Region 15 Regional Healthcare Partnership 40th Public Meeting

1. Region 15Regional Healthcare Partnership40th Public Meeting Wednesday, NOVEMBER 30, 2016 University Medical Center of El Paso Anchor Hospital Texas tech university health sciences center – Medical Education Bldg (MEB) – Rm 1110

2. Confirmation of Participants Roll Call • University Medical Center of El Paso • Texas Tech University Health Sciences Center at El Paso • El Paso Children’s Hospital • Hospitals of Providence (Tenet) • Las Palmas – Del Sol Hospital (HCA) • El Paso Health Department • Emergence Health Network • El Paso Medical Society • Visitors

3. ANCHOR UPDATES Cathy Gibson Anchor RHP 15 • Compliance Monitoring • Waiver Renewal • Community Health Needs Assessment • Timeline

4. ANCHOR UPDATES • Myers & Stauffer Compliance Monitoring • MSLC will prepare a summary for Cat 1 and 2 reviews soon • Anchor will receive and distribute to providers

5. ANCHOR UPDATES • Waiver Renewal • Negotiations underway with CMS • October 21st face to face meeting in DC • Key Areas for Waiver negotiations: • Size of Uncompensated Care (UC) Pool • Size and evolution of the DSRIP Pool • CMS Supports Managed Care Delivery Model for Texas • 5-Year waiver period beginning Jan 01 2018 • DSRIP Specific negotiations • CMS Focus on “payment reform” for all current waivers that contain DSRIP • CMS guiding principles on DSRIP • Should be about incentives, start-up funds and capacity building • NOT on-going program operations • Integration of funding into Medicaid Manage Care • However, a portion of DSRIP could continue OUTSIDE of Managed Care for UNINSURED • HHSC trying to understand CMS’s definition of value based purchasing and timelines for this transition to occur

6. ANCHOR UPDATES • Community Health Needs Assessment • Currently June 2017 (may move to a later date) • Paso Del Norte Foundation • DRAFT

7. TIMELINE • January 3, 2017 • IGT settlement date • January 13, 2017 • DY5 Oct DSRIP payments processed for hospitals • January 16, 2017 • 11:59 pm Responses due to HHSC for NMI requests. • January 31, 2017 • DY5 Oct DSRIP payments processed for all other providers • February 24, 2017 • HHSC/CMS approve or deny NMI requests • November 1, 2016 • HHSC Review of October submissions • November 18, 2016 • HHSC estimates IGT (October reporting) • November 21, 2016 • 5:00pm IGT approve and comment on estimates • December 2, 2016 • 5:00pm – Submission of any IGT changes • December 9, 2016 • HHSC/CMS complete review and approval of October reports and/or NMI

8. Project PRESENTATION

9. ANNUAL REPORT INPUT Oscar Perez DSRIP Program Manager • Go to your browser: • http://pollev.com/oscarperez394 • OR Text: OSCARPEREZ394 • to 22333 • To join the session

10. DY6 MILESTONES Oscar Perez DSRIP Program Manager • Quantifiable Patient Impact (QPI) • Core Component Reporting • Sustainability Plan

11. Cat 1 and 2 Requirements (Milestones) • Standardized for ALL projects Four (4) Total Milestones 2 Quantitative 2 Qualitative • 1. Total QPI Value is 25% • 2. MLIU QPI Value is 25% • 3. Core Component Report Value is 25% • 4. Sustainability Plan Value is 25%

12. MLIU – Medicaid low income uninsured • To qualify as MLIU QPI • Enrolled in Medicaid • at the time of at least one encounter during the DY • Qualified as Low-Income or Uninsured • Below 200% of Federal Poverty Level (FPL) OR • at the time of at least on encounter during the DY • Uninsured • at the time of a separate encounter during the DY • If patient was on Medicaid and then became Low-Income or Uninsured during the DY • Counted as “Medicaid” for DSRIP purposes • Either • Individuals Served OR • Encounters Provided • Stipulated by the project

13. Milestone 1: Total QPI • HHSC will determine the target • Same as DY5 (TOTAL QPI Goal) • May request variance from HHSC (TBD)** • Grouping must be same as DY5 • No changes • Pre-DSRIP baselines remain the same • No changes • Carry Forward IS allowed

14. Milestone 2: MLIU QPI • If project had MLIU goal in DY5 • DY6 goal is same as DY5 goal • Pre-DSRIP baseline stays same • If project had no MLIU goal in DY5 • DY6 is • Pre-DSRIP QPI x %MLIU (DY3 or earliest on record) • EXAMPLE • MLIU QPI MAY BE PFP OR PFR • Projects in Project Area 1.9.* • % MLIU Not Achieved in DY3, DY4, DY5 • Identified by HHSC and notified

15. Milestone 3: Core Component Reporting • Based on Project Option • Each Core Component must be addressed • Usually 3 or more of these • ALL have a Continuous Quality Improvement (CQI) Element • EXAMPLE

16. Milestone 4: Sustainability Plan • Project Level • “How does the institution plan to keep this project going when the DSRIP dollars are gone?” • Plan may Include • Systems for Exchange of Health Information • Integration into Managed Care • Collaboration with other community partners • Project Level Evaluation • Return On Investment • Quantifiable Outcomes

17. REGIONAL learning collaborative PLAN Oscar Perez DSRIP Program Manager • Go to your browser: • http://pollev.com/oscarperez394 • OR Text: OSCARPEREZ394 • to 22333 • To join the session

18. REGIONAL learning collaborative PLAN • New Plan needed for DY6+ • Annual Summit for the Region (minimum) • Established Workgroups • Diabetes • Behavioral Health • Re-Focus : Integration of DSRIP projects: • Medicaid Managed Care • Value Based Purchasing • Alternative Payment Models • Sustainable Strategies for Low Income Uninsured Patients • Stakeholder’s Forum • Regional Community Healthcare Needs Assessment • Paso Del Norte Foundation • Tentatively DUE June 2017

19. Key Aspects of collaboratives • Focus on Closing the gap of a known problem with known solutions • Use Standard Model for this work • Must be Fast Paced with timeline for goals • Must use Standard Measures • Working Membership • Sharing of ideas and data is required • “All Teach, All Learn” philosophy

20. Contact Information • NEW Waiver Website: • https://hhs.texas.gov/lawsregulations/policiesandrules/Medicaid1115waiver • Waiver E-Mail: • TXHealthcare Transformation@hhsc.state.tx.us • UMC RHP15 Website: • http://www.umcelpaso.org • Region 15 - RHP

21. Next Meeting: January 25, 2017 1:00pm