Region 15 Regional Healthcare Partnership Fifth Public Meeting

1. Region 15Regional Healthcare PartnershipFifth Public Meeting Wednesday, August 22, 2012 University Medical Center of El Paso Anchor Hospital

2. Confirmation of New Participants • El Paso County • UBH • Salvation Army • El Paso Child Guidance Center

3. New Template and Evaluation Form • Revised RHP 15 Project Template • Multiple changes to reflect the latest revisions by HHSC • Added section for narrative to be included for each project valuation • HHSC would prefer to see fairly flat valuations across the 4 years • Maximum project value over the four year period is the greater of 10% of entity’s Pass 1 allocation or $10,000,000 • DSRIP Proposal Evaluation Form • For use by IGT Entities to evaluate outside entity project proposals

4. Summit Recap – UC Tool & RHP Plan Template Tool • UC Protocol Approval • Hospital and Physician UC Protocols Approved • The tool has been uploaded • 30 days from posting to due date • Completion of this tool will provide UC Reimbursement • UC -- DY1 Payment = late November / December 2012 • UC – DY2 Payment = Early 2013 • Issues with macros in the tool • HHSC will publish a UC Tool Training webcast online ASAP • An electronic RHP Plan Template Tool will be released after the protocols are approved by CMS (8/31/12). • Webinar training will be provided for this tool

5. Anchor Call Recap - DSRIP Menu Changes • ICD-10 Coding and ED Door to Doc Times, both removed from the Menu (Cat 1 and 2) • Patient Experience moved to Category 3 (Outcome Measure) • Residency Programs – Yes • No longer a 3 project requirement in Category 3 • Waiver Projects surrounding Jail system – patients or services must be for a Medicaid eligible patient • They would like to see a listing of our projects that we considered but excluded from the Plan, i.e. No List

6. Anchor Call Recap - DSRIP Menu Changes • Significant Changes in the entire format of the Menu! • Involving Metrics and Outcomes Reporting for Categories 1, 2 & 3 • All Category 1& 2 projects MUST have an associated Category 3 Outcome • New Definition – 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” • Category 1&2 contain many “outcomes measures” that will be moved to Category 3. • Other Improvement measures that do not meet the outcomes definition will remain in Cat 1&2. • A list of Category 3 Outcomes is under development.

7. Anchor Call Recap – Category 3 Payments • Possible Options: • Cat 3 DY 2 & 3 Payments will be for preparing to report outcomes for DY 4 & 5, i.e. establishing baselines and preparing data systems • Or, no funding in Cat 3 for DY 2 & 3 • Cat 3 DY 4 & 5 payments will be for meeting outcome targets • Can either set an estimated outcome goal in plan, or list TBD • Criteria to meet the targets has not been developed yet • HHSC is proposing that Cat 3 be a combination of pay for performance and pay for reporting • Partial payments for Outcomes may be considered

8. Medicaid Waiver Timeliness • Final Approval on PFM Protocol and Menu – August 31, 2012 • Draft that was just sent to CMS is on our website • Two weeks after approval – IGT Entities and Private Hospitals submit their final Chapter of Projects to Anchor • Estimate September 14, 2012 • October 31, 2012 – Submit RHP to HHSC (4 year plans) • December 15, 2012 - CMS completes review • RHPs returned for revisions during the 30 day period • January 15th, 2013 - Revised RHP Plans to CMS • February 1st, 2013 - CMS Final Decision

9. New Draft DSRIP MenuCategory I Project Areas • Expand Primary Care Capacity • Increase Training of Primary Care Workforce • Implement and Utilize Disease Management Registry Functionality • Enhance Interpretation Services and Culturally Competent Care • Collect Accurate Race, Ethnicity and Language (REAL) Data to Reduce Disparities • Enhance Urgent Medical Advice • Introduce Telemedicine • Expand Specialty Care Capacity • Enhance Performance Improvement and Reporting Capacity • Expand Behavioral Health Services • Expand Dental Services • Expand or Enhance Emergency Medical Transportation Services

10. New Draft DSRIP MenuCategory II Project Areas • Expand Medical Homes • Expand Chronic Care Management Models • Redesign Primary Care • Redesign for Cost Containment • Establish/Expand a Patient Care Navigation Program • Apply Process Improvement Methodology to Improve Quality/Efficiency • Use Palliative Care Programs • Conduct Medication Management • Implement/Expand Care Transitions Programs • Health Promotion and Disease Prevention • Behavioral Health

11. New Draft DSRIP MenuCategory III Project Areas Potentially Preventable Admissions • Congestive heart failure admission rate • Diabetes, short-term complications, admission rate • Diabetes, uncontrolled diabetes, admission rate • Behavioral health potentially preventable admissions • Chronic obstructive pulmonary disease or asthma in adults admission • Hypertension admission rate • Diagnosis and management of asthma Potentially Preventable Readmissions • All cause readmission rate • Congestive heart failure readmission rate • Diabetes readmission rate • Behavioral health readmission • COPD readmission • Stroke readmission

12. New Draft DSRIP MenuCategory III Project Areas (cont.) Potentially Preventable Complications Perinatal Outcomes • Birth trauma rates • Elective pre 39-week delivery Diabetes Composite Measure • Hemoglobin A1c (National Quality Forum (NQF) 0059) • Blood Pressure (NQF 0061) • Low-Density Lipoprotein Cholesterol (NQF 0064) • Retinal or dilated eye exam (NQF 0055) • Foot exam (NQF 0056) • Nephropathy screening (NQF 0062). Patient Experience

13. New Draft DSRIP MenuCategory IV Project Areas • Potentially Preventable Admissions • Congestive heart failure admission rate • Diabetes, short-term complications, admission rate • Diabetes, uncontrolled diabetes, admission rate • Behavioral health potentially preventable admissions • Chronic obstructive pulmonary disease or asthma in adults admission • Hypertension admission rate • Diagnosis and Management of Asthma • 30-Day Readmissions • All-cause readmission rate • Congestive heart failure readmission rate • Diabetes readmission rate • Behavioral health readmission • COPD readmission • Stroke readmission • Pediatric asthma

14. New Draft DSRIP MenuCategory IV Project Areas (cont.) • Provider Preventable Complications • Patient-centered Health Care • Patient satisfaction • Medication management • Emergency Department • Admit decision time to ED departure time for admitted patients • Diabetes Composite Measures • Hemoglobin A1c • Blood Pressure • Low-Density Lipoprotein Cholesterol • Retinal or dilated eye exam • Foot exam • Nephropathy screening

15. Roundtable

16. Contact Information • Waiver Website & Email Address: • http://www.hhsc.state.tx.us/1115-waiver.shtml • TXHealthcareTransformation@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