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Proposed DY7-8 Program Funding & Mechanics Protocol

This presentation outlines the proposed transition and funding shifts for the DY7-8 program in Northeast Texas. It covers the background of the waiver, the proposed transition plan, and the requirements for updated RHP plans. The language of the text is English.

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Proposed DY7-8 Program Funding & Mechanics Protocol

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  1. Proposed DY7-8 Program Funding & Mechanics Protocol Stephanie Fenter, MBA Director, Program Planning Anchor, RHP 1 UT Health Northeast RHP 12 Learning Collaborative March 24, 2017

  2. Presentation Outline • Waiver Timeline/Background • Proposed DY7-8 Transition • Category & Funding Shift • DY7-8 General Reporting Timeline • HHSC DY7-8 Planning Timeline • Requirements for Updated RHP Plans NORTHEAST TEXAS REGIONAL HEALTHCARE PARTNERSHIP

  3. Waiver Background • December 2011 • Approval for 5 year Waiver • October 2011 – September 2016 (DY1-5) • May 2016 • Approval received for 15 month extension • October 2016 – December 2017 (DY6-6A) • Provisions for step-down approach of current funding levels • January 2017 • HHSC requested additional 21 months of level funding for UC and DSRIP • Extend Waiver through September 30, 2019 (DY7-8) THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  4. Proposed DY7-8 Transition • Shift from project-level reporting to provider-level reporting of larger-scale transformational impact • Less focus on project-level intervention metrics and greater emphasis on outcome measure bundles • Opportunity to move further towards sustainability of transformed systems and alternative payment model development for services for Medicaid and low-income or uninsured individuals Implementation of new DSRIP structure is dependent approval of the additional 21 months and DSRIP protocols THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  5. Current DY2-6 Structure Category 3 Outcome 1a Category 1 or 2 Project 1 – MLIU QPI Category 3 Outcome 1b Category 3 Outcome 2a Category 1 or 2 Project 2 – MLIU QPI Provider A Category 3 Outcome 3a Category 3 Outcome 3b Category 1 or 2 Project 3 – MLIU QPI Category 3 Outcome 3c Category 4 – P4R (only hospitals) Total Performing Provider Valuation per DY - $5 million Source: Texas HHSC

  6. Proposed DY7-8 Structure Category C - Measure Bundle 1 Measure 1a Measure 1b Category C - Measure Bundle 2 Measure 2b Measure 2a Provider A Measure 2d Measure 2c Category A - Core Activities Alternative Payment Methodology, Costs & Savings, Collaborative Activities Category B – MLIU PPP for Performing Provider “system” Category D – P4R (all Performing Providers) Total Performing Provider Valuation per DY - $5 million Note that any DY6 QPI and Category 3 milestones/metrics carried forward to DY7 will follow the DY6 structure and requirements. Source: Texas HHSC

  7. Proposed DY7-8 Funding • DSRIP pool allocation for DY7-8 would be $3.1 billion per DY • HHSC sought feedback for uses of remaining unallocated DSRIP funds, estimated at $25 million per DY • Provider valuations for each DY7 and DY8 will remain at current levels (with a few exceptions) • Including valuation tied to ‘replacement projects’ • Valuation, and other factors, will be used to determine minimum measure bundle requirements THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  8. Categories A - D • Categories 1 – 4 will transition to Categories A – D • Category A: Required reporting elements • Category B: Medicaid and Low-income or Uninsured (MLIU) Patient Population by Provider (PPP) • Category C: Outcome Measure Bundles • Category D: Statewide Reporting Measure Bundles THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  9. Category & Funding Shift • Category 1 or 2 Project • Provider Summary • Core Components • Process Milestones • QPI & MLIU QPI • Funds: 57% / 80% Category A - Required Reporting Funds: 0% Category B - MLIU Patient Population by Provider Funds: 10% Category C – Outcome Measure Bundles Funds: 80-85% Category 3 Outcome Measures Funds: 20% / 33% Category 4 Hospital Reporting Funds: 0% / 10% Category D - Statewide Measures Funds: 5-10%

  10. What about my projects? • Existing Category 1 or 2 projects can continue under new structure • Existing projects, planned replacement projects, and new activities would represent “core activities” • Core Activities: initiatives that assist the providers to meet measures that are included in the selected measure bundles • Core activities throughout DY7-8 can be adjusted by provider without plan modifications THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  11. Category A: Required Reporting • Essentially replaces Cat 1 and Cat 2 components: • Overall Provider Summary • Project Summary • Individual metric components • Requires four areas of reporting: • Progress on core activities, alternative payment model arrangements, costs & savings, collaborative activities • Funding distribution: 0% • Reporting required during October reporting period of each DY to be eligible for payment of Categories B, C, and D THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  12. Cat A: Required Reporting • Core activities • Current processes and activities implemented under existing DSRIP project(s) and new activities and initiatives to impact/focus on specific outcome measures • Alternative Payment Model (APM) arrangements • Progress toward or implementation of APM arrangements with any Medicaid managed care organizations or other payors • Cost and savings • Costs associated with core activities and forecasted/generated savings • Collaborative activities • Required participation in regional LC activities THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  13. Category B: MLIU PPP • Medicaid and Low-Income or Uninsured (MLIU) Patient Population by Provider (PPP) • Essentially replaces the QPI and MLIU QPI components of Cat 1 and 2 • Requires system-level data/numbers • Funding distribution: 10% of provider’s total valuation • 5%: number of MLIU individuals served in DY7 & DY8 • 5%: ratio of MLIU individuals served in DY7 & DY8 • Reported in April for prior demonstration year • Partial payment can be earned (90%, 75%, 50%) • Carryforward is not allowed THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  14. Cat B: MLIU PPP • Provider baselines will be submitted in updated RHP Plan • Total number of individuals served by system • Total number of MLIU individuals served by system • Based on average of DY5 and DY6 numbers • To earn payment: number and ratio of MLIU individuals must be maintained for DY7 and DY8 • HHSC will calculate allowable variation, based on provider size and types • All reported performance will be subject to compliance monitoring THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  15. Category C: Measure Bundles • Proposed bundles will contain measures that share a unified theme, apply to a similar population, and are impacted by similar activities • Bundling aims to increase standardization of measures across the state and allow for ease in measure selection and approval • Each Bundle can be tied back to one or more Cat 1 or 2 project areas • Funding distribution: 80 or 85% of provider’s total valuation THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  16. Cat C: Measure Bundle Menu • Measure Bundle options will vary among provider types • Hospitals • Health Departments • LMHAs/CMHCs (“create your own”) • Academic Health Science Centers/Physician Practices • Final menu may include: • Common existing Cat 3 outcome measures • New or updated measures from authoritative sources • Mix of process measures (NSA) and patient clinical outcome measures (SA) • Innovative measures recommended by you • Currently under development by HHSC, Clinical Champions Workgroups, and Bundle Advisory Teams THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  17. Cat C: Measure Bundle Points • Measure Bundles will have an assigned point value • Number and difficulty of measures in the bundle • Status of measures as P4P vs P4R • Whether bundle/measure is considered a state priority • Each provider will be assigned a minimum point threshold • DY7 valuation • Size and role in serving MLIU population • UC/DSH report data • Providers would select one or more bundles to meet or exceed their minimum point threshold • Available late March THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  18. Ex: Minimum Point Threshold • Standard Point Valuation: $200,000 • Minimum point value cap: 100 • Minimum points increased for providers with statewide ratio >2 • If SR < 2: MPT = DY7 Valuation / Standard Point Valuation • If SR ≥ 2: MPT = (DY7 Valuation / Standard Point Valuation) * (SR/2)

  19. Measure Bundle Valuation • Funding Distribution: 80 or 85% of total DY7 valuation divided amongst selected bundle • Each bundle valuation dependent upon points relative to all other provider-selected bundles • Each measure within a bundle is valued equally • Valuation methodology may vary between provider types (non-hospital/physician groups) Individual Measure Bundle Points Total Provider Points Selected Value of Individual Measure Bundle Provider’s Total DY7 Cat C Valuation

  20. Example: Measure Bundle Selection • Provider’s Minimum Point Threshold: 12 points • Total Points Selected: 13

  21. Example: Measure Bundle Valuation • Provider’s Total Category C Valuation: $1,000,000

  22. Cat C: Measurement Periods • Baseline and reporting periods depend on measure designation • P4P – calendar year (CY) • P4R – demonstration year (DY) • Pay-for-Performance (P4P) • Baseline: CY2017 • Performance Year 1 (PY1): CY2018 • Performance Year 2 (PY2): CY2019 • Pay-for-Reporting (P4R) • PY1: DY7 (Oct. 2017 – Sept. 2018) • PY2: DY8 (Oct. 2018 – Sept. 2019) THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  23. Cat C: Reporting & Payment • Milestone structure and valuation for DY7-8 would be as follows: THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  24. Cat C: P4P Measure Goals

  25. Cat C: Reporting & Payment • Each measure’s denominator includes all individuals served by the provider system (as applicable for that measure) • Payment for P4P achievement milestones requires achievement of MLIU rate (some exceptions will be allowed) • Payment for P4P and P4R reporting milestones requires rates for All Payer, Medicaid, and LIU payer types (some exceptions will be allowed) • Partial payments and carryforward of reporting (not achievement) will be allowed for P4P measures THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  26. Cat D: Statewide Reporting • Similar to Category 4 population-focused measures • Designated as pay-for-reporting • Additional measures (TBD) developed to include non-hospital Performing Providers • Funding Distribution: 5 or 10% • 5% of provider’s total valuation can shift from Cat C (P4P) to Cat D (P4R) if current (DY6) level of private hospital participation is maintained • 3% margin allowed • Regional demonstration determined when RHP Plan Update is submitted THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  27. Proposed Reporting Timeline

  28. HHSC DY7-8 Planning Timeline • February 2017: PFM review and feedback on measure bundles • March 2017: HHSC review of stakeholder feedback of PFM and addressed concerns/make changes to PFM • April 2017: HHSC will submit PFM to CMS • March – May 2017: Measure Bundle Development • Clinical Champion subgroups (BATs) • CMHCs (Texas Council) • LHDs • Anchors THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  29. HHSC DY7-8 Planning Timeline • Bundle Advisory Teams (BATs) • Behavioral Health & Chronic Pain Management • Chronic Disease and Care Transitions • Dental • Hospital Safety • Palliative Care • Pediatric and Maternal Care • Primary Care and Prevention • Rural Hospitals • Specialty Care • Conference call scheduled for March 27th THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  30. HHSC DY7-8 Planning Timeline • June/July 2017: DY7-8 proposed rules posted for public comment • July 2017: HHSC will submit Measure Bundle protocol to CMS • August 2017: Targeted CMS approval of protocols • November 30, 2017: Anchors submit RHP Plan Updates • January-February 2018: Providers respond to HHSC feedback and requests for changes • March 2018: Final HHSC approval of RHP Plans THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  31. Updated RHP Plans • Updated community needs assessment & stakeholder forum/engagement documentation • MLIU Patient Population by Provider baselines • Measure Bundle selections • Narratives to describe plans for DY7-8 including: • continuation of DY2-6 project activities that support selected measure bundles • new activities that will support measure bundle achievement • DSRIP Valuation amounts & confirmed funding sources THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  32. Now What? • Think about what definition of “system” makes sense for your organization • With existing Cat 3 outcome measures as a starting point think about outcome measures that you need to improve, consider data needed to report, and begin looking at your current performance in those areas • Think about what current DSRIP activities support improvement in those outcome areas • Think about what else you can do to ‘move the needle’ for your patient population THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  33. Questions? THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

  34. Contact Information Stephanie Fenter, MBA Director, Program Planning RHP 1 Anchor UT Health Northeast 903-877-5953 Stephanie.Fenter@uthct.edu THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER

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