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Region 15 Regional Healthcare Partnership 20 th Public Meeting

Region 15 Regional Healthcare Partnership 20 th Public Meeting. Wednesday, February 26, 2014 University Medical Center of El Paso Anchor Hospital. Confirmation of Participants. Roll Call. 3 Year Projects. $23 Million to redistribute to all regions in left over funds for 3 year projects.

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Region 15 Regional Healthcare Partnership 20 th Public Meeting

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  1. Region 15Regional Healthcare Partnership20th Public Meeting Wednesday, February 26, 2014 University Medical Center of El Paso Anchor Hospital

  2. Confirmation of Participants • Roll Call

  3. 3 Year Projects $23 Million to redistribute to all regions in left over funds for 3 year projects

  4. Category 3 New Payment Methodology Assign New Values to all Category 3 • Total amount for Category 3 Outcomes will be provided and Providers must re-allocate percentages to each measure • There will be a minimum percentage assigned by Provider • There may also be exceptions to using certain percentages • This will be performed in the spreadsheet tool

  5. Category 3 New Payment Methodology DY3 • April, 2014 – payment based on status narrative report of establishing baseline • October, 2014 – payment based on submitting baseline • A signed certification will be required with submission of baseline rates by an executive of your entity

  6. Category 3 • Measure Type – You must review the new measures and if you can find a P4P measure to fit, use it. HHSC will be sending measures back where the choice is P4R and they find a P4P that fits. • P4P • P4R • Stretch Activities or Population Focused Activities in DY5 • Standalone (SA) or Non-Standalone (NSA) • Measure Specifications • Setting – Inpatient, Ambulatory, ED, Both • Prior Authorization (PA)

  7. Category 3 Benchmark Measurements • QSMIC – Quality Improvement System for Managed Care • High Performance Levels (HPL) – 90th Percentile • If your baseline is above the HPL, you cannot use the measure • Minimum Performance Levels (MPL) – 10th Percentile • If baseline is at MPL or above: • DY4 – 10% gap reduction to HPL • DY5 – 20% • Improvement Over Self (IOS) • 5% improvement in DY4 • 10% improvement in DY5

  8. Category 3 Measurements Numerator / Denominator • New materials list detailed elements required • Subsets – Can measure based on: • Payor • Race • Gender • Facility • Age • You cannot choose to measure only the patients enrolled in your project • CMS wants broader results

  9. Category 3 New Payment Methodology P4P OUTCOME MEASURES P4r Outcome Measures (requires Prior Authorization • DY4 • 50% P4R • 50% P4P • If improvement goal is not achieved, then partial payments can apply • DY5 • 100% P4P • If improvement goal is not achieved, then partial payments can apply • DY4 • 100% P4R • DY5 • 50% P4R • 50% P4P on Population-focused priority measure or stretch activity

  10. Additional Activities for P4R • Priority Population Focused Measures • Spreadsheet posted on website • Stretch Activities • SA1- Validation of P4R measure • SA2- Apply for National Quality Forum (NQF) Endorsement • SA3- Alternative Approaches to Program and Outcome Linkages • SA4- Emergency Department Improvements • SA5- Regional exchange of public health surveillance data • SA6- Community surveillance for at-risk and disparity groups • SA7- Texas HIE participation • SA-8- Data Governance Structure

  11. Helpful Resources • Selection Tool – Partial Data Sent 2/26/14 • Companion – not posted yet • Compendium – not posted yet • Decision Tree – HHSC PPT • Risk Adjusting Document – not posted yet • Denominator One Pager – ?? • Reporting Templates for DY3 – not posted yet

  12. Questions for HHSC Inbox Title by: • Category 3 – Selection tool • Category 3 – Select measures to fit cat 1 or 2 • Category 3 – population-focused priority measures • Category 3 – stretch activities • Category 3 – achievement methodology • Category 3 – data collection processes • Category 3 – tools/surveys • Category 3 - other

  13. Timelines • February 28, 2014 (delayed since Feb. 7)– October Reporting NMI • Eligible for April Reporting • Soon – Replacement Projects • March 10, 2014 –Category 3 measures due to HHSC • Providers send to HHSC and cc Anchor • By March 14, 2014 – HHSC submits New 3-Year Projects to CMS • Late April, 2014 – Results from CMS on New 3-Year Projects • April 2014, probably later – Full RHP Plan submission to HHSC • April 30, 2014 – April DY3 Reporting and Semi-Annual Progress Reports due from providers • Early June 2014 – HHSC approves April reports or NMI • July 9, 2014 – Estimate IGT due date for April DY3 milestone/metric achievement • Mid-July 2014 – Providers supply additional information if necessary following April DY3 reporting • July 31, 2014 – HHSC reviews and approves or disapproves additional information submitted by providers following April DY3 reporting. • July 31, 2014 – Estimated payment date for April DY3 reporting • June 30, 2014 – Plan Modifications for DY4-5.

  14. Roundtable DSRIP Project Discussions

  15. Contact Information • Waiver Website & Email Address: • http://www.hhsc.state.tx.us/1115-waiver.shtml • TXHealthcare Transformation@hhsc.state.tx.us • UMC Website: • http://www.umcelpaso.org • Region 15 - RHP • Paso del Norte Blue Ribbon Committee Needs Assessment: • http://www.elpasotexas.gov/health/_documents/BRCGapBook.pdf

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