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Region 15 Regional Healthcare Partnership 4 th Public Meeting

Region 15 Regional Healthcare Partnership 4 th Public Meeting. Wednesday, July 25, 2012 University Medical Center of El Paso Anchor Hospital. Confirmation of New Participants. Medicaid Waiver Timelines. Medicaid Waiver Timelines.

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Region 15 Regional Healthcare Partnership 4 th Public Meeting

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  1. Region 15Regional Healthcare Partnership4th Public Meeting Wednesday, July 25, 2012 University Medical Center of El Paso Anchor Hospital

  2. Confirmation of New Participants

  3. Medicaid Waiver Timelines

  4. Medicaid Waiver Timelines • Program Funding & Mechanics (PFM) and the RHP/DSRIP protocol • HHSC is reviewing more than 900 public comments and in negotiation with CMS • Final Approval - ?? • UC Protocol Approval • Hospital and Physician UC Protocols Approved • The tool should be available on July 30th • Individual pre-populated tool will be created for each Hospital • 30 days from posting to due date • Still finalizing the Ambulance and Dental tools

  5. RHP Planning Summit • Pre-Summit Webinar – tentatively August 3rd: • Changes in PFM Protocol • Clarifications re Public Comments • Overview of the DSRIP Planning Status • RHP Planning Summit – August 7,8, 2012 Austin, TX • Final protocol for submission of RHPs will be rolled out to Anchors • Instructions on electronic template submission rules • Webinar to view the Summit, watch presentations and hear discussions: http://www.hhsc.state.tx.us/1115-waiver.shtml

  6. Medicaid Waiver Timelines • September 1, 2012 – Submit RHP to HHSC (4 year plans) • HHSC / CMS extended the deadline for submission of RHPs to October 31, 2012 for regions that require an extension. • RHP15 would like to submit the plan to HHSC on August 15th • Timelines of 1st year payments are dependent on when RHP is submitted to HHSC/CMS • September 1 - October 31, 2012 – HHSC Submit Final RHP to CMS • Dependent upon when Region submits to HHSC • HHSC is requesting submission the soonest possible date from regions • October 15, 2012 – RHPs make changes to their plan if required • 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

  7. RHP 15 DSRIP Projects • See Handout • Categories I and II for all Performing Providers • Categories III and IV for Hospital Performing Providers • Hospitals must submit: • Category III Optional Project and Measurements • Category IV Reporting Data

  8. New Draft DSRIP MenuCategory I Project Areas 1. Expand Primary Care Capacity 2. Increase Training of Primary Care Workforce 3. Implement and Utilize Disease Management Registry Functionality 4. Enhance Interpretation Services and Culturally Competent Care 5. Collect Accurate Race, Ethnicity and Language (REAL) Data to Reduce Disparities 6. Enhance Urgent Medical Advice

  9. New Draft DSRIP Menu Category I Project Areas (cont.) 7. Introduce Telemedicine 8. Enhance Coding and Documentation for Quality Data 9. Expand Specialty Care Capacity 10. Enhance Performance Improvement and Reporting Capacity 11. Expand Behavioral Health Services 12. Expand Dental Services 13. 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 to Improve Patient Experience • Redesign for Cost Containment • Establish/Expand a Patient Care Navigation Program

  11. New Draft DSRIP MenuCategory II Project Areas (cont.) • Apply Process Improvement Methodology to Improve Quality/Efficiency • Improve Patient Flow in the Emergency Department/Rapid Medical Evaluation • Use Palliative Care Programs • Conduct Medication Management • Implement/Expand Care Transitions Programs • Health Promotion and Disease Prevention

  12. New Draft DSRIP MenuCategory III Project Areas • Severe Sepsis Resuscitation and Management (Mandatory) • Choose Process Measure • Choose Improvement Measure • 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

  13. 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)

  14. New Draft DSRIP MenuCategory IV Project Areas 1. 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 2. 30-Day Readmissions • All-cause readmission rate • Congestive heart failure readmission rate • Diabetes readmission rate • Behavioral health readmission • COPD readmission • Stroke readmission • Pediatric asthma

  15. New Draft DSRIP MenuCategory IV Project Areas (cont.) 3. Provider Preventable Complications 4. Patient-centered Health Care a. Patient satisfaction b. Medication management 5. Emergency Department a. Admit decision time to ED departure time for admitted patients 6. Diabetes Composite Measures a. Hemoglobin A1c b. Blood Pressure c. Low-Density Lipoprotein Cholesterol d. Retinal or dilated eye exam e. Foot exam f. Nephropathy screening

  16. Roundtable

  17. 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

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