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Texas Healthcare Transformation and Quality Improvement Program Medicaid 1115 Waiver

Texas Healthcare Transformation and Quality Improvement Program Medicaid 1115 Waiver. Katrina Lambrecht, JD, MBA VP and Chief of Staff January 9, 2012. Background.

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Texas Healthcare Transformation and Quality Improvement Program Medicaid 1115 Waiver

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  1. Texas Healthcare Transformation and Quality Improvement ProgramMedicaid 1115 Waiver Katrina Lambrecht, JD, MBA VP and Chief of Staff January 9, 2012

  2. Background • Texas Legislature (General Appropriations Act and Senate Bill 7) instructed Texas Health and Human Services Commission (HHSC) to: • Expand managed care to achieve cost savings • Preserve locally funded supplemental payments to hospitals (UPL)

  3. Texas Healthcare Transformation and Quality Improvement Program • Demonstration waiver of section 1115 of the Social Security Act • Submitted by the Texas HHSC to Centers for Medicare and Medicaid Services (CMS) on July 15, 2011 • Approved by CMS on December 12, 2011 • Set to expire on September 30, 2016

  4. 1115 Demonstration Waiver • Expands existing Medicaid managed care programs (STAR and STAR+PLUS) • Increases amount of federal funding for Medicaid • Establishes two funding pools • Uncompensated Care Pool (UC) • Delivery System Reform Incentive Pool (DSRIP) • Develops Regional Healthcare Partnerships (RHP)

  5. Funding Pool Overview • Funding must be generated locally and matched federally through the State of Texas • Uncompensated Care (UC) Pool • More payments in this pool in the early years • HHSC working on final UC report for hospitals • Delivery System Reform Incentive Pool (DSRIP) • More payments in this pool in later years • Created to incentivize delivery system reform • Based on the triple aim: • Improving the experience of care • Improving the health of populations • Containing costs • Both funding pools administered through RHPs

  6. Delivery System Reform Incentive Pool • Initiative categories modeled after the California DSRIP program • Category 1 – Infrastructure development Investments in people, places, processes, and technology • Category 2 – Program innovation and redesign Piloting, testing, replicating, and expansion of innovative care models • Category 3 – Population-focused improvement Hospitals report on measures across four domains including: patient care experience, effectiveness of care coordination, prevention, and health outcomes of at-risk populations • Category 4 – Urgent clinical improvements Targeted quality and patient safety improvement measures

  7. Regional Healthcare Partnerships • Anchored by public hospitals or local governmental entity • Create regional assessment, planning and redesign infrastructure • Create 5-year coordinated regional health plan that: • Includes regional assessment of health needs • Outlines projects and interventions that support delivery system reform and are tailored to the needs of the regional population • Identifies goals, milestones, metrics, and expected results from the interventions • Incorporates private hospitals via RHP agreements

  8. UTMB Proposal to Anchor Southeast Texas Region • 27 counties • HHSC Regions 5 & 6, exclusive of Harris County • UTMB has contracts with all but 4 counties • UT-Tyler has proposed HHSC Region 4

  9. UTMB’s Statewide Impact Community Clinic Regional Maternal and Child Health Clinic Telemedicine Clinic Educational Affiliation East Texas Area Health Education Center Contracted County for Indigent Care TDCJ Prison Clinic Federal Bureau of Prisons Clinic TYC Facility Clinic 0 1 - 50 51 - 100 101 - 250 251 - 500 501 - 1,000 1,001 - 5,000 Over 5,001 FY10 Number of Patients Treated

  10. UTMB Strengths • Relationships • Historical commitment to care for underserved populations • Accountability and transparency • Innovation • Expertise and experience in delivery system reform elements • EMR, meaningful use, quality reporting • Telemedicine/Telehealth • Regional Maternal Child Health Program • Community Health Program

  11. Next Steps • Texas 1115 Waiver Steering Committee already working • Health Management Associates has been engaged to assist with development of strategy • Continue working with UT System and HHSC • HHSC deadlines: • March 31, 2012 – submission of proposed regions, including potential stakeholders and potential level of funding • August 31, 2012 – confirm/approve final regions • October 31, 2012 – submission of final regional health plans

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