Transcript 1115 Waiver Update - Texas Regional Health Partnership 7

1115 Medicaid Waiver:
DSRIP Project Work Session
Sarah Cook
September 25, 2012
Agenda
 Goal
 Overview: Where we are now
 Step-by-step project prep
 Timelines
 Work Time
7/17/2015
www.CentralHealth.net
2
Goal
Leave today ready to write projects that fit
within RHP Protocols and Plan Template
requirements
7/17/2015
www.CentralHealth.net
3
Overview




RHP Protocol has been approved
Plan Template has been approved
Valuation Workbooks have been released
Of Note:
Addition of Core Components for Projects
 Category 3 Outcomes for each Category 1 & 2 Project
 Continuous Quality Improvement & Learning
Collaborative element for projects “encouraged”

7/17/2015
www.CentralHealth.net
4
How Projects Achieve Our Aim
Community
Need
Regional
Vision &
Goals
Health Care
Transformation
Category 1
&
Category 2
Projects
Process
Measures
Improvement
Measures
Category
3
Outcomes
Quality
Care
Other RHP Category 1, 2 & 3 Projects
7/17/2015
www.CentralHealth.net
5
What now?
7/17/2015
www.CentralHealth.net
6
Evaluate Projects
 Do these still fit within the new
protocols?
 Do they need to be expanded? Split?
Dropped?
 Shovel ready? Needs planning?
7/17/2015
www.CentralHealth.net
7
Example Project
Keep primary care clinics open into the
evenings and on weekends so that lowincome working adults with children are
able to access routine primary care
services and avoid unnecessary
Emergency Department use.
7/17/2015
www.CentralHealth.net
8
Step 1: RHP Protocol Review
Make sure the project fits within the RHP
Protocol
Category 1, Area 1:
1.1: Expand Primary Care Capacity (p.10)
7/17/2015
www.CentralHealth.net
9
Step 2: Project Option Selection
Choose a project option within the project
area
1.1.2: Expand existing primary care
capacity (p.10)
7/17/2015
www.CentralHealth.net
10
Step 3: Core Components
Review required core components
Project Option 1.1.2
Expand Existing Primary Care Capacity
Required Core Components
a. Expand primary care clinic space
b. Expand primary care clinic hours
c. Expand primary care clinic staffing
(p.10)
7/17/2015
www.CentralHealth.net
11
Step 3b: Core Component Exclusion
If core components are not applicable,
prepare justification for elimination
Our existing primary care clinic space is
adequate to serve the expanded population.
In light of the recent construction of a new
70,000 square foot health center in North
Austin, this core component is not necessary
for the successful implementation of the
project and achievement of related
outcomes.
7/17/2015
www.CentralHealth.net
12
Step 4: Milestone Selection
Select, at minimum, 1 Process Milestone & 1
Improvement Milestone, for the 4 year
Project
P-4: Expand hours, including evening &
weekend hours. (p. 11)
I-12: Increase primary care clinic volume of
visits and evidence of improved access for
patients seeking services. (p.16)
7/17/2015
www.CentralHealth.net
13
Step 4b: Milestone Selection
May choose more than 1 Process or
Improvement Milestone
 P-X: In DY2, conduct needs/gap analysis to
determine which clinics need extended
hours (p.7)
 P-4: In DY3&4, expand hours (p.11)
 P-5: In DY3&4, hire staff (p.11)
 P-X: In DY3-5, participate in learning
collaborative to share best practices (p.7)
7/17/2015
www.CentralHealth.net
14
Step 5: Metrics
Review metrics associated with selected
milestones
P‐4.1. Metric: Increased number of hours at
primary care clinic over baseline
a. Data Source: Clinic documentation
b. Rationale/Evidence: Expanded hours not
only allow for more patients to be seen, but
also provide more choice for patients.
(p. 11)
7/17/2015
www.CentralHealth.net
15
Step 5b: Metrics
Some milestones have more than 1 required metric:
I-12: Increase primary care clinic volume of visits and evidence of improved
access for patients seeking services. (p.16)
I‐12.1. Metric: Documentation of increased number of visits. Demonstrate
improvement over prior reporting period.
a. Total number of visits for reporting period
b. Data Source: Registry, EHR, claims or other Performing Provider source
c. Rationale/Evidence: This measures the increased volume of visits and is a
method to assess the ability for the Performing Provider to increase capacity to
provide care.
I‐12.2. Metric: Documentation of increased number of unique patients, or size of
patient panels. Demonstrate improvement over prior reporting period.
a. Total number of unique patients encountered in the clinic for reporting
period.
b. Data Source: Registry, EHR, claims or other Performing Provider source
c. Rationale/Evidence: This measures the increased volume of visits and is a method
to assess the ability for the Performing Provider to increase capacity to provide care.
7/17/2015
www.CentralHealth.net
16
Step 6: Category 3 Outcome
Domain
Use Outcome Domain Tables in RHP
Protocol to narrow down selection of the
appropriate Improvement Target for
Category 1 & 2 Projects (p. 359)
Of the 13 possible domains, 10 are
indicated for Project Area 1.1 Expand
Primary Care; we choose OD-9, “Right
Care, Right Setting” (p. 405)
7/17/2015
www.CentralHealth.net
17
Step 7: Improvement Targets
Choose an Improvement Target from selected Category 3 Outcome
Domain: either 1 standalone measure, or 3 non-standalone
measures
IT‐9.2 ED appropriate utilization (Standalone measure)
 Reduce all ED visits (including ACSC)
 Reduce pediatric Emergency Department visits (CHIPRA Core Measure)
 Reduce Emergency Department visits for target conditions
 Congestive Heart Failure
 Diabetes
 End Stage Renal Disease
 Cardiovascular Disease /Hypertension
 Behavioral Health/Substance Abuse
 Chronic Obstructive Pulmonary Disease
 Asthma
(p. 405)
7/17/2015
www.CentralHealth.net
18
Category 3 Process Measures
In DY2 & 3, Category 3 Process Measures allow
providers to plan & prepare reporting on outcome
measures. Choice of 7; Metric, data sources,
goals and rationale defined by provider.
P‐1 Project planning ‐ engage stakeholders,
identify current capacity and needed resources,
determine timelines and document
implementation plans.
P‐2 Establish baseline rates.
(p. 363)
7/17/2015
www.CentralHealth.net
19
Step 8: Project Narratives
Translate Project & Outcome Choices into Plan
Template Requirements
 Read Plan Template in Detail; refer to
anchor handout
 Enter project titles in Valuation Workbook
to generate required project numbers
 Refer to anchor CNA table; related project
table
 Assemble Milestone & Metric tables
7/17/2015
www.CentralHealth.net
20
Step 9: Valuation
 This is simultaneous with project & metric
selection
 Re-evaluate project valuation, especially if
project scope has been increased or initial
project has been split into multiple projects
 Describe approach and rationale (e.g., size
factor, project scope, community benefit,
cost avoidance, etc.)
7/17/2015
www.CentralHealth.net
21
Project Taxonomy
Category
Outcome
Domain
Project
Area
Project
Option
Process
Milestone(s)
Improvement
Target(s)
Core
Components
7/17/2015
Process
Milestone(s)
Process
Metric(s)
Improvement
Milestone(s)
Improvement
Metric(s)
www.CentralHealth.net
22
Timeline
 Pass 1 Projects due to CH: October 12th
 Projects posted online: October 17th
 Pass 1 Public Hearings: October 22nd
 Pass 1 Materials Submitted: October 31st
 Pass 2 Projects due to CH: November 9th
 Complete Plan Submitted: November 30th
7/17/2015
www.CentralHealth.net
23
Information, Questions, Comments:
www.texasregion7rhp.net
[email protected]
512-978-8195
www.centralhealth.net