloud-based data platform that will enable ED staff to quickly verify that a patient is a super-utilizer and gain access to the community treatment plan.CHCS will expand treatment to encompass a holistic perspective, including integrated primary and behavioral health care and clinical and organizational alignment with other community providers involved in care. Establish a comprehensive, safe, structured therapeutic milieu for females at Haven for Hope (a master planned campus for homeless families and individuals), to be known as the In-House Women’s Wellness Program (IHWWP). Because the target population is expected to have co-occurring mental health and/or substance use and chronic physical disorders, and to have experienced significant trauma, the program will support return of functioning by integrating and managing all aspects of their care, including offering single-site, trauma-informed primary and behavioral health care. View page: 1 2 3 4

Care Management Project Areas: 1. 3, 2. 2, 2
Care Management Project Areas: 1.3, 2.2, 2.11 Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Unique Project ID Project Option Provider Name Project Description 1.3.1 UT Health San Antonio Develop longitudinal clinical registries to improve quality of care at collaborating primary care practices that train medical students and residents in medicine and implement patient navigation to address health risks in patients who are not meeting their disease management goals Implement a Health Information Exchange (HIE) which will automate the flow of key clinical information between disparate EHR systems of University Health System, UT Medicine, and the community HIE. Data in the HIE will be used to populate a chronic disease registry enabling effective population management. University Health System Improve patient care quality by developing and utilizing a master chronic disease management registry that will allow providers to more efficiently monitor a patient's disease status, adherence to treatment plans, medication management as well as tailor delivery of appropriate clinical/care coordination interventions 2.2.2 Integrate and coordinate health and Behavioral health intervention/ prevention and neuropsychological interventions, for lead exposed and children with asthma to improve physical, neuropsychological and parental health management services. This project will implement lead and asthma prevention and intervention services for children and families living in housing identified by City and HUD officials as having environmental contamination for lead or other respiratory hazards. 2.2.1 Implement specific Chronic Care Model activities within the practice, including a comprehensive care management plan, adopting evidence-based protocols, implementing patient self-management plans for chronic conditions, nurse-care management and medical group visits. Implement Chronic Care Model (CCM) activities at two primary care sites within the University Health System network for patients with diabetes. Community Medicine Associates Establish an interdisciplinary care coordination team within its ambulatory network of care. These teams will be comprised of RN case managers, social workers, and patient educators to identify and support chronic and other health care needs and education of patients the receive services at respective regional medical home clinics. 2.11.2 Provide access to a clinical pharmacist in the ambulatory home during the medical consult. This pharmacist will be dedicated to the provision of education and medication management for patients with chronic diseases (ambulatory care sensitive conditions) who are on multiple medications and whose disease process is not well controlled and/or patients who utilize the Emergency Department or are hospitalized for their chronic disease.

Health Promotion / Disease Prevention Project Areas: 2. 6, 2
Health Promotion / Disease Prevention Project Areas: 2.6, 2.7 Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Project ID Project Option Provider Project Description 2.7.1 Hill Country Memorial Hospital Provide comprehensive health screening and wellness education for at least 500 uninsured (targeting Medicaid and Indigent individuals) employed residents of Hill Country Memorial Hospital’s service area by partnering with local businesses who are not able to offer insurance to their employees or whose employees are unable to afford the insurance offered due to cost and their low incomes. 2.6.1 San Antonio Metropolitan Health District Metro Health teen pregnancy prevention project 1) Educate adolescents using evidence-based teen pregnancy, STD & HIV prevention programs. 2). Expand access to affordable reproductive healthcare services for adolescents 3). Conduct training to providers on the Adolescent Medical Home (AMH) model 4). Provide case management services to teen mothers through the evidence-based Healthy Outcomes through Perinatal Education and Support (HOPES) project to reduce repeat teen pregnancies. 2.7.5 Implement the Neighborhood Based Physical Activity and Health Promotion Project in ten neighborhoods in San Antonio/Bexar County to improve the health status of children and families and increase community member engagement in a neighborhood and community-school partnership approach for childhood obesity prevention. 2.6.2 Implement the Community Diabetes Project, that will expand access to the Stanford Chronic Disease Self Management and Diabetes Self Management Programs for individuals living with diabetes and their family members/caregivers as well as those that are at risk for developing diabetes. Expand HIV and Syphilis screenings, with a special focus on high risk populations in Bexar County in order to reduce the spread of HIV and Syphilis. Establish a “Baby Café” breastfeeding drop-in center to expand services and attract mothers of all ages and from all sectors of the community. This will be done by providing breastfeeding help and support, from both skilled health professionals, paraprofessionals, and other mothers, in a friendly, non-clinical, café style environment. Southwest General Hospital Develop, implement, and evaluate a mobile cardiovascular screening program through which individuals with chronic cardiovascular conditions will be identified and offered self-management education. Texas Center for Infectious Disease 1) Increase targeted testing for latent tuberculosis infection (LTBI) in high-risk populations; 2) Provide routine testing for LTBI with interferon gamma release assays (IGRAs) instead of tuberculin skin testing to minimize false positive tests in BCG-vaccinated patients and avoid unnecessary LTBI therapy; 3) Provide routine treatment of LTBI through a 12-dose, 12-week regimen administered by DOT to improve patient adherence and completion of LTBI therapy; 4) Facilitate hospitalization for TB care for those few patients who cannot be successfully treated as outpatients. University Health System Enhance access to evidence-based preventive screenings for the residents of Bexar County, Texas by working with regional providers, health center and community-based organizations to collaborate coordinate and establish a strategy that encourages adherence to breast cancer prevention screening in under and uninsured women.

University Health System
Interpretation Services Project Area: 1.4 Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Project ID Project Option Provider Project Description 1.4.1 Nix Health Nix Health will expand awareness and access of services for individuals with disabilities and Limited English Speaking Persons (LEP). In addition to services provided to patients at all Nix locations within Bexar County, this service will also be expanded to include rural markets. University Health System Enhance awareness and establish an integrated interpretation service in order to ensure that health information is provided in a manner that is appropriate to a patient’s linguistic and cultural orientation. This will include development and implementation of a 24/7 web-based video interpretation program, increasing staffing capacity with trained volunteer staff interpreters, and establishing a standard document translation process.

Oral Health Project Area: 1
Oral Health Project Area: 1.8 Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Project ID Project Option Provider Project Description 1.8.9 San Antonio Metropolitan Health District Improve access to preventive dental services (dental sealants and fluoride varnish applications) by providing services in non-traditional settings to include early childhood education settings and economically disadvantaged public schools. Provide early identification of children with unmet dental needs and reinforce the importance of linking families to a “main dental home” in the community. 1.8.6 University Health System Establish an affiliated/integrated dental health services program that incorporates patient navigation within the medical home model of care by partnering with Federally Qualified Health Centers, resulting in timely, accessible, integrated, and patient-centered preventive dental health care services for economically underserved populations with chronic disease UT Health San Antonio Establish an emergency dental clinic for treating patients presenting with urgent dental conditions including oral infections, abscesses, pain and fractured dental restorations. This clinic will work to resolve the emergency condition and refer patients seeking comprehensive oral care to the UTHSCSA Dental School

Palliative Care Project Area: 2
Palliative Care Project Area: Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Project ID Project Option Provider Project Description 2.10.1 Guadalupe Regional Medical Center This project will establish a program to provide Palliative Services to chronically ill patients to relieve suffering, improve quality of life, and assist in the transitions from acute hospital care into home care, hospice or a skilled nursing facility. University Health System Increase the quality of palliative care services and expand education regarding palliative medicine among primary care providers at University Hospital. The project will improve the quality of life for patients and families facing serious illness through earlier advanced care planning, better communication, as well as improved pain and symptom management and coordination of care. Uvalde Memorial Hospital Offer palliative care services for patients and their families. It will emphasize the importance of comfort and quality of life for high risk patients who have late stage chronic illnesses.

Patient-Centered Medical Homes Project Area: 2
Patient-Centered Medical Homes Project Area: 2.1 Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Project ID Project Area Project Description 2.1.2 CHRISTUS Santa Rosa Health System Increase access to primary care and improve the management of chronic diseases in the community by contributing to the expansion of medical homes, which involves integration of multiple, small practices who together act as a single, large integrated PCMH. The target population is ethnically diverse, low-income Medicare beneficiaries who have significant impediments to accessing primary care. 2.1.1 Community Medicine Associates Achieve Level 3 Patient Centered Medical Home (PCMH) recognition in order to provide improved quality, better access and more efficiency. Nix Health Implement the Medical Home Model in at least 1 primary care clinic.

Patient Navigation & Care Coordination Project Areas: 1. 6, 2. 9, 2
Patient Navigation & Care Coordination Project Areas: 1.6, 2.9, 2.12 Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Project ID Project Option Provider Project Description 2.9.1 Bluebonnet Trails Community Services In collaboration with the Guadalupe Regional Medical Center, implement a patient navigation project for persons who are frequent users of the Emergency Department due to behavioral health disorders. We will employ a Peer Support Specialist and a registered Nurse to work on site at Guadalupe Regional Medical Center to provide rapid triage, assessment and alternative services to frequent users of the ED. 2.12.1 CHRISTUS Santa Rosa Health System Implement a post-discharge transitions program to help patients make a smooth transition from the inpatient to the post-acute setting . The project will help patients that are being discharged understand the care regimen, have follow-up care scheduled, and are at reduced risk for avoidable readmissions. 1.6.2 Dimmit Regional Hospital Introduce an urgent medical advice line while simultaneously creating a “fast track” triage system for the ED 2.12.2 Guadalupe Regional Medical Center Implement improvements in transitioning patients and coordination of care from inpatient to outpatients, post-acute care, and home care settings. The Patient Navigation project will identify patients with high utilization of ED services, and assist to match resources; such as physicians, clinics, teaching, behavioral health and prescription assistance. Medina Regional Hospital The project will provide access to medical advice and direction to the appropriate level of care and increase access to appropriate healthcare by establishing a nurse call center. Additionally, an integrated system of urgent appointments/scheduling will be instituted. This will allow patients to schedule an appointment the next day in one of our Rural Health Clinics. Nix Health Implement a Patient Navigator Program to assist patients in taking control of their chronic diseases Peterson Regional Medical Center Implement a new discharge and care transition process for the targeted population (Diabetic patients) at PRMC. University Health System Implement a care transitions program specifically to improve access and will involve follow up calls to and/or home visits to better activate patient engagement by a transition coach following a routine visit and or discharge from an acute setting. 2.2.1 Implement Chronic Care Model (CCM) activities at two primary care sites within the University Health System network for patients with diabetes. This project will implement a care transitions program to improve access to, and coordination of, care for Medicaid and uninsured patients in need of treatment in long term acute care hospitals and/or skilled nursing facilities. The project will create a partnership between UHS and long-term care providers to provide the right care in the most appropriate setting in a timely manner. Establish a patient navigation model comprised of social workers and case managers within the ambulatory setting to enhance quality of care, and access to clinical and social support for medically complex patients. Implement a a care transitions program for patients identified as having congestive heart failure as a primary or secondary diagnosis. A core component of this program is the training of primary care physicians in a patient centered medical home by a culturally competent, board certified cardiology specialist regarding treatment guidelines, algorithms, and other specialty care for CHF patients that can be delivered during routine primary care, which expands the benefit of a patient centered medical home. 2.9.2 UT Health San Antonio Implement a patient navigator program linked to a primary care safety net clinic to improve diabetes outcomes. Community health workers will engage high-risk patients, identified by glycosylated hemoglobin values greater than 9%, through home and community-based interventions to address barriers to successful interaction with the health system and self-management Val Verde Regional Medical Center The project would implement improvements in transitioning patients and coordination of care from inpatient to outpatient, post-acute, and home care settings. The program will provide for an ED case manager trained in transitional care coordination as well as established policies and procedures.

Primary Care Expansion & Redesign Project Areas: 1. 1, 1. 2, 2
Primary Care Expansion & Redesign Project Areas: 1.1, 1.2, 2.3 Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Project ID Project Option Provider Project Description 1.1.1 Baptist Health System Establish additional primary care locations in Bexar County and add incremental primary care providers. Children's Hospital of San Antonio (CHofSA) With new academic partner, expand the capacity of primary care by developing a geographically dispersed network of pediatric primary clinics throughout San Antonio. 1.1.2 CHRISTUS Santa Rosa Health System Expand primary care capacity by increasing the number of primary care clinics, hours and staffing (total of 4 providers), which will improve overall access for the targeted population 1.2.2 Community Medicine Associates Increase the number of mid-level provider and allied health professional trainees, including Nurse Practitioners and Physician Assistants, in the primary care setting by increasing the number of training slots available to midlevel provider and allied health professional students. Connally Memorial Medical Center Establish additional hospital owned and operated primary care clinics to provide care for unassigned patients and coordinate care with other medical providers, including hospital ED and specialty physicians. Frio Regional Hospital Expand access to primary care by recruiting additional physicians, building new clinic space and increasing efficiencies in clinic offices Guadalupe Regional Medical Center Move a long standing indigent clinic (that would potentially close soon due to unsafe conditions) to the hospital campus, improving access and security. Increase the volume and scope of services to improve continuity, access and effectiveness of chronic disease care in the community. Medina Regional Hospital Add needed staff (physicians and/or mid-level providers), clinic staff, and square footage to increase clinic visits and expand clinic hours. Methodist Healthcare System Expand primary care capacity by locating an Urgent Care Center in Central San Antonio in a community area of need. University Health System Partner with Federally Qualified Health Centers to increase access to women’s health services for residents of Bexar County, Texas by establishing clinical sites and increasing number of primary care visits to enhance access to early preventive care. The purpose of implementing a Primary Care Clinic program in partnership with the San Antonio Housing Authority is to increase access to women’s health and pediatric health services for residents of the eastside sector of Bexar County, Texas by establishing a clinical site and increasing the number of primary care visits to enhance access to early preventive care. Increase access to primary care for residents of Bexar County by enlarging primary care clinic space, expanding hours of operations at primary care clinic sites and adding more clinical staff 1.1.3 Expand primary care access by developing and implementing school-based health centers alongside mobile screenings in order to more effectively link students with clinical preventive care services. This will occur by establishing school-based health centers at or near a school campus, and/or having a mobile health clinic visit the school and/or provide these services by having students transported to a regional medical home located with the Health System ambulatory network of care to receive preventive screenings and immunizations Increase pediatric primary care (including pediatric urgent care) clinic visit volume and provide evidence of improved access for patients seeking services. Accomplish this intervention through hiring more pediatricians and mid-level providers to enhance access for pediatric patients View page: 1 2

Primary Care Expansion & Redesign Project Areas: 1. 1, 1. 2, 2
Primary Care Expansion & Redesign Project Areas: 1.1, 1.2, 2.3 Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Project ID Project Option Provider Project Description Withdrawn 1.1.1 UT Health San Antonio Build 2 new medical homes that in addition to the usual primary care clinicians, will have services provided by BH professionals, pharmacists, nutritionists and RN case management services to deal with patients with complex medical problems 1.2.3 Increase the number of primary care physicians trained in San Antonio by increasing the size of the UTHSCSA Family Medicine Residency. 1.1.2 Expand the hours and days of operation and primary care and psych/ behavioral health services at 4 clinical settings where UT Nursing Clinical Enterprise provides care. 1.2.2 Uvalde Memorial Hospital Increase primary care capacity while decreasing potentially preventable readmissions by recruiting new primary care physicians and by training community health workers Val Verde Regional Medical Center Expand primary care resources in an medically underserved community by adding providers to affliated clinic. Will consider a call-a-nurse program that will also serve as an additional clinic resource while the patient is at home View page: 1 2

Process Improvement / Patient Experience Project Areas: 1. 5, 1. 10, 2
Process Improvement / Patient Experience Project Areas: 1.5, 1.10, 2.4, 2.5, 2.8 Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Project ID Project Option Provider Project Description 1.10.1 Baptist Health System Establish and staff an office of Operational Improvement to train staff and physicians on Lean and other Process Improvement (PI), thereby improving efficiencies and reducing variation in care processes resulting in improvement in quality measures and reduced costs 2.8.1 Using the enhanced Performance Improvement capacity created with Project 1.10, apply these tools to identify clinical care areas and processes to conform to current best practices and reduce variation in treatment plans and health outcomes. Baptist will drive process improvement in at least the following specific clinical areas: bowel surgery, CHF, and ED treatment of abdominal pain Medina Regional Hospital Implement process improvement methodologies that will improve patient safety, quality, and efficiency. Resources will be put in place to conduct, report, drive and measure quality improvement; Specifically an office and director will be established/hired and a formal process of education will be implemented. 2.4.2 Methodist Healthcare System Improve how patients experience the care and the patient's satisfaction with the care provided. 2.8.11 Improve process methodology for Sepsis Bundles Mortality and Length of Stay (LOS) in the adult population. Nix Health Utilize continuous rapid process improvement programs to identify and implement best practices that will help improve the safety, quality and efficiency of the care for our geriatric patients during hospitalization. Physicians will be educated on the findings, and encouraged to admit their medical/surgical elderly patients to the ACE Program (Acute Care for the Elderly) where these process improvement interventions will be applied and the patient will be cared for using an interdisciplinary team approach. 1.10.2 Peterson Regional Medical Center Allow for a decision support analyst position to write reports from our current data repository as well as manage software modules. The decision support analyst will utilize tools, technology, and applications to access clinical, financial, and quality information on a timely basis. 2.4.1 University Health System Develop and implement a comprehensive patient-centered training program based on the Patient-Centered Improvement Guide (Planetree, Inc and Picker Institute) protocol. The program will build a culture centered on providing a positive experience for all patients cared for within University Health System. Establish new operational standards within each department based on transparent key performance indicators (KPIs). Visual management boards will be designed specifically for each department so that staff, administration, physicians, and even patients can understand and be encouraged to evaluate the performance for a given department. There will also be a continued focus on training staff/providers on Lean Healthcare Methodologies. UT Health San Antonio Implement the evidence-based national standard of team performance training, TeamSTEPPS, with healthcare providers across a range of inter-professional disciplines. Following train-the-trainer interventions, quality improvement projects will be performed throughout the region, spreading the team performance training and improving healthcare for patients. Upgrade the oral healthcare IT infrastructure to be used with Certified Software in support of the dental treatment of all patients served by the Dental School, including special populations and mothers, infants, and children. Certified version of the EHR incorporates core clinical quality measures allowing for the tracking of medical conditions related to dental health status, and the treatment of special needs patients Implement the CG-CAHPS patient experience survey on behalf of all UT Medicine providers and develop an employee suggestion system that allows for the identification of issues that impact the work environment, patient care and satisfaction, efficiency, etc.

Specialty Care Project Area: 1
Specialty Care Project Area: 1.9 Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Project ID Project Option Provider Project Description 1.9.2 Baptist Health System Increase access to specialty care by: 1) adding locations with the following specialties: EP, cardiology, and obstetrics; 2) adding physicians in the following specialties to existing locations: obstetrics, general surgery, orthopedics, and hospitalists and intensivists. Children's Hospital of San Antonio (CHofSA) Increase access to pediatric specialty care by hiring the following 16 pediatric specialists: 1 ENT; 3 orthopedic surgeons; 3 cardiologists; 2 nephrologists; 2 endocrinologists; and 5 gastroenterologists Clarity Child Guidance Center Create a children’s regional psychiatric service where the patient can be assessed and treatment plans implemented, bypassing ER’s where psychiatric services are often not available. 5 beds of a 20 bed expansion will be reserved as a regional psychiatric service to assess patients sooner and provide the appropriate treatment plan. 1.9.1 Connally Memorial Medical Center Establish hospital owned and operated specialty clinics for cardiovascular and gastroenterology related services Dimmit Regional Hospital Expand the range of specialty care services and providers available to rural population, decreasing transfers to specialist providers in San Antonio Southwest General Hospital Develop and implement a Gestational Diabetes program to educate and monitor patients throughout their pregnancy, therefore improving fetal outcomes. University of Texas Health Science Center at San Antonio Add staff at the UHS Seizure Clinic, which provides outpatient epilepsy services to Medicaid-enrolled and uninsured adults of Bexar County Improve access to outpatient neurology services with the addition of 1.0 FTE mid-level provider and 1.0 FTE LVN Develop and expand the Neuropsychological Division to improve access to neuropsychological evaluation and testing services for patients with epilepsy, stroke, Alzheimer’s disease, brain tumors, and traumatic brain injuries with the addition of 1.0 FTE neuropsychologist and 1.0 FTE psychometrist. Val Verde Regional Medical Center Recruit 1 cardiologist, 1 urologist, and 1 ENT specialist to an affiliated clinic in the medically underserved area of Val Verde County.

Telemedicine Project Area: 1
Telemedicine Project Area: 1.7 Project Options are further subcategorized into Project Options, per the RHP Planning Protocol. Before drilling down to Provider, note the Project ID of interest. Exit Project ID Project Option Provider Project Description 1.7.1 Frio Regional Hospital Implement telemedicine to provide patient consultations by a cardiologist for inpatient, outpatient and emergent situations Methodist Healthcare System Deploy telemedicine services that will provide instant telemedicine consultations with trained specialists in selected services, allowing patients experiencing barriers to specialty care to receive initial care in their home facility. Stroke and behavioral health are the first two services that have been identified. University Health System Employ telemedicine services to improve access to specialty care for patients experiencing barriers to such care and allowing specialists and other members of the health care team to more efficiently monitor a patient's disease status, adherence to treatment plans, and medication management University of Texas Health Science Center at San Antonio Establish pilot hearing health care delivery model with the goal of making hearing health care services more accessible and affordable. Incorporate newly evolving teleaudiology technology placed in existing healthcare locations that do not have audiology services. integrate Doctor of Audiology education with the education of other professional students (e.g. nursing students, PA students, etc) who would be completing the new “Teleaudiology Clinical Technician Course”, and the deliver teleaudiology clinical services via teams of audiologists/TCTs in a “Drop In Hearing Clinic” placed in collaborative partnership in the UTHSCSA Student/ Employee Health 1.7.2 Use telemedicine to provide specialized cancer-care to underserved areas safely and effectively in their own communities Val Verde Regional Medical Center Develop a robust telemedicine program aimed at enhancing access to services across the full continuum of care for patients in the hospital and at the clinic

Bexar County Exit View page: 1 2 ADD INFORMATION ADD LINKS
Baptist Health System 4 projects Baptist Health System includes five acute- (Baptist Medical Center, Mission Trail Baptist Hospital, North Central Baptist Hospital, Northeast Baptist Hospital, and St. Luke’s Baptist Hospital) which offer 1,674 licensed beds. In 2011, Baptist Health System was recognized by U.S. News and World Report for earning more, high performing specialty rankings (5) than any other health system in the San Antonio metropolitan area. All five hospitals have earned Accredited Chest Pain Center designation, as well as Primary Stroke Center Certification. Medicare has designated each as Texas’ only Medicare Value Based Care Centers. The system also includes Baptist Regional Children’s Center, Baptist Breast Center, HealthLink wellness and fitness center, Baptist M&S Imaging Centers, community health and wellness programs, ambulatory services, rehabilitation services, air medical transport, School of Health Professions, and other health-related services and affiliations. It is part of the Nashville, Tennessee-based Vanguard Health Systems. Collaborating with Communicare, San Antonio Police Department Crisis Team, Center for Hope, and the Presa Community Center Children’s Hospital of San Antonio 2 projects Children’s Hospital of San Antonio (CH of SA) is a 249 bed academic children’s hospital serving San Antonio, New Braunfels, the Southern and Western boarders of Texas, as well as the Central Texas hill country. Collaborating with CentroMed CHRISTUS Santa Rosa Health System 3 projects CHRISTUS Santa Rosa Health System (CSRHS) is a Catholic, non-profit health and wellness system with three adult acute care hospitals, one short-stay surgical hospital, two free standing emergency departments and several physician joint-venture ambulatory surgery centers. With a combined total of 496 beds, CSRHS currently serves the San Antonio and New Braunfels markets which has a total population of 1.9 million. Collaborating with employed and non-employed physician practices Clarity Child Guidance Center 1 project Clarity Child Guidance Center is a non-profit children’s psychiatric hospital located in San Antonio, Texas, providing a continuum of services, from preventive therapy to acute care. Our 52-bed hospital, along with day treatment and outpatient therapy will help over 8,000 children. Patients primarily arrive from Bexar County, with a county seat that is the 7th largest city in the nation. However, 20% of Clarity’s patients arrive from surrounding rural counties, which often lack any psychiatric services. Collaborating with UT Health, JSA Health, STRAC, Bexar County Mental Health Consortium, and the Health Collaborative Community Medicine Associates 3 projects Community Medicine Associates (CMA) is the provider group practice of University Health System, a publicly supported, academic medical center and safety net provider. CMA serves the San Antonio area with an estimated population of 2 million. CMA currently has approximately 100 providers who practice within an ambulatory network of 19-primary, specialty and preventive health clinics located throughout Bexar County. Collaborating with UTHSCSA ADD INFORMATION ADD LINKS Methodist Healthcare System 4 projects Methodist Hospital, , includes the campuses of six acute care hospitals: Methodist Hospital, Methodist Children’s Hospital, Methodist Specialty and Transplant Hospital, Northeast Methodist Hospital, Metropolitan Methodist Hospital, and Methodist Texsan Hospital. For more than 49 years Methodist has provided high quality care to patients from San Antonio and throughout South Texas. Collaborating with hospital providers in Wilson, Medina, Dimmit, Uvalde, and Guadalupe Counties Nix Health 6 projects Nix Health Care System is a 297 licensed bed (160 operating beds), multi-campus provider of inpatient and outpatient acute care services, psychiatric services, physical rehabilitation services and home care services. The primary service area is comprised of Bexar County, Texas and parts of the surrounding seven counties. Collaborating with University Health System and the San Antonio Food Bank US Census Quick Facts County Health Rankings View page: 1 2

Bexar County Exit View page: 1 2 ADD INFORMATION ADD LINKS
San Antonio Metropolitan Health District 6 projects The San Antonio Metropolitan Health District (Metro Health) is the public health agency charged by State law, City code, and County resolution with the responsibility for providing public health programs in San Antonio and unincorporated areas of Bexar County. Services include health code enforcement, food inspections, immunizations, clinical services, environmental monitoring, disease control, health education, dental health, and emergency preparedness. As a public health department Metro Health provides services to all residents, but has a particular focus on underserved populations and those experiencing health disparities which often include a higher representation of Medicaid funded individuals. Collaborating with TCID, University Health System, UT Health, WIC clinics, local schools and colleges, YMCA, City of San Antonio, and San Antonio Housing Authority Southwest General Hospital 2 projects Southwest General Hospital is a 327-bed, acute care hospital in San Antonio, Texas serving residents of South San Antonio and surrounding areas. RHP 6 encompasses 20 counties and covers 24,734 square miles, comprising about 9.5% of the total land area of Texas. Collaborating with local businesses and physicians Texas Center for Infectious Disease 1 project The Texas Center for Infectious Disease (TCID; ) is a 75 bed facility that is currently the only inpatient facility dedicated to tuberculosis (TB) care in the U.S. TCID hospitalizes the most complicated and challenging TB patients in TX. Collaborating with University Health System and SAMHD The Center for Health Care Services 11 projects Center for Health Care Services (CHCS) is the Local Mental Health Authority for Bexar County (population 1.75M). CHCS provides behavioral health services and treatment to children, adolescents and adults. Collaborating with Haven for Hope UT Health San Antonio 20 projects UT Health San Antonio serves San Antonio and the 50,000 square-mile area of South Texas. It extends to campuses in the metropolitan border communities of Laredo and the Rio Grande Valley. More than 3,000 students a year train in an environment that involves more than 100 affiliated hospitals, clinics and health care facilities in South Texas. Collaborating with University Health System, Uvalde Memorial Hospital, Clarity Child Guidance Center, Avance Head Start, refugee clinics, local businesses, providers, and organizations ADD INFORMATION ADD LINKS University Health System 23 projects University Hospital (UH) is the 496-bed acute care hospital of University Health System, owned by the people of Bexar County. It serves as the primary teaching hospital for the University of Texas Health Science Center San Antonio, and the lead Level I Trauma Center and safety net provider for the estimated 2 million residents of Bexar County and South Texas. Over the past two decades University Health System has expanded access to primary, specialty and preventive health care services, and currently operates 19 health centers and clinics throughout Bexar County. Collaborating with UT Health, SAMHD, San Antonio Housing Authority, Communicare, CetroMed, school districts, and TCID US Census Quick Facts County Health Rankings View page: 1 2

Dimmit County Exit Dimmit Regional Hospital 2 projects
Dimmit Regional Hospital (previously Dimmit County Memorial Hospital) is a 48-bed hospital located in Carrizo Springs, TX. The hospital serves Dimmit County, population approximately 10,000, across 1,329 square miles. Dimmit County is designated as both a HPSA and a MUA. Collaborating with University Health System Camino Real Community Services 4 projects Camino Real Community Services is a Local Mental Health Authority that provides outpatient mental health services to child, adolescent, and adult patients with severe and persistent mental illness. The provider is located in a 10,000 square mile rural service area with a total population of approximately 206,777 (RHP6 counties include Atascosa, Dimmit, Frio, La Salle, McMullen, Wilson, and Zavala). In 2012, the Center provided services to 3,538 adults and children that met criteria for services. The Mental Health Operating budget is approximately 6.9 million dollars. The programs work closely with schools, health centers, hospitals, law enforcement, judiciary and local elected officials to coordinate the provision of services. Collaborating with Federally Qualified Health Centers and South Texas Behavioral Institute ADD INFORMATION ADD LINKS US Census Quick Facts County Health Rankings

Frio County Exit Frio Regional Hospital 2 projects
Frio Regional Hospital is a 22 bed hospital in Pearsall, Texas serving the people of Frio and LaSalle Counties with a combined population of about 25,000. Collaborating with local providers Camino Real Community Services 4 projects Camino Real Community Services is a Local Mental Health Authority that provides outpatient mental health services to child, adolescent, and adult patients with severe and persistent mental illness. The provider is located in a 10,000 square mile rural service area with a total population of approximately 206,777 (RHP6 counties include Atascosa, Dimmit, Frio, La Salle, McMullen, Wilson, and Zavala). In 2012, the Center provided services to 3,538 adults and children that met criteria for services. The Mental Health Operating budget is approximately 6.9 million dollars. The programs work closely with schools, health centers, hospitals, law enforcement, judiciary and local elected officials to coordinate the provision of services. Collaborating with Federally Qualified Health Centers and South Texas Behavioral Institute US Census Quick Facts County Health Rankings

Gillespie County Exit Hill Country Memorial Hospital 1 project
Hill Country Memorial Hospital is 88-bed medical center serving eight counties and a population of 140,000. Collaborating with local businesses Hill Country MHDD Centers 8 projects Hill Country Community MHMR Center (dba Hill Country MHDD Centers) is a community mental health center providing mental health, substance use disorder, early childhood intervention and intellectual and developmental disability services to the following counties of RHP6 (Bandera, Comal, Edwards, Gillespie, Kendall, Kerr, Kinney, Medina, Real, Uvalde and Val Verde). Hill Country serves a 14,390 square mile area of RHP6 with a population of approximately 401,123 in 2012. Collaborating with hospitals, schools, and judicial systems US Census Quick Facts County Health Rankings

Guadalupe County Exit Bluebonnet Trails Community Services 3 projects
Bluebonnet Trails Community Services (BTCS) is the state designated Local Mental Health Authority (LMHA) for Guadalupe County in Region 6 as well as for seven other Counties located east of and parallel to IH 35 and extending north of Austin, Texas in Travis County. In that capacity we are responsible for an array of public services as well as for behavioral health planning and coordination throughout our local service area. As the LMHA, we contract with the Department of State Health Services (DSHS) to provide specialty behavioral health services to children and adolescents with Severe Emotional Disturbance (SED) that DSHS identifies as the “priority population.” BTCS is the only publicly funded behavioral health provider in the County of 131,533 in population. Collaborating with Guadalupe Regional Hospital, Department of State Health Services, and the Teddy Buerger Center Guadalupe Regional Medical Center 3 projects GRMC is a 125 bed city/county community hospital serving a population of approximately 100,000 in 8 counties. Collaborating with Bluebonnet Trails Community Services, the Teddy Buerger Center, and the Texas Diabetes Institute ADD INFORMATION ADD LINKS US Census Quick Facts County Health Rankings

Kerr County Exit Hill Country MHDD Centers 8 projects
Hill Country Community MHMR Center (dba Hill Country MHDD Centers) is a community mental health center providing mental health, substance use disorder, early childhood intervention and intellectual and developmental disability services to the following counties of RHP6 (Bandera, Comal, Edwards, Gillespie, Kendall, Kerr, Kinney, Medina, Real, Uvalde and Val Verde). Hill Country serves a 14,390 square mile area of RHP6 with a population of approximately 401,123 in 2012. Collaborating with hospitals, schools, and judicial systems Peterson Regional Medical Center 2 projects Peterson Regional Medical Center (PRMC) is the only healthcare organization within Kerr County and is located in the town of Kerrville. The population for Kerrville (2011) was listed as 22,423 and the population for Kerr County (2011) was 49,783. Kerr County is a total of 1,108 sq miles (45 persons/sq mile) with only 20.3 (1,100.7 persons/sq mile) of that belonging to Kerrville. PRMC provides healthcare and medical resources to nine surrounding counties with a total population of 187,293. Kerr County has been listed as a Healthcare Provider shortage area; this however is magnified by the fact that the majority of surrounding counties is also listed as shortage areas, and/or is unable to provide any healthcare services at all. It was found in our Community Health Needs Assessment held in October of this year that 28% of Kerr County’s population is unfunded, which is much higher than the national average of unfunded population which was found to be 16% and the national benchmark 11%. The cost of care for these groups is on the rise,; it is crucial that changing our practice to provide efficient, cost effective, high quality care is placed at the top of our priority list. Of PRMC’s total diabetic population visits, Medicaid/Indigent/Self-pay comprised 11%. Collaborating with home health agencies ADD INFORMATION ADD LINKS US Census Quick Facts County Health Rankings

Medina County Exit Medina Healthcare System 3 projects
Medina Healthcare System is comprised of Medina Regional Hospital (“MRH”) and three Rural Health Clinics. MRH is a 25 bed critical access hospital and is the sole hospital provider in Medina County with an approximate population of 47,000 and square mileage of 1,335. The hospital is located in the City of Hondo, which is a 10 square mile area, and approximate population of 9,000. Collaborating with Dimmit Regional Hospital, University Health System, EmCare, and Methodist Healthcare System Hill Country MHDD Centers 8 projects Hill Country Community MHMR Center (dba Hill Country MHDD Centers) is a community mental health center providing mental health, substance use disorder, early childhood intervention and intellectual and developmental disability services to the following counties of RHP6 (Bandera, Comal, Edwards, Gillespie, Kendall, Kerr, Kinney, Medina, Real, Uvalde and Val Verde). Hill Country serves a 14,390 square mile area of RHP6 with a population of approximately 401,123 in 2012. Collaborating with hospitals, schools, and judicial systems ADD INFORMATION ADD LINKS US Census Quick Facts County Health Rankings

Uvalde County Exit Uvalde Memorial Hospital 3 projects
Uvalde Memorial Hospital is a 66-bed sole community hospital located in Uvalde, TX serving approximately 47,000 individuals residing within 5 counties (7,000 square mile area). Collaborating with Avance Hill Country MHDD Centers 8 projects Hill Country Community MHMR Center (dba Hill Country MHDD Centers) is a community mental health center providing mental health, substance use disorder, early childhood intervention and intellectual and developmental disability services to the following counties of RHP6 (Bandera, Comal, Edwards, Gillespie, Kendall, Kerr, Kinney, Medina, Real, Uvalde and Val Verde). Hill Country serves a 14,390 square mile area of RHP6 with a population of approximately 401,123 in 2012. Collaborating with hospitals, schools, and judicial systems ADD INFORMATION ADD LINKS US Census Quick Facts County Health Rankings

Val Verde County Exit Val Verde Regional Hospital 4 projects
Val Verde Regional Medical Center is a 93-bed acute care county hospital located in the medically underserved border community of Del Rio, Texas. It is the only hospital serving Val Verde County. The county’s population is approximately 50,000 with the majority of those persons living in and around Del Rio. Collaborating with University Health System Hill Country MHDD Centers 8 projects Hill Country Community MHMR Center (dba Hill Country MHDD Centers) is a community mental health center providing mental health, substance use disorder, early childhood intervention and intellectual and developmental disability services to the following counties of RHP6 (Bandera, Comal, Edwards, Gillespie, Kendall, Kerr, Kinney, Medina, Real, Uvalde and Val Verde). Hill Country serves a 14,390 square mile area of RHP6 with a population of approximately 401,123 in 2012. Collaborating with hospitals, schools, and judicial systems ADD INFORMATION ADD LINKS US Census Quick Facts County Health Rankings

Wilson County Exit Connally Memorial Medical Center 2 projects
Connally Memorial Medical Center (CMMC) is a 44-bed hospital in Floresville, TX. CMMC is the sole community hospital serving Wilson County with a population of 43,000 Collaborating with hospitals, schools, and judicial systems Camino Real Community Services 4 projects Camino Real Community Services is a Local Mental Health Authority that provides outpatient mental health services to child, adolescent, and adult patients with severe and persistent mental illness. The provider is located in a 10,000 square mile rural service area with a total population of approximately 206,777 (RHP6 counties include Atascosa, Dimmit, Frio, La Salle, McMullen, Wilson, and Zavala). In 2012, the Center provided services to 3,538 adults and children that met criteria for services. The Mental Health Operating budget is approximately 6.9 million dollars. The programs work closely with schools, health centers, hospitals, law enforcement, judiciary and local elected officials to coordinate the provision of services. Collaborating with Federally Qualified Health Centers and South Texas Behavioral Institute ADD INFORMATION ADD LINKS US Census Quick Facts County Health Rankings

Project Title /QPI Targets
Baptist Health System Exit Contact Information Melody Laughlin, MPH Quality Director (210) 615 Soledad St. #300, San Antonio, TX 78205 IGT Funding: University Health System Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 26% DY6 MLIU=7,166 encounters 1.1.1 Establish more primary care clinics: Expand Primary Care Capacity Encounters: DY3=10,867; DY4=13,584; DY5=27,994; DY6=27,994 IT-9.10 ED throughput Measure Bundle Narrative; Milestones Sustaining outside of DSRIP DY6 MLIU=16,809 encounters 1.9.2 Improve access to specialty care: Expand Specialty Care Capacity Encounters: DY3=18,718; DY4=28,076; DY5=65,919*; DY6=65,919 IT-3.3 Risk adjusted readmission rate for Congestive Heart Failure IT-3.9 Risk adjusted readmission rate for Acute Myocardial Infarction Narrative; Milestones ; DY5 Poster; DY6 Poster DY5MLIU: 26% DY6 MLIU=19,558 encounters Enhance improvement capacity within people Encounters: DY3=60,539; DY4=62,053; DY5=75,222*; DY6=75,222 Narrative; Milestones; DY3 Poster; DY5 Poster; DY6 Poster Partially sustaining outside of DSRIP DY5 MLIU: 48% DY6 MLIU=5,351 encounters 2.8.1 Design, develop and implement a program of continuous, rapid process improvement that will address issues of safety, quality and efficiency Encounters: DY3=11,225; DY4=11,225; DY5=11,265; DY6=11,265 Narrative; Milestones; DY3 Poster; DY5 Poster; DY6 Poster * Target raised in DY4

Bluebonnet Trails Community Services
Exit Contact Information Meghan Nadolski, LCSW Project Coordinator, 1115 Waiver (802) 1009 N. Georgetown Street, Round Rock, TX IGT Funding: Bluebonnet Trails Community Services Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 Project withdrawn August 2015 Develop and implement crisis stabilization services to address the identified gaps in the current community crisis system. Child Crisis Respite Individuals: DY3=3; DY4=16; DY5=31 IT-9.1 Potential preventable admissions/readmissions to a criminal justice setting Narrative; Milestones; Project Withdrawal Form DY5 MLIU: 70% DY6 MLIU=280 individuals Expand the number of community based settings where behavioral health services may be delivered in underserved areas: Substance Abuse Treatment and Intervention Services Individuals: DY3=100; DY4=200; DY5=400; DY6=400 IT-11.8 Initiation of and Engagement in Treatment for alcohol and other drug dependence Narrative; Milestones; DY5 Poster Continuing as a Core Activity DY5 MLIU: 75% DY6 MLIU=225 individuals 2.9.1 Provide navigation services to targeted patients who are at high risk of disconnect from institutional health care: Patient Navigator for Persons with Chronic Mental Illnesses Individuals: DY3=15; DY4=150*; DY5=200*; DY6=300 IT-3.14 Readmission for any cause within 30 days of discharge Narrative; Milestones DY3 Poster; DY4 Poster Partially sustaining outside of DSRIP DY5 MLIU: 80% PROJECT COMBINED INTO RHP 7 for DY6 Design, implement, and evaluate research‐supported and evidence‐based interventions tailored towards individuals in the target population Individuals: DY3=8; DY4=12; DY5=18 IT-11.26c Improvement in ANSA scores DY3 Poster; DY6 Poster * Target raised in DY4

Children’s Hospital of San Antonio
Exit Contact Information Name: Pamela Mote Program Director, Strategic Planning (210) Address: 333 North Santa Rosa Street, San Antonio, TX 78207 IGT Funding: University Health System Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 20% DY6 MLIU=1,783 encounters 1.9.2 Improve access to specialty care: Pediatric Subspecialty Expansion Encounters: DY3=1,574; DY4=4,714; DY5=8,914; DY6=8,914 IT-9.4.h Percent of children ages diagnosed with asthma with one or more asthma- related emergency room visits Narrative; Milestones; DY6 Poster Sustaining outside of DSRIP DY6 MLIU=740 encounters 1.1.1 – Establish more primary care clinics: Primary Care Expansion Program Encounters: DY3=405; DY4=2,436; DY5=3,0702; DY6=3,702 IT-8.20 Percent of children screened for risk of developmental, behavioral and social delays during the first three years of life IT-8.21 Percent of patients under 15 months who had six or more well-child visits IT-8.24 Percent of patients years of age with at least one comprehensive well-care visit Narrative; Milestones

CHRISTUS Santa Rosa Health System
Exit Contact Information Name: Pamela Mote Program Director, Strategic Planning (210) Address: 333 North Santa Rosa Street, San Antonio, TX 78207 IGT Funding: University Health System Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 20% DY6 MLIU=1,650 encounters 1.1.2 Expand existing primary care capacity Encounters: DY3=750; DY4=4,500; DY5=8,250; DY6=8,250 IT-1.10 Percent of diabetes patients with HbA1c level greater than 9% or not tested IT-1.11 Percent of diabetes patients with blood pressure <140/90 Narrative; Milestones Sustaining outside of DSRIP DY5 MLIU: 5% DY6 MLIU=544 individuals 2.1.2 Collaborate with an affiliated Patient- Centered Medical Home to integrate care management and coordination for shared, high-risk patients: Patient-Centered Medical Home Individuals: DY3=2,136; DY4=2,097*; DY5=10,878*; DY6=10,878 Sustaining outside of DSRIP DY6 MLIU=29 individuals Develop, Implement, and evaluate standardized clinical protocols and evidence- based care delivery model to improve care transitions: Care Transitions – Intervention Nurse Program Individuals: DY3=74; DY4=75; DY5=300*; DY6=300 IT-3.3 Risk adjusted readmissions for Congestive Heart Failure IT-3.9 Risk adjusted readmissions for Acute Myocardial Infarction DY3 Poster; DY4 Poster; DY6 Poster * Target raised in DY4

Camino Real Community Services
Exit Contact Information Eva de la Fuente Quality Management Director (210) 19965 FM 3175 N., Lytle, TX 78052 IGT Funding: Community Real Community Services Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 100% PROJECT COMBINED INTO RHP 20 for DY Development of Behavioral Health Crisis Stabilization Services as alternatives to hospitalization Individuals: DY4=50; DY5=108 IT Assessment of risk to self/others IT-6.2.a General satisfaction across varied health and human services Narrative; Milestones Continuing as a Core Activity DY6 MLIU=546 individuals Enhance service availability (i.e., hours, locations, transportation, mobile clinics) of appropriate levels of behavioral health care: mobile clinics Individuals: DY3=100; DY4=120; DY5=510; DY6=546 IT e.i PHQ-9 assesses and monitors depression severity IT d Assess dimensions crucial to good clinical decision- making for expensive health service interventions DY6 MLIU=19 individuals Design, implement, and evaluate research supported and evidence-based interventions tailored towards individuals in the target population Individuals: DY3=3; DY4=8*; DY5=11*; DY6=19 DY3 Poster; DY5 Poster PROJECT COMBINED INTO RHP 20 for DY6 Design and implement integrated primary and behavioral health care services Individuals: DY3=50; DY4=55; DY5=60 Narrative; Milestones; DY4 Poster * Target raised in DY4

Clarity Child Guidance Center
Exit Contact Information Michael Bernick, CMA Executive Vice President, Finance (210) 8535 Tom Slick, San Antonio, TX 78229 IGT Funding: University Health System Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 58% DY6 MLIU=191 encounters 1.9.2 Improve access to specialty care Encounters: DY4=315; DY5=330; DY6=330 IT-2.7 Behavioral Health / Substance Abuse Hospital Admission Rate Narrative; Milestones DY3 Poster; DY5 Poster; DY6 Poster Continuing as a Core Activity

Connally Memorial Hospital
Exit Contact Information Name: Michelle Felux Clinical Operations Analyst 499 10th Street, Floresville, TX 78114 IGT Funding: Connally Memorial Hospital Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 23% DY6 MLIU=1,774 encounters 1.9.1 Expand high impact specialty care capacity in most impacted specialties Encounters: DY3=4,200; DY4=4,620; DY5=7,712; DY6=7,712 IT-1.6 Percent of patients with cardiovascular condition who had LCL- C <100 mg/dL Narrative; Milestones DY3 Poster Sustaining outside of DSRIP DY6 MLIU=1,649 encounters 1.1.1 Establish more primary care clinics Encounters: DY3=2,860; DY4=3,146; DY5=7,170; DY6=7,170 IT-1.10 Percentage of patients with diabetes who had HbA1c > 9% Narrative; Milestones; DY5 Poster; DY6 Poster Continuing as a Core Activity Wilson

University Medicine Associates
Exit Contact Information Gabriela Canales, MBA Director, DSRIP Project Management (210) 4502 Medical Dr., San Antonio, TX 78229 IGT Funding: University Health System Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 78% DY6 MLIU=1,560 encounters 1.2.2 Increase the number of primary care providers (nurse practitioners and physician assistants) and other clinicians/staff (allied health professionals) Encounters: DY4=1,000; DY5=2,000; DY6=2,000 IT-1.11 Percent of patients with diabetes whose most recent blood pressure reading is <140/90 mm Hg Narrative; Milestones; DY4 Poster Sustaining outside of DSRIP DY5 MLIU: 80% DY6 MLIU=920 individuals 2.2.2 Apply evidence-based care management model to patients identified as having high-risk care needs: Implement Care Model for Clinic settings Individuals: DY3=600; DY4=900; DY5=1,150; DY6=1,150 IT-9.4.b Rate of ED utilization for preventable Diabetes conditions or complications per 100,000 Narrative; Milestones Continuing as a Core Activity DY6 MLIU=4,310 individuals Develop, implement, and evaluate action plans to enhance/eliminate gaps in the development of various aspects of PCMH standards: Community Medicine Associates Individuals: DY3=2,443; DY4=3,812; DY5=5,388; DY6=5,388 DY3 Poster; DY6 Poster Suspended/Discontinued

Dimmit Regional Hospital
Exit Contact Information Carmen Esquivel, RN Chief Nursing Officer (830) ext 500 704 Hospital Dr., Carrizo Springs, TX 78834 IGT Funding: Dimmit County Hospital District Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 35% DY6 MLIU=963 encounters 1.9.1 Expand high impact specialty care capacity in most impacted medical specialties: Improving Rural Access to Specialty Care Encounters: DY3=500; DY4=2,500; DY5=2,750; DY6=2,750 IT-3.22 Risk-adjusted hospital readmissions Narrative; Milestones DY3 Poster Sustaining outside of DSRIP DY5 MLIU: 70% DY6 MLIU=281 encounters 1.6.2 – Establish/expand access to medical advice and direction to the appropriate level of care to reduce Emergency Department use for non- emergent conditions and increase patient access to health care. Encounters: DY3=730; DY4=1,825; DY5=401*, DY6=401 IT-9.10 a,b,c Emergency Department throughput bundle Continuing as a Core Activity *Target reduced in DY4

Frio Regional Hospital
Exit Contact Information Thomas Grimert Chief Financial Officer (830) Address: 200 IH 35 South, Pearsall, TX 78061 Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 33% DY6 MLIU=1,320 encounters 1.1.2 Expand Primary Care Capacity Encounters: DY3=1,500; DY4=3,600; DY5=4,000; DY6=4,000 IT-1.12 Percent of patients with diabetes who received a retinal or dilated eye exam IT-1.13 Percent of patients with diabetes who received a foot exam IT-1.14 Percent of patients with diabetes who received a nephropathy screening test Narrative; Milestones; DY5 Poster; DY6 Poster Expanding outside of DSRIP DY6 MLIU=66 encounters 1.7.1 Implement telemedicine program to provide or expand specialist referral services in an area identified as needed to the region Encounters: DY4=100; DY5=200; DY6=200 IT-9.10 ED throughput measure bundle Narrative; Milestones Sustaining outside of DSRIP Frio

Guadalupe Regional Medical Center
Exit Contact Information Kara Maierhofer, MHA Clinical Quality Data Analyst (830) 1215 E Court St., Seguin, TX 78155 IGT Funding: Guadalupe Regional Medical Center Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 100% DY6 MLIU=2,440 encounters 1.1.2 Expand Existing Primary Care Capacity – GRMC Encounters: DY3=480; DY4=960; DY5=2,440; DY6=2,440 IT-1.10 Percentage of patients with diabetes who had HbA1c > 9% Narrative; Milestones DY3 Poster; DY4 Poster Continuing as a Core Activity DY5 MLIU: 30% DY6 MLIU=142 encounters Implement/Expand Care Transitions Program Individuals: DY3=210; DY4=263; DY5=474; DY6=474 IT-3.22 Risk-adjusted hospital readmissions Sustaining outside of DSRIP DY6 MLIU=75 individuals 2.9.1 Provide navigation services to targeted patients who are at high risk of disconnect from institutionalized health care Individuals: DY3=100; DY4=175; DY5=250; DY6=250 IT-9.4 Rate of ED utilization for BH/SA conditions per 100,000 Narrative; Milestones; DY6 Poster DY5 MLIU: 39% DY6 MLIU=39 encounters Implement a Palliative Care Program to address patients with end-of-life decisions and care needs Encounters: DY3=25; DY4=65; DY5=100; DY6=100 IT-13.2 Percent of patients with chart documentation of preferences for life sustaining treatments IT-13.5 The percent of hospice patients with documentation of discussion of spiritual/religious concerns IT-13.6 Palliative Care: Documentation of interdisciplinary family meeting Narrative; Milestones; DY5 Poster

Hill Country Memorial Hospital
Exit Contact Information John Leftwich Strategy Analyst (830) 1020 Texas 16, Fredericksburg, TX 78624 IGT Funding: Fredericksburg Hospital Authority Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 85% DY6 MLIU=170 individuals 2.7.1 Implement innovative evidence‐based strategies to increase appropriate use of technology and testing for targeted populations: Health Screening and Education for the Uninsured Individuals: DY3=100; DY4=200; DY5=200; DY6=200 IT-12.1 Percent of women who had a mammogram every two years IT Intensive behavioral dietary counseling for patients with hyperlipidemia and other risk factors IT Ankle brachial index Narrative; Milestones DY3 Poster; DY4 Poster; DY5 Poster; DY6 Poster Sustaining outside of DSRIP

Hill Country Mental Health & Development Disabilities Centers
Exit Contact Information Kristie Jacoby 1115 Waiver Projects Manager (830) x2093 819 Water Street Suite 300, Kerrville, TX 78028 IGT Funding: Hill Country MHDD Centers Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 86% DY6 MLIU=777 individuals Provide an intervention for a targeted behavioral health population to prevent unnecessary use of services in a specific setting: Mobile Crisis Outreach Teams Individuals: DY3=30; DY4=600*; DY5=900*; DY6=900 IT ADL functional assessment Narrative; Milestones DY3 Poster; DY5 Poster Sustaining outside of DSRIP PROJECT COMBINED INTO RHP 7 for DY6 Provide virtual psychiatric and clinical guidance to all participating primary care providers delivering services to behavioral patients regionally: Hill Country Virtual Psychiatric and Clinical Guidance Individuals DY4=1,500; DY5=2,500 IT Assessment for substance abuse problems of psychiatric patients IT Assessment for psychosocial issues of psychiatric patients IT Documentation of presenting features of depression at time of diagnosis Continuing as a Core Activity PROJECT COMBINED INTO RHP 7 for DY Provide an intervention for a targeted behavioral health population to prevent unnecessary use of services in a specific setting: Co-occurring Psychiatric and Substance Use Disorder Individuals: DY3=50; DY4=109; DY5=130 DY3 Poster Provide an intervention for a targeted behavioral health population to prevent unnecessary use of services in a specific setting: Trauma Informed Care Individuals: DY3=40; DY4=170*; DY5=180* Kerr View page: * Target raised in DY4 1 2

Project Title /QPI Targets PROJECT COMBINED INTO RHP 7 for DY6
Hill Country Mental Health & Development Disabilities Centers Exit Contact Information Kristie Jacoby 1115 Waiver Projects Manager (830) x2093 819 Water Street Suite 300, Kerrville, TX 78028 IGT Funding: Hill Country MHDD Centers Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 86% PROJECT COMBINED INTO RHP 7 for DY6 Design, implement, and evaluate whole health peer support for individuals with mental health and/or substance use disorders: Whole Health Peer Support Individuals: DY3=25; DY4=120; DY5=200 IT ADL functional assessment Narrative; Milestones Continuing as a Core Activity Design, implement, and evaluate research-supported and evidence-based interventions tailored towards individuals in the target population: Veteran Mental Health Services Individuals: DY3=40; DY4=80; DY5=140 Discontinued Design, implement, and evaluate research-supported and evidence-based interventions tailored towards individuals in the target population: Mental Health Courts Individuals: DY3=20; DY4=50; DY5=80* Narrative; Milestones; DY6 Poster Sustaining outside of DSRIP DY6 MLIU=34 individuals Provide an intervention for a targeted behavioral health population to prevent unnecessary use of services in a specific setting: IDD Crisis Services Individuals: DY3=15; DY4=25; DY5=40; DY6=40 IT-10.2.a Supports Intensity Scale (SIS) Partially sustaining outside of DSRIP Kerr View page: * Target reduced in DY4 1 2

Medina Healthcare System
Exit Contact Information Billie Bell, RN, BSN, CCM VP Operations (830) 3100 Avenue E, Hondo, TX 78861 IGT Funding: Medina Regional Hospital Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 32% DY6 MLIU=2,052 encounters Expand existing primary care capacity: a) expand primary care clinic space; b) expand primary care clinic hours; and c) expand primary care clinic staffing. Encounters: DY3=239; DY4=1,435; DY5=6,515; DY6=6,515 IT-12.1 Percent of women who had a mammogram every two years IT-12.3 Percent of patients who had appropriate screening for colorectal cancer IT-12.4 Percent of patients who have ever received a pneumococcal vaccine Narrative; Milestones DY3 Poster1; DY3 Poster 2; DY4 Poster Continuing as a Core Activity DY5 MLIU: 26% DY6 MLIU=26 individuals Enhance improvement capacity within people – Medina Healthcare System Individuals: DY3=50; DY4=100; DY5=100; DY6=100 IT-9.10 Emergency Department throughput bundle Sustaining outside of DSRIP DY5 MLIU: 27% DY6 MLIU=27 encounters 1.6.2 Establish/expand access to medical advice and direction to the appropriate level of care to reduce Emergency Department use for non-emergent conditions and increase patient access to health care. Encounters: DY3=30; DY4=82; DY5=100; DY6=100 IT-9.10a Median time from ED arrival to ED departure for discharged ED patients IT-9.10b Median time from admit decision time to time of departure for ED for ED patients admitted to inpatient IT-9.10c Median time from ED arrival to time of ED departure for patients admitted to facility from the ED Narrative; Milestones; DY5 Poster; DY6 Poster

Methodist Healthcare System
Exit Contact Information Lisa Smyle (210) 7700 Floyd Curl Dr., San Antonio, TX 78229 IGT Funding: University Health System Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 55% DY6 MLIU=1,840 encounters 1.7.1 Introduce, Expand, or Enhance Telemedicine/Telehealth Metric 1 – Encounters: DY3=50; DY4=100; DY5=150 Metric 2 – Encounters: DY3=1,250; DY4=2,250; DY5=3,125 Combined DY6=3,275 IT-4.17 Proportion of acute ischemic stroke patients with IV t-PA initiated within three hours IT-9.6 Percent of patients presenting to the ED who did not wait after having clinical information documented IT-9.10.a Median time from ED arrival to departure Narrative; Milestones DY3 Poster; DY4 Poster Continuing as a Core Activity DY5 MLIU: 43% DY6 MLIU=1,290 encounters 1.1.1 Establish more primary care clinics Encounters: DY3=600; DY4=1,900; DY5=3,000; DY6=3,000 IT-1.13 Percent of patients with diabetes who received a foot exam DY5 MLIU: 30% DY6 MLIU=2,100 individuals 2.4.2 Redesign to Improve Patient Experience Individuals: DY3=5,000; DY4=6,000; DY5=7,000; DY6=7,000 IT-4.5 Documented falls Narrative; Milestones; DY5 Poster ; DY6 Poster DY5 MLIU: 19% DY6 MLIU=200 individuals Apply Process Improvement Methodology to improve quality/efficiency: Sepsis Individuals: DY4=525; DY5=1,050; DY6=1,050 IT-4.2 CLABSI rate DY3 Poster

Nix Health Exit Contact Information Carey Adkins 1115 Waiver Data Analyst (210) 414 Navarro St., San Antonio, TX 78205 IGT Funding: Dimmit County Memorial Hospital, Frio Hospital District, Medina Regional Hospital, and Uvalde County Hospital Authority Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 85% DY6 MLIU=238 individuals Expand the number of community based settings where behavioral health services may be delivered in underserved areas Individuals: DY3=30; DY4=240; DY5=280; DY6=280 IT-1.18 Percent of MH patients discharged from hospital and having follow up within 7 and 30 days Narrative; Milestones Sustaining outside of DSRIP DY6 MLIU=200 encounters 1.4.1 Expand Access to Written and Oral Interpretation Services Encounters: DY3=130; DY4=336; DY5=372; DY6=372 IT-6.1.a.v HCAHPS measuring patients’ perceptions of hospital experience Narrative; Milestones; DY6 Poster DY6 MLIU=612 individuals 2.17 Establish improvements in care transition from the inpatient setting for individuals with mental health and / or substance abuse disorders. Individuals: DY3=128; DY4=600; DY5=720; DY6=720 IT-6.2.a General satisfaction across varied health and human services IT-1.13 Percent of patients with diabetes who received a foot exam View page: 1 2

Nix Health Exit Contact Information Carey Adkins 1115 Waiver Data Analyst (210) 414 Navarro St., San Antonio, TX 78205 IGT Funding: Dimmit County Memorial Hospital, Frio Hospital District, Medina Regional Hospital, and Uvalde County Hospital Authority Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 28% DY6 MLIU=700 2.1.1 Enhance/Expand Medical Homes: Nix Health Medical Homes Individuals: DY3=500; DY4=1,000; DY5=2,500; DY6=2,500 IT-12.1 Percent of women who had a mammogram every two years IT-12.3 Percent of patients who had appropriate screening for colorectal cancer IT-12.4 Percent of patients who have ever received a pneumococcal vaccine Narrative; Milestones DY3 Poster; DY4 Poster; DY5 Poster Sustaining outside of DSRIP DY5 MLIU: 29% DY6 MLIU=213 2.8.1 Design, develop, and implement a program of continuous rapid process improvement that will address issues of safety, quality, and efficiency within the Nix Geriatric Med/Surg Inpatient Population Individuals: DY3=600; DY4=668; DY5=735; DY6=735 IT-4.3 CAUTI rate Discontinued DY5 MLIU: 50% DY6 MLIU=450 2.9.1 Establish a Patient Care Navigation Program Individuals: DY3=600; DY4=750; DY5=900; DY6=900 IT-3.5 Risk adjusted readmission rate for diabetes patients Continuing as a Core Activity View page: 1 2

Peterson Regional Medical Center
Exit Contact Information Tracy Davis, RN, BSN, CCM Director of Care Coordination (830) 551 Hill Country Dr., Kerrville, TX 78028’ IGT Funding: Fredericksburg Hospital Authority Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 11% DY6 MLIU=198 individuals Enhance Improvement Capacity through Technology Individuals: DY4=1,800; DY5=2800; DY6=1,800 IT-3.4 Risk adjusted readmissions for any cause Narrative; Milestones; DY5 Poster Sustaining outside of DSRIP DY6 MLIU=128 individuals Develop, implement and evaluate standardized clinical protocols and evidence- based care delivery model to improve care transitions Individuals: DY4=920; DY5=1,165; DY6=1,165 Narrative; Milestones DY3 Poster; DY4 Poster; DY6 Poster

San Antonio Metropolitan Health District
Exit Contact Information Tessie Medina Performance Improvement Manager (210) Riverview Towers | 111 Soledad | 10th Floor, Ste. 1000, San Antonio, TX 78205 IGT Funding: San Antonio Metropolitan Health District Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 15% DY6 MLIU=2,211 individuals 1.8.9 – The implementation or expansion of school‐based sealant and/or fluoride varnish programs that provide sealant placement and/or fluoride varnish applications to otherwise underserved children by enhancing dental workforce capacity through collaborations and partnerships with dental and dental hygiene schools, local health departments (LHDs), federally qualified health centers (FQHCs), and/or local dental providers. Individuals: DY3=8,126; DY4=11,834*; DY5=14,740*; DY6=14,740 IT-7.6 Percent of children with urgent dental care needs Narrative; Milestones DY3 Poster; DY4 Poster Continuing as a Core Activity DY5 MLIU: 50% DY6 MLIU=860 individuals 2.6.1 Engage in population-based campaigns or programs to promote healthy lifestyles using evidence-based methodologies including social media and text messaging in an identified population Comprehensive Teen Pregnancy Prevention Individuals: DY3=1,200; DY4=1,200; DY5=1,719; DY6=1,719 IT-8.9 Number of pregnancies per 1,000 women aged 15-19 Partially sustaining outside of DSRIP DY5 MLIU: 33% DY6 MLIU=569 individuals 2.7.5 Implement innovative evidence-based strategies to reduce and prevent obesity in children and adolescents: Neighborhood Based Physical Activity and Health Promotion Project Individuals: DY3=1,000; DY4=1,500; DY5=1,723; DY6=1,723 IT-10.1.h HRQOL surveillance program DY3 Poster View page: * Target raised in DY4 1 2

San Antonio Metropolitan Health District
Exit Contact Information Tessie Medina Performance Improvement Manager (210) Riverview Towers | 111 Soledad | 10th Floor, Ste. 1000, San Antonio, TX 78205 IGT Funding: San Antonio Metropolitan Health District Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 15% DY6 MLIU=180 individuals 2.6.2 Establish self-management programs and wellness using evidence-based designs: Community Diabetes Project Individuals: DY3=1,000; DY4=1,200; DY5=1,200; DY6=1,200 IT-10.1.h HRQOL surveillance program Narrative; Milestones DY3 Poster; DY4 Poster; DY5 Poster Continuing as a Core Activity DY5 MLIU: 80% DY6 MLIU=838 individuals 2.7.1 Implement innovative evidence-based strategies to increase appropriate use of technology and testing for targeted populations Individuals: DY3=800; DY4=800; DY5=1,047; DY6=1,047 IT Proportion of individuals who undergo follow up clinical and/or serological evaluation after treatment for Syphilis DY3 Poster; DY4 Poster; DY6 Poster DY6 MLIU=105 individuals 2.7.5 Implement innovative evidence-based strategies to reduce and prevent obesity in children and adolescents – Breastfeeding Promotion for Childhood Obesity Prevention Individuals: DY3=500; DY4=600; DY5=700; DY6=700 IT-8.14 Proportion of caregivers who report child is exclusively breastfed through three months of age IT-8.14 Proportion of caregivers who report child is exclusively breastfed through six months of age IT-8.16 Proportion of caregivers who report child was breastfed at least once through six months of age DY3 Poster; DY4 Poster View page: 1 2

Southwest General Hospital
Exit Contact Information Sarah Humme, DNP, RN, NEA-BC, CENP (210) 7400 Barlite Blvd., San Antonio, TX 78224 IGT Funding: University Health System Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 89% DY6 MLIU=1,79 6 encounters 1.9.2 Improve Access to Specialty Care: Improve Outcomes for Diabetic Pregnancies Encounters: DY3=2,500 ; DY4=2,035*; DY5=2,242*; DY6=2,018 IT-8.2 Percent of births with birth weight <2,500 grams Narrative; Milestones; DY5 Poster ; DY6 Poster Discontinued DY5 MLIU: 45% DY6 MLIU=90 individuals Establish self management programs and wellness using evidence based designs: Develop, implement, and evaluate evidence based self management program for individuals identified with chronic cardiovascular condition/s through a mobile cardiovascular screening program. Individuals: DY3=50; DY4=100; DY5=200; DY6=200 IT-1.7 Percent of patients with diagnosis of hypertension and who blood pressure was adequately controlled. Narrative; Milestones DY3 Poster; DY5 Poster Partially sustaining outside of DSRIP * Target reduced in DY4

DSHS / Texas Center for Infectious Disease
Exit Contact Information Yolanda Cantu Texas Department of State Health Services Health Service Region 08 (210) 7430 Louis Pasteur, San Antonio, TX 78229 IGT Funding: Department of State Health Services Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 30% DY6 MLIU=1,050 individuals 2.7.1– Implement innovative evidence-based strategies to increase appropriate use of technology and testing for targeted population: Tuberculosis Identification and Treatment Project Individuals: DY4=3,500; DY5=3,500; DY6=3,500 IT Persons with latent tuberculosis who complete a course of treatment Narrative; Milestones; DY4 Poster; DY5 Poster; DY 6 Poster Continuing as a Core Activity

The Center for Health Care Services
Exit Contact Information Burt Santos, MS, LPC-I Project Director (210) 601 N Frio St. San Antonio, TX 78207 IGT Funding: The Center for Health Care Services Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 93% DY6 MLIU=140 individuals Develop and implement crisis stabilization services to address the identified gaps in the current community crisis system: Bexar CARES for Children: Crisis and Respite Center Individuals: DY4=100; DY5=150; DY6=150 IT-6.2.a General satisfaction across varied health and human services Narrative; Milestones DY3 Poster; DY4 Poster; DY6 Poster Sustaining outside of DSRIP DY5 MLIU: 96% DY6 MLIU=1,575 individuals Establish extended operating hours at a select number of Local Mental Health Center clinics or other community-based setting in areas of the State where access to care is likely to be limited: Expanded OP Capacity Individuals: DY3=230; DY4=1,167; DY5=1,750; DY6=1,750 IT-10.1.b.iii RAND SF-35 survey DY5 MLIU: 79% DY6 MLIU=375 individuals Develop and implement crisis stabilization services to address the identified gaps in the current community crisis system: Hospital Diversion Recovery Services Individuals: DY4=270; DY5=475; DY6=475 IT-6.2.a General satisfaction across varied health and human services DY6 MLIU=221 individuals Expand the number of community based settings where behavioral health services may be delivered in underserved areas: Children’s Mental Health Individuals: DY3=38; DY4=115; DY5=230; DY6=230 Narrative; Milestones; DY4 Poster View page: 1 2 3

The Center for Health Care Services Exit Contact Information Burt Santos, MS, LPC-I Project Director (210) 601 N Frio St. San Antonio, TX 78207 IGT Funding: The Center for Health Care Services Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 84% DY6 MLIU=73 individuals Expand the number of community based settings where behavioral health services may be delivered in underserved areas: Dual Diagnosis Clinic Individuals: DY3=40; DY4=64; DY5=87; DY6=87 IT-6.2.a General satisfaction across varied health and human services Narrative; Milestones; DY4 Poster Sustaining outside of DSRIP DY5 MLIU: 98% DY6 MLIU=372 individuals Design, implement and evaluate research supported and evidence‐based interventions tailored towards individuals in the target population Individuals: DY3=338; DY4=368; DY5=400; DY6=400 IT-9.1 Percent of individuals receiving the intervention that had a potentially preventable admission/readmission to a criminal justice setting Narrative; Milestones DY3 Poster Partially sustaining outside of DSRIP DY5 MLIU: 73% DY6 MLIU=128 individuals Design, implement, and evaluate projects that provide integrated primary and behavioral health care services: PCY Integrated Clinic Individuals: DY4=125; DY5=175; DY6=175 IT Assessment for psychosocial issues of psychiatric patients Continuing as a Core Activity DY6 MLIU=1,278 individuals Design, implement, and evaluate projects that provide integrated primary and behavioral health care services: Integrated Primary Care for SA and HIV Population Individuals: DY4=1,250; DY5=1,750; DY6=1,750 IT-10.1.b.iii RAND SF-35 survey DY3 Poster; DY6 Poster View page: 1 2 3

The Center for Health Care Services Exit Contact Information Burt Santos, MS, LPC-I Project Director (210) 601 N Frio St. San Antonio, TX 78207 IGT Funding: The Center for Health Care Services Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 MLIU: 84% DY6 MLIU=155 individuals Design, implement and evaluate research- supported and evidence-based interventions tailored towards individuals in the target population: Coordinated Community Integrated Care Response for Super-Utilizing Consumers- Expand and Enhance Pilot Project Individuals: DY3=125; DY4=160; DY5=185; DY6=185 IT-10.1.b.iii RAND SF-35 survey Narrative; Milestones; DY6 Poster Continuing as a Core Activity MLIU: 73% DY6 MLIU=111 individuals Design, implement and evaluate research- supported and evidence-based interventions tailored towards individuals in the target population: In House Women's Wellness Program (IHWWP) Individuals: DY3=92; DY4=122; DY5=152; DY6=152 Narrative; Milestones Sustaining outside of DSRIP MLIU: 92% DY6 MLIU=110 individuals 2.2.5 Develop care management functions that integrate the primary and behavioral health needs of individuals: Behavioral healthcare workforce development in integrated healthcare settings Individuals: DY3=40; DY4=60; DY5=120*; DY6=120 IT-6.2.a General satisfaction across varied health and human services Narrative; Milestones; DY5 Poster; DY6 Poster * Target raised in DY4 View page: 1 2 3

Exit Contact Information Gabriela Canales, MBA Director, DSRIP Project Management (210) 4502 Medical Dr., San Antonio, TX 78229 IGT Funding: University Health System Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 82% DY6 MLIU=4,264 encounters 1.1.1 Establish more primary care clinics: University Hospital Encounters: DY3=2,200; DY4=4,756*; DY5=5,200*; DY6=5200 IT-8.2 Percent of births with birth weight <2,500 grams Narrative; Milestones Sustaining outside of DSRIP DY5 MLIU: 74% DY6 MLIU=17,108 encounters 1.1.2 Expand existing primary care capacity: University Hospital expanding capacity Encounters: DY3=9,775; DY4=14,663; DY5=28,286*; DY6=23,119 IT-9.4.b Rate of ED utilization for preventable Diabetes conditions per 100,000 Narrative; Milestones; DY5 Poster Continuing as a Core Activity DY5 MLIU: 58% DY6 MLIU=989 individuals 1.3.1 Implement/enhance and use chronic disease management registry functionalities Individuals: DY3=225; DY4=1,150; DY5=1,700; DY6=1,700 IT-1.7 Percent of patients with diagnosis of hypertension and who blood pressure was adequately controlled. Suspended / Discontinued DY5 MLIU: 55% DY6 MLIU=715 encounters 1.7.1 – Implement telemedicine program to provide or expand specialist referral services in an area identified as needed to the region: University Hospital Telemedicine Program Encounters: DY3=144; DY4=1,200; DY5=2,400; DY6=1,310 Partially sustaining outside of DSRIP View page: 1 2 3 4 5 6 * Target raised in DY4

Exit Contact Information Gabriela Canales, MBA Director, DSRIP Project Management (210) 4502 Medical Dr., San Antonio, TX 78229 IGT Funding: University Health System Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 81% DY6 MLIU=3,508 encounters Expand Mobile Clinics: University Hospital’s Healthy U Encounters: DY3=3,000; DY4=3,300; DY5=4,325; DY6=4,325 IT-8.2 Percent of patients 3-6 years who received one or more well-child visits IT-12.8 Percent of adolescents who had recommended immunizations by their 13th birthday IT-12.6 Percent of patients who received influenza immunization Narrative; Milestones Sustaining outside of DSRIP DY5 MLIU: 85% DY6 MLIU=15,372 encounters 1.4.1 Expand Access to Written and Oral Interpretation Services Encounters: DY3=12,000; DY4=15,000; DY5=18,000; DY6=18,000 IT-6.1.a.v HCAHPS DY3 Poster; DY4 Poster; DY5 Poster DY5 MLIU: 78% DY6 MLIU=22,686 encounters 1.1.2 Expand existing primary care capacity: Patient-centered pediatric care Encounters: DY3=1,329; DY4=17,565*; DY5=33,799*; DY6=29,085 IT-1.22 Percent of time recommended care was provided Continuing as a Core Activity DY5 MLIU: 74% DY6 MLIU=1,240 individuals Develop and Implement crisis stabilization services to address the identified gaps in the current community crisis system Psychiatric Emergency Services (PES) Individuals: DY4=840; DY5=1,680; DY6=1,680 IT Assessment of risk to self/others IT-1.26 Patients with eplipsy having seizure frequency documented in the medical record IT-1.13 Percent of patients with diabetes who received a foot exam DY3 Poster * Target raised in DY4 View page: 1 2 3 4 5 6

Exit Contact Information Gabriela Canales, MBA Director, DSRIP Project Management (210) 4502 Medical Dr., San Antonio, TX 78229 IGT Funding: University Health System Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 65% DY6 MLIU=166 individuals Develop and implement crisis stabilization services to address the identified gaps in the current community crisis system: Crisis Intervention Unit (CIU) Individuals: DY4=162; DY5=256; DY6=256 IT Assessment of risk to self/others IT-1.13 Percent of patients with diabetes who received a foot exam IT Percent of individuals with schizophrenia and cardiovascular disease who had an LDL-C test during the year Narrative; Milestones Suspended / Discontinued DY5 MLIU: 100% DY6 MLIU=1000 encounters 1.8.6 The expansion of existing dental clinics, the establishment of additional dental clinics, or the expansion of dental clinic hours. Encounters: DY3=300; DY4=910*; DY5=1,000*; DY6=1,000 IT-7.9 Percent of chronic disease patients with improved disease control following treatment DY5 MLIU: 62% DY6 MLIU=820 encounters 1.1.1 Establish more primary care clinics: University Hospital Encounters: DY3=1,200; DY4=1,260; DY5=1,323; DY6=1,323 IT-1.7 Percent of patients with diagnosis of hypertension and who blood pressure was adequately controlled. Sustaining outside of DSRIP DY6 MLIU=975 1.3.1 Real-time Risk Stratification Tool Individuals: DY3=150; DY4=1,000; DY5=1,500; DY6=1,500 IT-3.22 Risk adjusted readmissions Partially sustaining outside of DSRIP * Target raised in DY4 View page: 1 2 3 4 5 6

Exit Contact Information Gabriela Canales, MBA Director, DSRIP Project Management (210) 4502 Medical Dr., San Antonio, TX 78229 IGT Funding: University Health System Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 65% DY6 MLIU=12,025 individuals Develop, implement and evaluate standardized clinical protocols and evidence- based care delivery model to improve care transitions Individuals: DY3=15,000; DY4=16,500; DY5=18,500; DY6=18,500 IT-3.22 Risk adjusted readmissions Narrative; Milestones Sustaining outside of DSRIP DY5 MLIU: 79% DY6 MLIU=346 individuals 2.4.1 Improve processes to measure and improve patient experience: University Hospital- The New “U” Individuals: DY3=83; DY4=376* DY5=436*; DY6=436 IT-4.3 CAUTI rate Narrative; Milestones; DY4 Poster DY6 MLIU=2,438 2.8.1 Design, develop, and implement a program of continuous, rapid process improvement that will address issues of safety, quality, and efficiency Individuals: DY3 =2,800; DY4=2,960; DY5=3,075; DY6=3,075 IT-3.3 Risk adjusted readmissions for CHF DY5 MLIU: 86% DY6 MLIU=1,032 2.9.1 – Provide navigation services to targeted patients who are at high risk of disconnect from institutionalized health care: Establish a Patient Care Navigation Program for University Health System Individuals: DY3=500; DY4=800; DY5=1,200; DY6=1,200 IT-9.4.b Rate of ED utilization for preventable Diabetes conditions per 100,000 Suspended / Discontinued * Target raised in DY4 View page: 1 2 3 4 5 6

Exit Contact Information Gabriela Canales, MBA Director, DSRIP Project Management (210) 4502 Medical Dr., San Antonio, TX 78229 IGT Funding: University Health System Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 70% DY6 MLIU=706 encounters Use a Palliative Care Programs to address patients with end-of-life decisions and care needs: Lifelong Intensive Family Emotional (L.I.F.E.) Care/Palliative Medicine Service Encounters: DY3=894; DY4=913; DY5=1,008; DY6=1,008 IT-13.1 Percent of hospital or palliative care patients screened for pain who received a clinical assessment of pain within 24 hours IT-13.5 Percent of hospice patients with documentation of discussion of spiritual/religious concerns IT-13.6 Percent of patients with documentation that an interdisciplinary family meeting was conducted Narrative; Milestones DY3 Poster; DY4 Poster Sustaining outside of DSRIP DY5 MLIU: 74% DY6 MLIU=3,256 encounters Implement innovative evidence-based strategies to increase appropriate use of technology and testing for targeted populations (e.g., mammograms, immunizations): UHS Encounters: DY3=1,450; DY4=13,000*; DY5=15,000*; DY6=4,400 IT-12.1 Percent of women who had a mammogram every two years IT-12.2 Percent of women screened for cervical cancer IT-12.3 Percent of patients who had appropriate screening for colorectal cancer DY5 MLIU: 78% DY6 MLIU=1,685 individuals Evidence-based interventions that put in place the teams, technology and processes to avoid medication errors: University Hospital Individuals: DY3=1,500; DY4=1,800; DY5=2,160; DY6=2,160 IT-1.10 Percent of diabetes patients with HbA1c level greater than 9% or not tested View page: 1 2 3 4 5 6

Exit Contact Information Gabriela Canales, MBA Director, DSRIP Project Management (210) 4502 Medical Dr., San Antonio, TX 78229 IGT Funding: University Health System Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 47% DY6 MLIU=254 individuals Implement a Care Transitions Project for the CHF Population Individuals: DY3=225; DY4=405; DY5=540; DY6=540 IT-3.3 Risk adjusted readmissions for CHF Narrative; Milestones Sustaining outside of DSRIP DY5 MLIU: 60% DY6 MLIU=480 individuals 2.2.1 Redesign the outpatient delivery system to coordinate care for patients with diabetes: University Hospital Individuals: DY3=400; DY4=800; DY5=800; DY6=800 IT-1.10 Percent of diabetes patients with HbA1c level greater than 9% or not tested DY3 Poster; DY4 Poster; DY5 Poster; DY6 Poster Continuing as a Core Activity DY5 MLIU: 84% DY6 MLIU=1,596 individuals Integrate Primary and Behavioral Health Care Services Individuals: DY3=800; DY4=1,300; DY5=1,900; DY6=1,900 IT-9.4.b Rate of ED utilization for preventable Diabetes conditions per 100,000 Narrative; Milestones; DY4 Poster DY5 MLIU: 100% DY6 MLIU=81 individuals Develop, implement and evaluate standardized clinical protocols and evidence-based care delivery model to improve care transitions: Skilled Nursing Facility and Long Term Acute Hospital Individuals: DY3=25; DY4=50; DY5=65; DY6=81 IT-5.1.d Cost Utility Analysis IT-5.2 Per episode cost of care management IT-5.1.c CEA – systematic analysis of the effects and costs of alternative methods or programs Partially sustaining outside of DSRIP View page: 1 2 3 4 5 6

UT Health San Antonio Exit Contact Information Bob Voss Senior Project Manager, DSRIP 7703 Floyd Curl Dr., San Antonio, TX 78229 IGT Funding: UT Health San Antonio Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 63% DY6 MLIU=316 individuals Enhance improvement capacity within people (Improving Inter-professional Team-Based Care for Patient Safety) Individuals: DY3=167; DY4=418; DY5=501; DY6=501 IT-6.1.b.ii CG-CAHPS Narrative; Milestones Sustaining outside of DSRIP DY5 MLIU: 85% DY6 MLIU=2,894 individuals 1.3.1 Implement/enhance and use chronic disease management registry functionalities (Longitudinal Diabetes and Other Chronic Disease Registries to Improve Patient Outcomes) Individuals: DY3=3,500; DY4=3,675; DY5=3,859; DY6=3,589 IT-1.11 Percent of patients with diabetes whose most recent blood pressure reading is <140/90 mm Hg IT-1.10 Percent of diabetes patients with HbA1c level greater than 9% or not tested Narrative; Milestones; DY5 Poster; DY6 Poster DY5 MLIU: 70% DY6 MLIU=3,221 encounters 1.2.3 Increase the number of residency/training program for faculty/staff to support an expanded, more updated program: Residency Expansion for Family Medicine Residency UTHSCSA Encounters: DY3=750; DY4=1,500; DY5=4,601; DY6=4,601 IT-9.2 Rate of ED utilization for ACSC per 100,000 UT Health Science Center – San Antonio 1.7 View page: 1 2 3 4 5 6 7 8

UT Health San Antonio Exit View page: 1 2 3 4 5 6 7 8
Contact Information Bob Voss Senior Project Manager, DSRIP 7703 Floyd Curl Dr., San Antonio, TX 78229 IGT Funding: UT Health San Antonio Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 39% PROJECT WILL NOT CONTINUE IN DY6 1.3.1 Implement/enhance and use chronic disease management registry functionalities Individuals: DY3=15,250; DY4=30,500; DY5=61,000 IT-12.1 Percent of women who had a mammogram every two years IT-12.3 Percent of patients who had appropriate screening for colorectal cancer IT-12.4 Percent of patients who have ever received a pneumococcal vaccine Narrative; Milestones; DY5 Poster Project withdrawn April 2015 Develop Workforce Enhancement Initiatives in Underserved areas through training as part of the Sustained Treatment as an Outpatient Priority (STOP) Program Patients: DY3=900; DY4=1,200; DY5=1,900 IT-3.4 Readmission for any cause within 30 days of discharge Narrative; Milestones; Project Withdrawal Form DY5 MLIU: 74% DY6 MLIU=666 encounters 1.9.2 Improve Access to Specialty Care: Outpatient Neurology Services Encounters: DY3=540; DY4=720; DY5=900; DY6=900 IT-6.1.d.i Visit Survey IT-1.1 Average number of days to third next available appointment Narrative; Milestones Sustaining outside of DSRIP UT Health Science Center – San Antonio 1.7 View page: 1 2 3 4 5 6 7 8

Project Title /QPI Targets Project withdrawn April 2015
UT Health San Antonio Exit Contact Information Bob Voss Senior Project Manager, DSRIP 7703 Floyd Curl Dr., San Antonio, TX 78229 IGT Funding: UT Health San Antonio Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 35% DY6 MLIU=120 encounters 1.9.2 Improve Access to Specialty Care: Neuropsychological Services Encounters: DY3=50; DY4=100; DY5=343; DY6=343 IT-6.1.d.i Visit Survey IT-1.1 Average number of days to third next available appointment Narrative; Milestones Sustaining outside of DSRIP DY5 MLIU: 50% DY6 MLIU=4,812 encounters 1.1.2 Expand existing primary care capacity – Establish more primary care clinics Encounters: DY3=6,684; DY4=8,020; DY5=9,624; DY6=9,624 IT-6.2.b VSQ-9 Narrative; Milestones; DY6 Poster Project withdrawn April 2015 1.1.1 Establish more primary care clinics: Primary care and behavioral care capacity expansion at UT Medicine San Antonio Visits: DY3=12,000; DY4=13,600; DY5=24,720 IT-1.10 Percent of diabetes patients with HbA1c level greater than 9% or not tested IT-1.11 Percent of patients with diabetes whose most recent blood pressure reading is <140/90 mm Hg Narrative; Milestones; Project Withdrawal Form UT Health Science Center – San Antonio 1.7 View page: 1 2 3 4 5 6 7 8

Project Title /QPI Targets PROJECT WILL NOT CONTINUE IN DY6
UT Health San Antonio Exit Contact Information Bob Voss Senior Project Manager, DSRIP 7703 Floyd Curl Dr., San Antonio, TX 78229 IGT Funding: UT Health San Antonio Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 60% DY6 MLIU=2,095 individuals 1.8.6 Increase, Expand and Enhance Dental Services Individuals: DY3=720; DY4=1,800; DY5=3,492; DY6=3,492 IT-6.2.b VSQ-9 Narrative; Milestones; DY4 Poster; DY5 Poster Sustaining outside of DSRIP Enhance Performance Improvement and Reporting Capability by enhancing improvement capacity through technology: Electronic Health Record Support for Clinical Quality Improvement IT-7.10 Percent of adults with untreated dental caries Narrative; Milestones DY5 MLIU: 75% PROJECT WILL NOT CONTINUE IN DY6 Implement telemedicine program to provide or expand specialist referral services in an area identified as needed to the region [Reengineering the Hearing Health Care System in South Texas: A Telehealth Model for Addressing the Unmet Hearing Health Care/Hearing Aid Needs of Adults with Mild to Severe Bilateral Sensorineural Hearing Loss] Encounters: DY3=200; DY4=400; DY5=400 UT Health Science Center – San Antonio 1.7 View page: 1 2 3 4 5 6 7 8

Project Title /QPI Targets PROJECT WILL NOT CONTINUE IN DY6
UT Health San Antonio Exit Contact Information Bob Voss Senior Project Manager, DSRIP 7703 Floyd Curl Dr., San Antonio, TX 78229 IGT Funding: UT Health San Antonio Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 64% DY6 MLIU=128 individuals Implement remote patient monitoring programs for diagnosis and/or management of care Individuals: DY3=60; DY4=100; DY5=200; DY6=200 IT-14.9 Number of practicing specialty care physicians per 1000 individuals in HPSA and per 100 in MUA Narrative; Milestones Suspended DY5 MLIU: 10% PROJECT WILL NOT CONTINUE IN DY6 Enhance improvement capacity within people [redesign to improve patient experience] Individuals: DY3=20,000; DY4=20,000; DY5=20,000 IT-6.1.d.iv Visit Survey DY5 MLIU: 51% DY6 MLIU=555 encounters 1.9.2 Improve Access to Specialty Care: Outpatient Epilepsy Encounters: DY3=544; DY4=726; DY5=1,088; DY6=1,088 IT-1.1 Average number of days to third next available appointment IT-6.1.d.i CG-CAHPS Visit Survey 2.0: Timeliness of Appointments, Care, and Information Sustaining outside of DSRIP UT Health Science Center – San Antonio 1.7 View page: 1 2 3 4 5 6 7 8

Project Title /QPI Targets Project withdrawn April 2015
UT Health San Antonio Exit Contact Information Bob Voss Senior Project Manager, DSRIP 7703 Floyd Curl Dr., San Antonio, TX 78229 IGT Funding: UT Health San Antonio Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 Project withdrawn April 2015 2.2.2 Apply evidence-based care management model to patients identified as having high risk-health care needs such as diagnosed asthma and identified lead poison exposed children by targeting environmental aspects of children’s health (TEACH). Individuals: DY3=491; DY4=491; DY5=506 IT-10.1.a.v Health-related quality of life in children and adolescents with acute and chronic health conditions Narrative; Milestones; Project Withdrawal Form DY5 MLIU: 100% DY6 MLIU=1,200 individuals Design, implement, and evaluate projects that provide integrated primary and behavioral health care services: PROXIMA (Primary Care Optimization for Excellence in Interventions Managing ADHD) Individuals: DY3=800; DY4=1,200; DY5=1,200; DY6=1,200 IT-11.6 Percent of children newly prescribed ADHD medication who had at least three follow up care visits Narrative; Milestones Sustaining outside of DSRIP DY5 MLIU: 80% DY6 MLIU=960 individuals Provide an intervention for a targeted behavior health population to prevent unnecessary use of services in a specified setting (transitional care upon hospital discharge). Individuals: DY3=800; DY4=1,000; DY5=1,200; DY6=1,200 IT-1.18 Percent of child mental health discharges for which patient received follow up within 7 and 30 days IT-3.14 Readmission for any cause within 30 days Narrative; Milestones; DY4 Poster; DY5 Poster UT Health Science Center – San Antonio 1.7 View page: 1 2 3 4 5 6 7 8

UT Health San Antonio Exit Contact Information Bob Voss Senior Project Manager, DSRIP 7703 Floyd Curl Dr., San Antonio, TX 78229 IGT Funding: UT Health San Antonio Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 85% DY6 MLIU=510 individuals 2.2.1 Redesign the outpatient delivery system to coordinate care for patients with chronic disease: Expanding chronic care management in a safety net clinic Individuals: DY3=200; DY4=400; DY5=600; DY6=600 IT-1.6 Percent of patients with cardiovascular condition who had LCL-C <100 mg/dL Narrative; Milestones Sustaining outside of DSRIP DY6 MLIU=306 individuals 2.9.2 Implement other evidence based project to establish a patient care navigation program in an innovative manner: Community health worker program to address health and social needs in a vulnerable population Individuals: DY3=180; DY4=360; DY5=360; DY6=360 IT-1.10 Percent of diabetes patients with HbA1c level greater than 9% or not tested DY5 MLIU: 100% DY6 MLIU=160 individuals Provide an intervention for a targeted behavioral health population to prevent unnecessary use of services in a specified setting (i.e., the criminal justice system) Individuals: DY3=150; DY4=150; DY5=160; DY6=160 IT-9.1 Percent of individuals receiving the intervention that had a potentially preventable admission/readmission to a criminal justice setting Narrative; Milestones; DY5 Poster; DY6 Poster UT Health Science Center – San Antonio 1.7 View page: 1 2 3 4 5 6 7 8

UT Health San Antonio Exit Contact Information Bob Voss Senior Project Manager, DSRIP 7703 Floyd Curl Dr., San Antonio, TX 78229 IGT Funding: UT Health San Antonio Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 30% DY6 MLIU=720 individuals 2.7.1 Implement innovative evidence- based strategies to increase appropriate use of technology and testing for targeted populations - Implementing HCV Screening and Linkage to Care for Baby Boomers in Primary Care Individuals: DY3=2,000; DY4=3,000; DY5=3,000; DY6=2,400 IT-15.8 Percent of patients with diagnosis of chronic Hepatitis C whose HCV RNA is less than 25 IU at 12 weeks post-treatment Narrative; Milestones; DY5 Poster; DY6 Poster Sustaining outside of DSRIP DY5 MLIU: 100% DY6 MLIU=150 individuals Design, implement, and evaluate research-supported and evidence- based interventions tailored towards individuals in a target population Individuals: DY3=100; DY4=150; DY5=150; DY6=150 IT-11.8 Percent of individuals who initiated AOD treatment Narrative; Milestones UT Health Science Center – San Antonio 1.7 View page: 1 2 3 4 5 6 7 8

Uvalde Memorial Hospital
Exit Contact Information Anthony Rodriguez QRM Statistician (830) x1028 1025 Garner Field Rd., Uvalde, TX 78801 IGT Funding: Uvalde County Hospital Authority Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 56% DY6 MLIU=5,152 encounters Increase the number of primary care providers and other clinicians/staff: Improving Rural Access to Primary Care Encounters: DY3=350; DY4=5,200; DY5=9,200; DY6=9,200 IT-3.22 Risk adjusted readmissions IT-9.2 Rate of ED utilization for ACSC per 100,000 Narrative; Milestones DY3 Poster; DY5 Poster; DY6 Poster Continuing as a Core Activity DY5 MLIU: 40% DY6 MLIU=600 individuals 1.3.1 Implement/enhance and use chronic disease management registry functionalities Individuals: DY3=100; DY4=600; DY5=1,500; DY6=1,500 IT-1.10 Percent of diabetes patients with HbA1c level greater than 9% or not tested Narrative; Milestones; DY6 Poster DY5 MLIU: 25% DY6 MLIU=95 encounters – Implement a Palliative Care Program to address patients with end of life decisions and care needs Encounters: DY3=75; DY4=150; DY5=380; DY6=380 IT-13.4 Percent of patients who died from cancer admitted to the ICU in the last 30 days of life DY3 Poster; DY6 Poster ADD PROJECT IDS ADD CONTACT INFORMATION

Val Verde Regional Medical Center
Exit Contact Information: Name: Brittany Longfellow, MSN, RN Phone: (830) Address: 801 N Bedell Ave., Del Rio, TX 78840 Project ID / MLIU Project Title /QPI Targets Outcome Measure(s) Files Transition to DY 7 DY5 MLIU: 40% DY6 MLIU=1,534 encounters 1.1.1 Expand Primary Care Capacity – Val Verde County and Del Rio, Texas Encounters: DY3=2,405; DY4=3,120; DY5=3,834; DY6=3,834 IT-12.1 Percent of women who had a mammogram every two years IT-12.2 Percent of women screened for cervical cancer IT-12.4 Percent of patients who have ever received a pneumococcal vaccine Narrative; Milestones Continuing as a Core Activity DY5 MLIU: 27% DY6 MLIU=614 encounters 1.9.2 Expand Specialty Care Capacity – For Val Verde County and Del Rio, Texas Encounters: DY3=1,600; DY4=2,005; DY5=2,275; DY6=2,275 IT-3.3 Risk adjusted readmissions for patients with CHF Expanding outside of DSRIP DY5 MLIU: 30% DY6 MLIU=345 encounters 1.7.1 Implement telemedicine program to provide or expand specialist referral services in an area identified as needed to the region – Val Verde County and Del Rio, Texas Encounters: DY4=1,000; DY5=1,150; DY6=1,150 IT-6.1.b.i CG-CAHPS IT-1.1 Average number of days to third next available appointment Sustaining outside of DSRIP DY5 MLIU: 35% DY6 MLIU=46 encounters Develop, Implement, and evaluate standardized clinical protocols and evidence-based care delivery model to improve care transitions: Care Transitions – Intervention Nurse Program Encounters: DY4=71; DY5=132; DY6=132 IT-3.22 Risk adjusted readmissions Narrative; Milestones; DY5 Poster; DY6 Poster Partially sustaining outside of DSIRP ADD CONTACT INFORMATION

Bexar County Private Hospitals
DY 1-6 DSRIP Incentives Earned/Paid as of May 2018 and Uncompensated Care (UC) Funds Earned by Provider Exit Bexar County Private Hospitals UC as of Sept 2017: $165,400,269 UC as of Sept 2017: $195,111,381 UC as of Sept 2017: $73,743,982 UC as of Sept 2017: $340,454,937 UC as of Sept 2017: $53,747,450 UC as of Sept 2017: $29,619,388 Legend: DSRIP Funds Received Allocated DSRIP Funds Remaining View page: 1 2 3 4 5

Mental Health Providers
DY 1-6 DSRIP Incentives Earned/Paid as of May 2018 and Uncompensated Care (UC) Funds Earned by Provider Exit Mental Health Providers Not eligible for UC Not eligible for UC UC as of Feb 2017: $2,720,744 Not eligible for UC Not eligible for UC Legend: DSRIP Funds Received Allocated DSRIP Funds Remaining View page: 1 2 3 4 5

Bexar County Public Entities
DY 1-6 DSRIP Incentives Earned/Paid as of May 2108 and Uncompensated Care (UC) Funds Earned by Provider Exit Bexar County Public Entities UC as of Sept 2017: $699,667,399 UC as of Sept 2017: $1,086,405 UC as of Sept 2017: $39,376,265 UC as of Sept 2017: $50,631,558 Not eligible for UC Legend: DSRIP Funds Received Allocated DSRIP Funds Remaining View page: 1 2 3 4 5

Exit Rural Providers View page: 1 2 3 4 5
DY 1-6 DSRIP Incentives Earned/Paid as of May 2018 and Uncompensated Care (UC) Funds Earned by Provider Exit Rural Providers UC as of Sept 2017: $9,091,427 UC as of Sept 2017: $4,607,578 UC as of Sept 2017: $8,474,169 UC as of Sept 2017: $40,467,012 UC as of Sept 2017: $21,612,951 UC as of Sept 2017: $10,624,115 Legend: DSRIP Funds Received Allocated DSRIP Funds Remaining View page: 1 2 3 4 5

Exit Rural Providers View page: 1 2 3 4 5
DY 1-6 DSRIP Incentives Earned/Paid as of May 2018 and Uncompensated Care (UC) Funds Earned by Provider Exit Rural Providers UC as of Sept 2017: $33,896,587 UC as of Sept 2017: $37,502,887 UC as of Sept 2017: $25,038,872 Participating in UC only: South Texas Regional Medical Center (Atascosa County) - $19,994,337 San Antonio State Hospital (Bexar County) – $5,758,587 Nix Community General Hospital (Frio County) - $3,044,931 Resolute Hospital (Comal County) - $10,671,887 Legend: DSRIP Funds Received Allocated DSRIP Funds Remaining View page: 1 2 3 4 5

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Regional Healthcare Partnership Plan Updated May 2018

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Regional Healthcare Partnership Plan Updated May 2018

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