Transcript Regional Healthcare Partnership 14

John O’Hearn
Region 14 Anchor Contact
Director of Regional Development
Medical Center Health System
1115 Waiver Background
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 March 1st, 2012- Switch to Medicaid Managed Care
 Upper Payment Limit (UPL) Program no longer viable
 Supplemental Funding crucial to Texas Hospitals
 New Source of Funding identified though 1115 Waiver
Protects UPL funding and expands pool of money
Based of California Model
Initial conversations started in July 2011
Places decisions regarding health care delivery system
improvements in the hands of local hospitals and hospital
districts, rather than a top-down, one-size-fits-all approach.
 Includes entities outside of hospitals
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1115 Waiver Background
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HHSC surveyed large urban hospitals in Texas to identify potential DSRIP projects
(October 2011).
HHSC hosted an RHP Planning Summit focusing on DSRIP development with
representatives from hospitals, associations and leadership offices (November 2011).
Clinical Champions created in February to provide clinical input into DSRIP project
selection.
20 Regional Healthcare Partnerships were formed (May 2012)
The RHPs are based on distinct geographic boundaries that generally reflect
patient flow patterns for the region
The RHPs have identified local funding sources to help finance the non-federal
share of DSRIP payments for Performing Providers
The RHPs have identified an Anchoring Entity to help coordinate RHP activities
1115 Waiver Background

 Program Funding and Mechanics (PFM) Protocol:
Outlines the minimum number of projects,
organization of the RHP Plan, plan review process,
required reporting, funding allocations, project
valuation, and plan modifications.
 Approved August 31, 2012
 RHP Planning Protocol: menu of projects,
milestones, and metrics eligible for DSRIP funds.
 Approved September 26, 2012
1115 Waiver Background

 Uncompensated Care Pool (UC)
 Pays hospitals based on uncompensated care costs
reimbursable today and additional uncompensated care
costs not being reimbursed today, such as costs for clinics,
physicians, and pharmacies. Payments will be based on
costs, not charges.
 Delivery System Reform Incentive Payment Pool (DSRIP)
 Payments for system improvements identified in Regional
Healthcare Partnerships delivery system reform and
improvement plans.
 Plans will identify approaches, baseline data, and timelines
for transforming and improving indigent and Medicaid
health care systems to improve clients experience, increase
quality, and better manage costs in Medicaid and indigent
programs.
Intergovernmental Transfers
(IGT)
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 A transfer of public funds from a governmental
entity or entities to HHSC.
 Any unit of local government, such as:
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•Public hospital
•Hospital District
•County
•City
•Local Mental Health Authority
Intergovernmental Transfers
(IGT)
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 A governmental entity can IGT if:
 The funds are in the governmental entity’s administrative
control
 The funds are not federal funds
 The funds are public funds, not private funds
 There is no statutory or constitutional requirement that
relates to the funds
 The funds are not impermissible provider-related donations
 Private Medicaid providers can support community
activities, and local governments that make IGTs may
take account of that support in deciding whether to make
an IGT that will be used to fund Medicaid payments to
those providers.
MCHS’s Role as Anchor
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 Coordinating the development of a community needs
assessment for the region
 Engaging stakeholders in the region, including the public
 Coordinating the development the 5-year RHP Plan that best
meets community needs in collaboration with RHP
participants; Ensuring that the RHP Plan is consistent with
Attachment I, Attachment J, and all other State/waiver
requirements
 Facilitating RHP Plan compliance with the RHP Plan Checklist
 Transmitting the RHP Plan and any associated plan
amendments to HHSC on behalf of the RHP
 Ongoing monitoring and annual reporting (as required in
paragraph 20) on status of projects and performance of
Performing Providers in the region
 Ongoing communication with HHSC on behalf of the RHP.
RHP 14 Counties
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Andrews
Brewster
Crane
Culberson
Ector
Glasscock
Howard
Jeff Davis
Loving
Martin
Midland
Presidio
Reeves
Upton
Ward
Winkler
RHP 14
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 Tier 4 RHP
 An RHP is classified in Tier 4 if one of the following
three criteria are met: (1) the RHP contains less than
3 percent share of the statewide population under
200 percent FPL as defined by the U.S. Census
Bureau: 2006-2010 American Community Survey
for Texas (ACS); (2) the RHP does not have a public
hospital; or (3) the RHP has public hospitals that
provide less than 1 percent of the region's
uncompensated care.
Planning Process
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 Regional Healthcare Partnership (RHP) maps were
finalized on May 30, 2012
 RHP 14’s First meeting was held on June 15th, 2012
 Participating entities met twice a month
 Mix of WebEx and Face-to-face
 Meetings covered updates, timelines, and general
program knowledge
Planning Process
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 Executive Committee
 Diverse Mix of Volunteers
 Member Organizations
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Medical Center Health System- Hospital District
Odessa Regional Medical Center- Private Hospital
Midland Memorial Hospital- Hospital District
Scenic Mountain Medical Center-Private Hospital
Permian Regional Medical Center- Hospital District
Big Bend Regional Medical Center-Private Hospital
Reeves County Hospital District- Hospital District
Texas Tech University Health Sciences Center-Academic Medical
Center
Permian Basin Community Centers- Local Mental Health Authority
West Texas Centers- Local Mental Health Authority
BCA- Odessa- Private Mental Health Facility
Ector County Health Department- County Health Department
Community Needs Assessment
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 Prepared by Brandon Durbin, Discovery Healthcare
Consulting Group, LLC & Terri Conner, Healthcare
Outcomes Research Consulting
 Used to identify gaps in service and overall need
 Factors in Strong Population Growth
 Limited Resources (Space and People)
 County Health Rankings
 RHP14_Sep5.pdf
Planning Process-Consultants
Involved
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 Kevin Nolting, Kevin Nolting Consulting
 Michael Spivey, Spivey Health Law
 Brandon Durbin, Discovery Healthcare Consulting
Group, LLC
 Terri Conner, Healthcare Outcomes Research
Consulting
 Lance Ramsey, Gjerset and Lorenz
 Eric Weatherford & Lane Greer, Brown McCarroll
 Don Gilbert
RHP 14 DSRIP Allocation
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 2.29% of total state funding
 Demonstration Year 1 (DY1) $11,426,916
 Demonstration Year 2 (DY2) $52,563,813
 Demonstration Year 3 (DY3) $60,928,316
 Demonstration Year 4 (DY4) $65,179,128
 Demonstration Year 5 (DY5) $70,846,879
 Five Year Total of $260,945,051
DY1 Allocation Formula
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 Anchor receives 20% of funding
 Remaining 80%
 Remaining DY 1 RHP DSRIP funding (less the
Anchoring Entity DY 1 DSRIP) shall be allocated to
Performing Providers based on an allocation formula.
The allocation formula divides an RHP Plan's
estimated dollar value of a Performing Provider's
DSRIP projects in Categories 1-4 over the DYs 2-5
period by the total value of the RHP's DSRIP projects
over the DYs 2-5 period. The resulting percentage is
then multiplied by the RHP's remaining DY
Pass 1 Allocations
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 Hospitals receive 75% of initial funding
 Non-Hospitals receive 25% of initial funding
 10%-Local Mental Health Authorities
 10%-Academic Medical Centers
 5%- County Health Departments
 Hospital Allocations based on:
 Participation in UPL and/or DSH required to receive Pass 1 Funding
 The hospital's percent share of Medicaid acute care payments in SFY
2011-25%
 The hospital's percent share of total SFY 2011 Medicaid supplemental
payments made to all potentially eligible hospital providers in the
RHP (former UPL program)-25%
 The hospital's percent share of uncompensated care in the RHP. A
hospital's uncompensated care is measured by its FFY 2012 Hospital
Specific Limit (HSL) or hospital's charity care costs reported in the
2010 Annual Hospital Survey trended to 2012 by an annual trend rate
of approximately 2 percent (4 percent total trend over the two-year
period) -50%
Pass 2
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 If there are unused DSRIP allocation amounts after
the first pass, the RHP may redirect the unused
allocations to fund new projects.
 An individual hospital provider is not limited to its
DSRIP allocation in the second pass.
 Physician practice groups not affiliated with academic
health science centers and new hospitals may
participate in DSRIP projects if they identify a source
of non-federal match.
 Pass 2 Allocations can’t be determined until all Pass 1
projects are submitted
Pass 2
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 25 percent allocation of unused Pass 1 DSRIP funds to
“new” Performing Providers
 15 percent to new hospitals.
 10 percent to physician practices not affiliated with an
academic health science center.
 75 percent allocation to Performing Providers that have
Pass 1 projects
 Each Performing Provider is allocated a proportion based
on the funding of Pass 1 projects in DYs 2-5.
 Within an RHP, Performing Providers may combine their
individual Pass 2 DSRIP allocations to fund a DSRIP
project.
Pass 2 Eligibility
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 A minimum number of major safety net hospitals
must participate in DSRIP as Performing Providers
 Tier 4 At least 1 – MMH and MCHS qualify
 RHPs shall fund a minimum percent of the Pass 1
DSRIP allocated to non-profit and private hospitals
based on Tier level.
 Tier 4 At least 5%- RHP 14 qualifies
1115 DSRIP Waiver Categories
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 Category I: Infrastructure Development
 Lays the foundation for the delivery system through
investments in people, places, processes and technology. Pay
for performance.
 Category II: Program Innovation & Redesign
 Pilots, tests and replicates innovative care models. Pay for
performance.
 Category III: Quality Improvements
 Health care delivery outcomes improvement targets tied to
Category 1 and 2 projects. Pay for outcomes.
 Category IV: Population-based Improvements
 Requires all RHPs to report on the same measures. Pay for
reporting
Acronym List
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MCHS- Medical Center Health System
MMH- Midland Memorial Hospital
ORMC- Odessa Regional Medical Center
TTUHSC- Texas Tech University Health Sciences Center
PRMC- Permian Regional Medical Center
RCHD- Reeves County Hospital District
WCMH- Winkler County Memorial Hospital
MCHD- Martin County Hospital District
WMH- Ward Memorial Hospital
CMH- Crane Memorial Hospital
BBRMC- Big Bend Regional Medical Center
SCMC- Scenic Mountain Medical Center
CH- Culberson Hospital
McCamey- McCamey County Hospital District
PBCC- Permian Basin Community Centers
WTC- West Texas Centers
BCA- BCA Permian Basin
ECHD- Ector County Health Department
MHD- Midland County Health Department
Category 1: Infrastructure Development
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 1. Expand Primary Care Capacity
 MCHS (3), PRMC, ORMC (2), MMH (2), WCMH, CMH, WTC, TTUHSC (2)
 2. Increase Training of Primary Care Workforce
 TTUHSC
 3. Implement and Use a Chronic Disease Management Registry
 4. Enhance Interpretation Services and Culturally Competent Care
 MCHS, MMH
 5. Collect Accurate Race, Ethnicity, and Language (REAL) Data to Reduce
Disparities
 6. Expand Access to Urgent Care and Enhance Urgent Medical Advice
 MMH
 7. Introduce, Expand or Enhance Telemedicine/Telehealth
 ORMC
 8. Increase, Expand and Enhance Dental Services
 9. Expand Specialty Care Capacity
 TTUHSC, ORMC (2), PBCC, MMH
 10. Enhance Performance Improvement and Reporting Capacity
Category 1: Infrastructure Development
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 Behavioral Health Projects
 11. Implement technology-assisted services (telemedicine,
telehealth and telemonitoring) to support, coordinate or
deliver services
 12. Enhance service availability to appropriate levels of
care
 13. Development of behavioral health crisis stabilization
services as alternatives to hospitalization
 14. Develop Workforce enhancement initiatives to
support access to providers in underserved markets and
areas
Category 2: Innovation and
Redesign
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 1. Enhance/Expand Medical Homes
 CH
 2. Expand Chronic Care Management Models
 MCHS, TTUHSC, ORMC (2), MMH/MHD Collaboration, RCHD
 3. Redesign Primary Care
 TTUHSC
 4. Redesign to Improve Patient Experience
 5. Redesign for Cost Containment
 6. Implement Evidence-based Health Promotion Programs
 MCHS, MMH, TTUHSC
 7. Implement Evidence-based Disease Prevention Programs
 MCHS/ECHD Collaboration, RCHD
 8. Apply Process Improvement Methodology to Improve
Quality/Efficiency
 MCHS(2), ORMC
 9. Establish/Expand a Patient Care Navigation Program
 MCHS, ORMC, MMH
Category 2: Innovation and
Redesign
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 10. Use Palliative Care Programs
 MCHS, MMH
 11. Conduct Medication Management
 12. Implement/Expand Care Transitions Programs
 MMH, McCamey
 Behavioral Health Projects
 13. Provide an intervention for a targeted behavioral health population to prevent
unnecessary use of services in specified setting
 14. Implement person-centered wellness self-management strategies
 15. Integrate Primary and Behavioral Healthcare Services
 WTC
 16. Provide virtual psychiatric and clinical guidance to primary care providers
 17. Establish improvements in care transitions from inpatient settings
 18. Recruit, train and support consumers of mental health services to provide peer
support services
 19. Develop Care Management Function that integrates primary and behavioral
health needs of individuals
Category 3: Quality
Improvements
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 CMS Outcomes definition:
 “… measures that assess the results of care experienced by
patients, including patients’ clinical events, patients’ recovery and
health status, patients’ experiences in the health system, and
efficiency/cost.”
 All Category 1 & 2 projects must have one or more associated
Category 3 outcomes.
 Outcomes measured are based on a specific patient population
served by the project. Broken into Outcome Domains (OD)
 DY 2&3 focus on Process Milestones and DY4&5 focus on
Improvement Targets
Category 3: Quality
Improvements
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 OD-1 Primary Care and Chronic Disease Management
 MMH-Controlling High Blood Pressure
 McCamey focusing on Diabetes care HbA1c poor control
 OD-2 Potentially Preventable Admissions
 MCHS-Uncontrolled Diabetes Admissions
 OD-3 Potentially Preventable Readmissions (30-day)
 MCHS focusing on All-Cause Readmissions
 OD-4 Potentially Preventable Complications and Healthcare
Acquired Conditions
 ORMC and MCHS- Sepsis Mortality
 OD-5 Cost of Care
 OD-6 Patient Satisfaction
 CMH, WTC, PBCC, and RCHD are focusing on Patient satisfaction
 OD-7 Oral Health
Category 3: Quality
Improvements
 OD-8 Perinatal Outcomes
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 MCHS focusing on Early Elective Deliveries
 OD-9 Right Care, Setting
 PRMC, Winkler, and Culberson are focusing on ED
Appropriate Utilization
 OD-10 Quality of Life/ Functional Status
 OD-11 Addressing Disparities
 MMH 68 Nurse Navigation for disparity group
 OD-12 Primary Care and Primary Prevention
 TTUHSC- Increase Cervical and Colorectal Cancer Screening
 OD-13 Palliative Care
 MMH and MCHS focusing on Pain Assessments and ICU
stays within the last 30 days of life
Category 4:Population Focused
Improvements
 Hospital only category
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 Exemption for Rural Hospitals
 A hospital is not a state-owned hospital or a hospital that is
managed or directly or indirectly owned by an individual,
association, partnership, corporation, or other legal entity that
owns or manages one or more other hospitals and:
 (1) is located in a county that has a population estimated by the United
States Bureau of the Census to be not more than 35,000 as of July 1 of
the most recent year for which county population estimates have been
published; or
 (2) is located in a county that has a population of more than 35,000, but
that does not have more than 100 licensed hospital beds and is not
located in an area that is delineated as an urbanized area by the United
States Bureau of the Census.
 Non-hospitals and exempt hospitals can put 100% of dollars
into other 3 categories.
Category 4:Population Focused
Improvements- Domains
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Potentially preventable admissions (PPAs)
30-day readmissions
Potentially preventable complications (PPCs)
Patient-centered healthcare, including patient satisfaction
and medication management
 Emergency department
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 Optional Domain 6
 Initial Core Set of Measures for Adults and Children in
Medicaid/CHIP- If a hospital chooses to report this domain,
they are then eligible to claim the full 15% for reporting.
Category Funding Distribution
 Hospital Allocations
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DY2
DY3
DY4
DY5
Cat. 1&2
No more
than 85%
No more
than 80%
No more
than 75%
No more
than 57%
Cat. 3
At least 10%
At least 10%
At least 15%
At least 33%
Cat. 4
5%
10-15%
10-15%
10-15%
 Non-Hospitals Allocations
DY2
DY3
DY4
DY5
Cat. 1&2
95-100%
No more
than 90%
No more
than 90%
No more
than 80%
Cat. 3
0-5%
At least
10%
At least
10%
At least
20%
Plan Modifications
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 Uncommitted DSRIP funding During DY2, if an RHP
does not propose to use its uncommitted DSRIP funds,
HHSC will redistribute the available DSRIP to RHPs with
interest and funding to implement new projects in DY3
and who met the broad participation requirement in Pass
1
 New DSRIP projects, new Performing Providers, and/or
new IGT Entities may be added in DY2 for
implementation in DY3.
 Other plan modifications will be allowed for:
 Changes to milestones/metrics for existing projects.
 Changes to outcome improvement targets.
 Deletion of projects.
Additional Details
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 A milestone bundle for Categories 1 or 2 may consist of
multiple metrics. A metric must be fully achieved to be
eligible for payment
 An outcome improvement target for Category 3 may be
partially achieved to be eligible for partial payment
 All measures within a Category 4 domain must be
reported to be eligible for payment
 Carry-forward is allowed for Categories 1, 2, and 3 until
the following demonstration year
 Requires a narrative of the current status of
milestones/outcome improvement targets and plan to
achieve milestones/targets within the following
demonstration year.
Reporting and Payment Schedule
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 Twice a year, Performing Providers are required to report on
achievement of milestone bundles/outcome improvement
targets to be eligible for incentive payments.
 IGT entities will review the reported performance.
 HHSC and CMS will have 30 days to approve or request
additional information.
 DSRIP will be paid twice per year based on approved reports.
 Turnaround on payment should be similar to DSH
 Reporting period of October I through March 31: the reporting
and request for payment is due April 30.
 Reporting period of April I through September 30: the reporting
and request for payment is due October 31.
Timeline- HHSC
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Sep. 21 – Oct. 19 – PPs complete Pass 1 DSRIP, including Categories 1-4 narratives within the RHP
Plan Template and all steps in the workbook
Oct. 10 – Anchor workbook, Pass 2 workbook for PPs, and Pass 3 (Anchor Pass) workbook for PPs
posted
Oct. 22 – Nov. 2 – Anchors review & compile Pass 1 DSRIP submitted by PPs and ensure requirements
are met. Anchors work with PPs to adjust narratives and workbooks as needed.
Oct. 31 – Anchors submit Sections I, II, & III of RHP Plan Template and Community Needs
Supplements electronically to HHSC
Nov. 5 – Anchors generate Pass 2 funding for all participating Pass 2 PPs and send to PPs
Nov. 5 – 9 – Anchors post Pass 1 DSRIP for public comment
Nov. 6 – 19 – PPs complete Pass 2 DSRIP, including Categories 1-4 narratives within the RHP Plan
Template and all steps in the workbook
Nov. 16 – Anchors submit Pass 1 DSRIP to HHSC with all sections of the RHP Plan completed for
Pass 1. Estimated IGT must be identified for all DSRIP.
Nov. 20 – Dec. 6 – Anchors review & compile Pass 2 DSRIP submitted by PPs and ensure
requirements are met. Anchors work with PPs to adjust narratives and workbooks as needed.
Dec. 7 – 14 – Anchors identify any DSRIP funding available after Pass 2 and complete Anchor Pass (if
applicable) in collaboration with PPs and IGT Entities.
Dec. 17 – 21 – Anchors post Pass 2 & Anchor Pass DSRIP within complete RHP Plan for public
comment
Dec. 31 – Pass 2 and Anchor Pass projects within complete RHP Plan due to HHSC
CMS has 45 Days to review plans
Timeline- Region 14
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 Tuesday, October 16, 2012: All Pass 1 Projects and Workbooks
due
 Thursday, October 18, 2012: RHP Plan Presentation
 Wednesday October 24, 2012: Executive Committee Meeting to
review project.
 Friday, October 26, 2012- All revised plans are due back to
Anchor.
 Monday, October 29, 2012- Friday, November 2, 2012- Plan
will be posted on Texasrhp14.com, link will be provided.
 October 31, 2012- MCHS will submit first 3 sections to HHSC.
 Monday, November 5, 2012- Final Pass 1 Plans will be sent to
HHSC.
Contact
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 John O’Hearn, MHA
Director of Regional Development
1115 Waiver Region 14 Anchor Contact
Medical Center Health System
PO Box 7239
Odessa, TX 79760
Office 432-640-2429
Cell 432-770-5077
Fax 432-640-1118
Questions
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