1. RHP 12 Learning Collaborative

2.  RHP 12 Learning Collaborative Summary & Feedback  Project Highlight  DSRIP In Action  Learning Collaborative Tentative Calendar  Waiver Updates

3.  63 Participants  28 Provider Partners Represented  Survey Results: Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Rate your overall satisfaction with the learning collaborative event73%25%2% - - Rate your overall satisfactions with the format of the event71%28%2% - - Rate your overall satisfaction with the provider project presentations68%32% - - Rate your overall satisfaction with speakers75%22%2% - - Rate your overall presentation with the poster presentations77%23% - Rate your overall satisfactions with the overall content of the learning collaborative event75%25% - - Peer to Peer Discussions87%10%3% - -

4. Posters ! Posters ! 1 st Place: Texas Panhandle Center 2 nd Place: Castro County Healthcare

5. Peer to Peer Discussions A Huge Success! Peer to Peer Discussions A Huge Success!

6.  We appreciate your Feedback! ◦ Many comments were received that we are addressing and will make changes. ◦ Overall- Event was a success and everyone left learning something new.  Improvement and Suggestions: ◦ More Question and Answer time. ◦ Keep round table discussions! ◦ Focus on Waiver 2.0 ◦ Tips for successful reviews/reporting.

7. We would like to highlight 4 projects in 2016. Our time spent with you and your project is informative, helpful and gives us a chance to visit with you at your location. Our visits will consist of the following.. ◦ We would like to see the successes and challenges of your projects. ◦ Visits can include a tour of your facility. ◦ Seeing how we can be of assistance to you if needed. ◦ We will share the highlights of our visit on our Monthly Status Calls which can benefit all of us!

8.  Our first DSRIP in Action will take place in or around the first couple of months of the new year.  Tentative Agenda: ◦ Welcome & Introductions ◦ Project in Action Presentation ◦ Discussion regarding challenges/lessons learned ◦ Brainstorm about opportunities for improvement ◦ Tour of the facility that is ….

9. We want to be considerate of your time and would like your feedback on how many Learning Collaborative Events you would like to attend next year. We have hosted 2 regional LC events the last two years but with the Statewide LC event being in August we wanted to give you the option for only 1 regional event. We are considering the following Options: OPTION1 - 1 Event : May 25 OPTION 2 - 2 Events : March 16 and September 28 ** We will send out a survey after the call today to get your vote FYI- Statewide Learning Collaborative Event: August 2016 (dates to be determined)

10. Bobbye Hrncirik

11.  October Reporting COMPLETED!  Preliminary Results ◦ Assuming all achieved milestones/metrics are approved:  DY4 Round 2 – 64,155,142  DY3 Round 2 - 4,550,145  TOTAL = $68,705,287 Gross dollars to RHP12  Estimated IGT =$29,453,956 (due in January)

12. Providers are required to work with Myers & Stauffer (MSLC) to complete the review process, including responding to follow up questions related to Corrective Action Plans. Please note that DSRIP payments are Medicaid payments, and as such, may be subject to state and federal audits.

13.  Myers & Stauffer hosted a webinar on November 4, 2015. We recorded the webinar and it is posted on our website in case you missed it. (www.texasrhp12.com).www.texasrhp12.com  CAT-3 Baseline audits are still the focus with another round scheduled to begin in Jan/Feb 2016.  CAT 1&2 Validation of DY 2 & DY 3 Metric Achievement is slated to begin soon and continue into 2016.

14.  The Clinical Champions workgroup continues to review those projects that submitted a Transformational Impact Summary (TIS), with many promising practices emerging from this process.  HHSC and the Clinical Champions are working together to describe effective models for care delivery, those that are showing the greatest promise of reaching DSRIP target populations as well as improving clinical, cost and population health outcomes, based largely on your TIS submissions.  HHSC will use this information around best and promising practices to support protocol development in the renewal period as well as offering guidance to providers on opportunities to make improvements in continuing DSRIP projects.

15.  This is what we know now/Is proposed.  The waiver team is focusing on additional details for the proposed transition year (DY6) and targets a December 2015 date to release more information.

16. ‣HHSC will notify projects not eligible to continue in early 2016 to give providers time to plan for replacement projects ‣RHP 12 Projects Impacted Currently  Projects from a removed project area = 9  Projects flagged during mid-point assessment = 5  Projects withdrawn after June 30, 2014 = 1  Projects Providers elect to discontinue and replace = not identified yet ‣HHSC will propose to CMS that current projects that will be replaced be eligible to continue for a transition period, including 2.4,2.5,2.8 and 1.10 projects

17. Initial proposals:  Transition year (DY 6 -10/1/2016 – 9/30/2017) ◦ Includes parameters for combining projects ◦ Laying the groundwork for performance bonus pools ◦ Setting a minimum annual valuation amount per provider  Revised protocols for extension/renewal (beginning 10/1/2017) ◦ Continuing and replacement projects ◦ Regional performance bonus pools

18.  There will be fewer metrics to report for achievement, and more standardized metrics. ◦ QPI milestones will be required each year – 50% of valuation  Request partial achievement of QPI metrics, perhaps with a reduced carry-forward window? ◦ For the other 50% of valuation each year, HHSC is considering two metrics reported via templates.  Reporting on core components, including continuous quality improvement (CQI)  Sustainability planning, including project-level evaluation, health information exchange, and integration with managed care where appropriate ◦ HHSC is considering changing all QPI metrics to individuals (vs. encounters).  Depending on the timeline for negotiations with CMS on waiver extension, propose to continue DY5 QPI in DY6 as a transition year until negotiations are completed.

19. Milestones/ Metrics Proposal  The DY 6 total quantifiable patient impact (QPI) goal will be equal to the DY5 QPI goal, with limited exceptions.  There will be a Medicaid/Low Income Uninsured (MLIU) QPI milestone for DY 6 for all projects. ◦ For projects with a DY 5 required MLIU, the DY 6 MLIU QPI goal will be equal to the DY 5 MLIU QPI goal. ◦ For projects that do not have an MLIU metric in DY 5, the QPI MLIU milestone for DY 6 will be pay-for-reporting (P4R). ◦ For projects that do not have a MLIU QPI metric in DY5, the DY 6 MLIU QPI goal will be equal to the MLIU goal percentage multiplied by the QPI goal. » example: DY 5 MLIU target is 65%, DY 5 QPI goal is 1,500; new DY 6 MLIU QPI milestone goal will be 1,500*0.65=975.

20. Milestones/ Metrics Proposal (cont.)  Non-QPI Category 1 and 2 DY 5 milestones/ metrics will be discontinued in DY 6 and potentially replaced with one or more of the following milestones: ◦ Core component reporting, including continuous quality improvement (CQI) ◦ Sustainability planning, including health information exchange, integration into managed care, and other community partnerships ◦ Medicaid ID reporting  HHSC will need to determine the percentage of a project’s Category 1- 2 valuation that each milestone is worth. HHSC is considering the following breakdown: ◦ QPI (Total QPI and MLIU QPI) – 60-70% ◦ Other (Core component reporting, sustainability planning, Medicaid ID reporting) – 30-40%

21.  Category 3 Proposal ◦ 50% of the Category 3 valuation will be for pay-for- reporting (P4R) on the existing Category 3 outcome(s) in DY 6. ◦ 50% of the Category 3 valuation will be P4R on project-level evaluation in DY 6.

22.  The extension application includes a proposal to analyze Medicaid data and available all-payer potentially preventable event (PPE) data for managed care service delivery areas and RHPs. HHSC will provide this global trend data to CMS from CY 2013 through the years of the extension period to show whether combined efforts are having an effect on key measures. ◦ HHSC has been working with Texas Medicaid’s external quality review organization, the Institute for Child Health Policy (ICHP), to determine measures ICHP already collects for Medicaid that intersect with DSRIP activities. ◦ A challenge for statewide analysis of DSRIP results is that HHSC doesn’t have access to much data on non-Medicaid populations (including lowincome uninsured). HHSC is exploring the use of all-payer data from the Department of State Health Services to add all-payer PPE measures to the statewide analysis.

23.  HHSC proposes to set aside 5-10% of each provider’s total DY 6 valuation to lay the groundwork for the performance bonus pool (PBP) that will reward high performing regions from DY 7 onward.  Providers will be paid in DY 6 based on regional agreement on, and selection of, the region’s shared performance measures. ◦ For the smallest providers (providers with less than $500,000 in total Category 1-4 DY 5 valuation), 5% of their DY 6 valuation will be set aside for the region’s PBP measure selection in DY 6. ◦ For larger providers (providers with $500,000 or more in total Category 1-4 DY 5 valuation), 10% of their DY 6 valuation will be set aside for the region’s PBP measure selection in DY 6. 17

24.  For providers not participating in Category 4, the 5% or 10% will be taken from their Category 3 funding.  For hospitals participating in Category 4, the 5% or 10% will be taken from their Category 4 funding. ◦ If the hospital’s Category 4 funding is higher than the required PBP funding, the additional funding will remain in Category 4 for DY 6 (e.g., if their Category 4 funding is 15% of their total valuation, all 15% will go to the region’s selection of performance measures). ◦ If the hospital’s Category 4 funding is lower than the required PBP funding, the remainder will be made up by taking proportionately from Category 3 funding. ◦ HHSC still is thinking through how to handle current Category 4 reporting in the transition year.