RHP 12 Regional Health Plan Overview

RHP Plan Overview CMS Initial Review 4 Phase Revision Process Updated CMS Review Status DY2 August Reporting DY2 October Reporting 3 Year Project Process Prioritized List What’s Next?

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Agenda

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RHP Region 12

Region 12

Anchor: UMC47 CountiesDSRIP Funding: $406 Million

Participating Providers:• Public Hospitals• Private Hospitals• TTUHSC• MHMRs• Local Health Departments

Assure residents receive high-quality, patient-centered care, in a cost-effective manner.

Focus on coordinated care delivery and improved health outcomes

Project focused on the Medicaid and uninsured patient populations

Contain cost growth Fulfill as many urgent and critical needs identified

as possible Improving quality and performance, increasing

access to care, and increasing prevention and early detection activities.

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Regional Vision

Developed utilizing:◦Focus groups◦Telephone surveys◦Existing needs assessments throughout

the region◦Behavioral Risk Factor Surveillance

Survey (BRFSS)◦Census◦Other health and demographic data

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Needs Assessment

Critical Needs:◦Severe primary care provider shortage, wait time, expense, lack of insurance, access to care

◦Lack of mental health services, inability to get an appointment, lack of insurance, need to use ERs for initial contact

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Needs Assessment

Urgent Needs:◦ Poor insurance support or uninsured◦ High incidence of obesity, diabetes mellitus and

heart disease.◦ Need for specialists to assist in the treatment of

obesity, diabetes mellitus, heart disease, asthma, chronic lung disease & other chronic diseases.

◦ Need for cancer screening with mammograms, pap smears, colonoscopy, sigmoidoscopy, rectal exam

◦ Insufficient maternal and prenatal care, especially the first trimester teen pregnancy, high percentage of unmarried mothers

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Needs Assessment

Important but Less Urgent:◦Alcohol abuse and binge drinking,

substance abuse◦Tobacco use◦High Prevalence of asthma and care issues◦Inadequate vaccination of the population◦High incidence of sexually transmitted

disease◦Shortage of dental care◦HIV Screening

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Needs Assessment

Infrastructure Development Innovation and RedesignQuality ImprovementsPopulation-focused Improvements

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DSRIP Categories

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Infrastructure Development Projects

Project Area Count1.1 - Expand Primary Care Capacity 151.2 - Increase Training of Primary Care Workforce 21.3 - Implement a Chronic Disease Management Registry 21.6 - Expand Access to Urgent Care and Enhance Urgent Medical Advice 31.7 - Introduce, Expand, or Enhance Telemedicine/Telehealth 41.8 - Increase, Expand, and Enhance Oral Health Services 31.9 - Expand Specialty Care Capacity 71.10 - Enhance Performance Improvement and Reporting Capacity 31.11 - Implement technology-assisted services (telehealth, telemonitoring, telementoring, or telemedicine) to support, coordinate, or deliver behavioral health services 21.12 - Enhance service availability (i.e., hours, locations, transportation, mobile clinics) to appropriate levels of behavioral health care 21.13 - Development of behavioral health crisis stabilization services as alternatives to hospitalization. 4Total Infrastructure Development Projects 47

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Innovation and Redesign Projects

Project Area Count2.1 - Enhance/Expand Medical Homes 32.2 - Expand Chronic Care Management Models 32.3 - Redesign Primary Care 22.4 - Redesign to Improve Patient Experience 42.6 - Implement Evidence-based Health Promotion Programs 32.7 - Implement Evidence-based Disease Prevention Programs 22.8 - Apply Process Improvement Methodology to Improve Quality/Efficiency 32.9 - Establish/Expand a Patient Care Navigation Program 72.10 - Use of Palliative Care Programs 32.11 - Conduct Medication Management 22.13 - 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, ER, urgent care etc.). 32.15 - Integrate Primary and Behavioral Health Care Services 32.17 - Establish improvements in care transition from the inpatient setting for individuals with mental health and / or substance abuse disorders. 12.18 - Recruit, train and support consumers of mental health services to provide peer support services 2Total Innovation and Redesign Projects 41

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Quality and Improvement Outcomes

Outcome Domain CountOD-1- Primary Care and Chronic Disease Management 10OD-2- Potentially Preventable Admissions 7OD-3 Potentially Preventable Re-Admissions - 30 day Readmission Rates (PPRs ) 9OD-4 Potentially Preventable Complications and Healthcare Acquired Conditions [under revision] 2OD-5 Cost of Care 1OD-6 Patient Satisfaction 22OD-7 Oral Health (Select one or more measures) 2OD-8 Perinatal Outcomes 1OD-9 Right Care, Right Setting 13OD-10 Quality Of Life/ Functional Status) 9OD-12 Primary Care and Primary Prevention 3OD-13 Palliative Care 5To Be Determined 11Total Quality and Improvement Outcomes 95

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Population-Focused Improvements

Reporting Domain CountPotentially Preventable Admissions 930-Day Readmissions 9Potentially Preventable Complications 8Patient-centered Healthcare, including Patient Satisfaction & Medication Management 8Emergency Department 8OPTIONAL: Children & Adult Core Mearsures 0Total Population-Focused Measures 42

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RHP 12 Initial Plan Submission to CMS

DY1 DY 2- 3 DY 4-5 TotalInitial plan submission n/a 17,777,700 17,777,700Category 1 & 2 88 147,006,202 147,600,172 294,606,374Category 3 94 14,987,776 43,708,085 58,695,861 Category 4 9 7,398,295 11,709,893 19,108,188 Total 191 169,392,273 203,018,150 390,188,123

Proposed Total Project Value (total computable)Number of Proposed

Of the 88 CAT 1 & 2 projects submitted:◦48 received 100% approval◦24 approved with Priority technical corrections

◦8 approved with proposed valuation adjustments

◦8 projects not approved 91% Overall Approval

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CMS Initial ReviewCAT 1 & 2 Projects

94 Category 3 Projects Submitted

71 Approved23 Not Approved76% Approval

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CMS Initial ReviewCAT 3 Projects

9 Category 4 Projects Submitted

9 Approved100% approval

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CMS Initial ReviewCAT 4 Projects

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CMS Initial Review Approval Rate by Region

Completed 3 of 4 Revision Phases

◦ Phase 1 – Completed (May thru June) - revised phase 1 projects – Projects with proposed valuation adjustments & Projects NOT initially approved

◦ Phase 2 – Completed (June thru July) – provided quantifiable patient impact and Medicaid/Indigent impact information for ALL projects

◦ Phase 3 – Completed (July thru September) – made necessary changes to DY2 milestones and metrics to assure DY2 payments

◦ Phase 4 – By December 2nd - make all priority technical corrections and Category 3 changes

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4 Phase Revision Process

CAT 1&2 Update Summary

4 CAT 1 &2 Still Not Approved:2 – Pending Phase 1 final review2 – Replacement projects

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Updated Status after Phase 1-3 completionCategory 1&2

CAT 1 & 2 Approved No Final Approval

Initial 80 8

Current Status – After Phase 1-3

84 4

CAT 3 Update Summary

16 CAT 3 Still Not Approved: 1 - Related Cat 1 or 2 project not initially approved 7 - Needs to define Quality of Life (QOL) tool 4 - Off-menu 4 - Different Cat 3 outcome recommended

CAT 4 – No Changes -100% approved 21

Updated Status after Phase 1-3 completionCategory 3 & 4

Approved Not Approved

Initial CMS Review 71 23

Current Status – After Phase 1-3

78 16

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Updated Status of Approved Projects and Valuations

# of Projects

Original Submission

CMS Initial Approved

CMS Newly Approved

Updated Total CMS Approved

Value Adjustments

AcceptedAwaiting Approval

Category 1 & 2 84 147,006,202 116,474,644 23,424,445 139,899,089 641,648 6,465,465 Category 3 78 14,987,776 11,390,497 1,202,031 12,592,528 - 2,395,248 Category 4 9 7,398,295 7,398,295 - 7,398,295 - - Total 171 169,392,273 135,263,437 24,626,476 159,889,913 641,648 8,860,713

DY2-3

72 of 88 Category 1 or 2 projects were eligible for August reporting

34 of the 72 eligible projects were reported on in August

18 of our 35 regional providers reported during DY2 August reporting

HHSC approved $24,366,766 of DSRIP funding for Milestones/Metrics reported in August going to 17 participating providers

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RHP 12DY2 August Reporting

DY2 October Reporting

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REQUIRED by All Performing Providers

In Progress - Due October 31st

Minimum Requirements:• “Overall Provider Summary” tab/sheet• “DY2 – Project Summary” section of each

project• “Progress Update” field – must be completed for

each Category 1 or Category 2 metric and each Category 3 milestone.

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DY2 October Reporting

You MUST select to carry-forward a metric if you have not 100% completed the metric:

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DY2 October Reporting

CAT 3 Status Update – All CAT 3 projects can report a status update and ultimately receive DY2 funding regardless of achieved milestones/metrics

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DY2 October Reporting

Unspent DSRIP funds and 3 Year Project

Process

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Each RHP required to submit a prioritized list of 3 year projects to HHSC by October 31st, 2013

HHSC will use the list to assess whether any DSRIP funds will be available for redistribution

REQUIRED for 3 Year Project process◦ Transparent process ◦ All Projects reviewed and scored based on community

needs, gaps in service, QPI, % Medicaid/Uninsured served & compliments other projects underway in RHP

◦ Alternate IGT entity

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Unspent DSRIP funds – Process for 3-Year DSRIP Projects

2 Healthcare Professionals recruited to review and score 3 Year Projects

All 3-Year DSRIP Projects reviewed & scored based on a scale of 1-9 (with 9 being the best) using the following weighted average domains:◦ Alignment with Community Needs (30%),◦ Transformational Impact (25%),◦ QPI/Medicaid/Uninsured Impact (25%),◦ Likelihood/Probability of Success (10%), and ◦ Sustainability After the Waiver (10%).

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Region 12’s 3 Year ProjectReview & Scoring Process

Northwest Texas Hospital System – ◦ DY3- DY5 Earmarked $11,840,081

WJ Mangold, Lockney, TX ◦ DY3- DY5 Earmarked $612,678

Funds from accepted Valuation Adjustments◦ DY3 – $340,719

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Region 12 “KNOWN”Unspent Funds

REQUIREMENTS of 3 Year Projects to be considered for Prioritized list◦ Projects MUST have an identified IGT source◦ All projects MUST be reviewed, scored &

prioritized based on community needs◦ Go through the Public Meeting Process

Region 12 Customized Process◦ 3 Tier Prioritizing Process

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Prioritized List Process

Tier 1 oRegion 12 Earmarked 100% of remaining funds in

March of 2014. Projects from providers with these earmarked funds fall into Tier 1 up to earmarked funding amounts. When and if a provider has utilized their earmarked threshold amount, any remaining lower scored projects for that provider will become Tier 3 projects.

Northwest - $11,840,081 (DY3-DY5)–2 projects WJ Mangold - $612,678 (DY3-DY5)–1 project

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Tier 1Prioritized List Process

Tier 2 oHighest scored project from any additional

provider that does not currently have a DSRIP project (new provider). Only ONE project (highest scored) per new provider will be included in Tier 2. If a new provider submits more than one New 3-Year Project, then all lower scored projects will be included in Tier

oRegion 12 has two providers that fall in this tier Swisher Memorial Healthcare System Baptist St. Anthony's (BSA) Health System

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Tier 2 Prioritized List Process

Tier 3◦ Projects from providers that currently have a

DSRIP project (existing providers), projects moved from Tier 1 to Tier 3 exceeding earmarked threshold amount, and lower scored projects from new providers that did not get included in Tier 2 due to the limit of one project (highest scored) per new provider.

◦ Region 12 has 16 projects in Tier 3

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Tier 3Prioritized List Process

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Region 12’s Prioritized ListSummary

Order Provider Name Project ID# Proj Opt Project Option Description

Total

Valuation

CAT 1-4 Avg Score

TIER 11 Northwest 137245009.1.1 1.1.2 Expand existing primary care capacity 6,841,273 6.93 2 WJ Mangold 126667806.1.1 1.1.2 Expand existing primary care capacity 612,678 6.50 3 Northwest 137245009.1.2 1.1.1 Establish more primary care clinics 4,998,808 4.83

TIER 24 Swisher 130721710.1.2 1.6.2 Establish/expand access to medical advice and direction to care 443,600 6.30 5 BSA 133457505.2.1 2.9.1 Provide navigation services to targeted patients 4,254,029 6.15

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Region 12’s Prioritized ListProject Categories & Weighted Score

Order Provider Name Project ID# Proj Opt Project Option Description

Total

Valuation

CAT 1-4 Avg Score

TIER 36 Golden Plains 197063401.1.4 1.1.1 Establish more primary care clinics 2,000,000 7.95 7 Texas Tech Lubbock 084599202.1.4 1.7.2 Implement remote patient monitoring of adult diabetic patients 3,441,662 7.90 8 University Medical Center 137999206.2.5 2.12.2 Implement one or more pilot intervention(s) in care transitions 7,710,625 7.70 9 WJ Mangold 126667806.2.1 2.9.1 Provide navigation services to targeted patients 447,685 7.48

10 Texas Panhandle Centers 127378105.2.4 2.13.1 Implement research supported and evidence based interventions ‐ ‐ 1,034,985 7.23 11 University Medical Center 137999206.2.6 2.9.1 Provide navigation services to targeted patients 5,342,760 7.03 12 Northwest 137245009.2.1 2.9.1 Provide navigation services to targeted patients 3,016,149 6.70 13 Texas Tech Amarillo 084563802.2.3 2.15.1 Design, implement projects that provide integrated services 3,559,500 6.53 14 Swisher 130721710.1.1 1.1.2 Expand existing primary care capacity 1,260,175 6.10 15 BSA 133457505.1.1 1.1.2 Expand existing primary care capacity 3,093,471 5.85 16 Childress Regional 133250406.1.2 1.9.2 Improve access to specialty care 1,911,144 5.60 17 Northwest 137245009.1.3 1.1.1 Establish more primary care clinics 3,267,495 4.95 18 Texas Tech Amarillo 084563802.2.4 2.10.1 Implement a Palliative Care Program 3,559,500 4.43 19 City of Amarillo 065100201.2.3 2.7.5 Innovative evidence based strategies to reduce obesity in children‐ 1,800,000 4.23 20 StarCare Specialty 084897001.2.1 2.9.1 Provide navigation services to targeted patients 2,600,000 4.23 21 Sunrise Canyon 136492909.2.2 2.9.1 Provide navigation services to targeted patients 1,350,000 3.90

62,545,539

October 28th

o IGT settlement date for August DY2 approved reporting October 31st 2013

o DY2 October Reporting Due to HHSCo Prioritized List Due to HHSC

o November 4th & November 18th

o Payment issue dates for August Reporting Soon

o DY 4-5 CMS Valuation Approval o Final Category 3 CMS Menu Approval

Mid-November/Early Decembero Regional Learning Collaborative Roll out Webinar

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What’s Next?

Early December◦ FULL 3 Year DSRIP projects Due◦ Phase 4 (priority technical issues & Cat 3 projects)◦ Project Plan revisions◦ October DY2 Reporting Feedback

January 4th 2014◦ Estimated IGT for approved DY2 October reporting◦ Additional information requested for non approved October

reporting January 24th 2014

◦ Estimated Payment for approved DY2 October reporting◦ Approval or denial of additional requested October information

March 31st 2014◦ Full RHP plan resubmitted as a single document

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What’s Next?

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Comments/Questions?

Please submit additional comments or feedback to us at the RHP email address below:

texasrhp12@umchealthsystem.com

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Feedback