RHP 17
Planning Orientation
May 3, 2012
9:30 a.m. to 11:00 a.m.
1:00 p.m. to 2:30 p.m.
Welcome & Introductions
• Meeting Facilitators
• Dr. Monica Wendel
• Ms. Angie Alaniz
Orientation Overview
• Update on HHSC, RHP 17 activities
• Presentation of Planning Process
• What will be included in the plan?
• Who should participate?
• What is the timeline?
HHSC Waiver Activities
• March 1st - Uncompensated Care
(UC) Protocol Finalized
• Submitted to Centers for Medicare and Medicaid
Services
• March/April – Statewide Outreach
• Informational meetings held regarding RHP
formation and DSRIP menu
• May 1st - RHP Regions established
RHP Regions (Unofficial)
HHSC Timeline
• May 17, 2012
• Public hearing on final regional boundaries
• August 31, 2012
• Final RHP regions, DSRIP project menu, and payment
protocol to CMS.
• September 1, 2012
• RHP Plans due to HHSC.
• October 31, 2012
• HHSC submits final RHP plans to CMS.
RHP Region 17
RHP 17 Activities
• March 14th - Established RHP 17
• Brazos, Burleson, Grimes, Leon, Madison, Robertson, and
Washington
• TAMHSC named as anchor; BVCOG as fiscal agent
• April 9th and 23rd - RHP 17 expands
• Montgomery and Walker join RHP 17
• April 18th – IGT Meeting
• Focus - RHP Governance Structure
RHP Principles
• RHPs should promote transformation:
•
•
•
•
Improved access
Quality
Cost-effectiveness
Coordination
RHP Participants
• Four Primary Participants
•
•
•
•
Intergovernmental Transfer Entities
Private Hospitals
Other Health Care Providers
Anchoring Entities
• Participants have defined roles and
responsibilities
IGT Entities
• Who are they?
• Cities, counties, hospital districts, hospital authorities,
academic health science centers, mental health
authorities, health districts, emergency management
districts
• General duties
• Determines use of its IGT funding for uncompensated
care (UC) and Delivery System Reform Incentive
Payments (DSRIP)
• Participates in RHP Planning
IGT Entities & RHP Planning
• RHP Plan
• Selects projects and provides baseline metrics for DSRIP
• Must be consistent with HHSC RHP Protocol for DSRIP
• Estimates IGT available for each of the 4 plan years
• IGTs are NOT being asked to make a legal commitment beyond
the first plan year.
IGT Entities and UC
• Estimates IGT for uncompensated
care (UC) by plan year
• Provides IGT match for self or
sponsored hospital
IGT Entities and DSRIP
• Estimates IGT for DSRIP by year
• Works with RHP, state, and CMS on
valuing projects in DY 1
• Provides IGT match
Private Hospitals
• Who are they?
• Private hospitals (without IGT) that choose to
participate in waiver program and receive funding
• General Duties
• Participates in the RHP planning to receive waiver
funding
• Coordinates with IGT providers to offer
transformational services or uncompensated care as
basis of receiving sponsored payments
Private Hospitals, UC, and DSRIP
• Provision of UC serves as the basis
for UC waiver payments
• UC payment contingent upon IGT provided by IGT
entities
• Performs transformation (DSRIP)
project
• Must meet performance metrics as basis for IGTfunded incentive payments
• Provides report to anchoring entity
Other Health Care Providers
• Who are they?
• Non-hospital health care providers such as clinics and
related service providers that a participating hospital
might contract with to meet waiver objectives
• General Duties
• Coordinates with IGT providers to offer
transformational services as basis for receiving
payments from hospitals.
RHP Anchors
• Who are they?
• Any IGT entity
•
•
•
•
A public hospital
A hospital district or a hospital authority
A county
A state university with a health science center or medical
school
• General Duties:
•
•
•
•
Single point of contact between HHSC and RHP
Facilitates RHP meetings with IGT entities
Includes other stakeholders in RHP planning
Holds public meeting prior to submission of final plan
Anchors and RHP Planning
• Ensures inclusion of key stakeholders
in RHP Plan development
• Coordinates, develops, and provides
RHP Plan to HHSC
• IGT contributing projects must be consistent with
DSRIP Project menu and based on IGT entities’ input
Anchors and DSRIP
• Coordinates DSRIP Project Reports to
HHSC
• Reports detail project milestones and metrics met
• Provides technical assistance to
participating providers
Proposed Governance Structure
RHP Executive Committee
Current IGT Entities
Brazos County
Burleson County Hospital District
Grimes County
Montgomery County Hospital District
Walker County Hospital District
Texas A&M Health Science Center
Anchor
Texas A&M Health Science Center
Fiscal Agent
BVCOG
RHP 17 Board
All current and potential IGT Entities
and
All current and potential Participating Providers*
Advisory Council
Other Providers &
Stakeholders
*Non-voting members
Notes:
•
•
Each IGT Entity and Participating Provider will name 1 board representative
There will be 1 vote per county/hospital district
RHP Plan
• HHSC’s Draft Template
• Released April 3rd
• Advised RHPs NOT to complete this draft template
• Hosting Planning Orientation in June
• Plan Components
•
•
•
•
•
RHP Organization & Executive Overview
Community Needs Assessment
Stakeholder Engagement
DSRIP Projects
Allocation of Funds & RHP Participation Certifications
RHP Organization & Overview
• RHP Sections I and II
• RHP Participants List
• e.g. IGT entity, Performing Providers, Anchor, Other
Stakeholders (not directly receiving UC or DSRIP)
• Organization name, Lead Representative, Contact information
• Executive Overview
•
•
•
•
Overarching RHP goals
Brief summary of RHP healthcare environment
Summary of how RHP will move from current status forward
Identification of regional areas, e.g. RHP counties
Community Assessment
• Section III – Needs Assessment
• Data used cannot be more than 5 years old
• Demographics (e.g. race, ethnicity, income, education,
employment, large employers)
• Insurance coverage (commercial, Medicaid, Medicare, UC)
• Description of region’s current health care infrastructure and
environment (number/types of providers; hospital sizes,
services, systems, and costs; HPSAs)
• Projected major changes (in first three areas)
• Key health challenges specific to region
• Assessment should be basis for selection of DSRIP
projects
Stakeholder Engagement
• Section IV - Participation in RHP
• Performing providers – Describe how every performing
provider directly eligible to receive pool payments was
engaged
• Eligible performing providers must participate in RHP planning
process in order to receive payments
• Public Engagement – Describe opportunities for public
input into the development of the plans. Identify the
stakeholders and groups that were engaged.
DSRIP Projects
• Section V – DSRIP Projects by Category
• Infrastructure Development
• Program Innovations and Redesign
• Quality Improvements
• Population Focused Improvements
IGT Funding & Certifications
• Sections VI and VII
• Allocation of Funds
• Amount of UC, DSRIP, and Estimated State Match for each
RHP Performing Provider
• RHP Participation Certifications
• Signature of IGT Entities and Performing Providers
DSRIP Project Menu
• Categories
• Infrastructure Development
• Investments in technology, tools, and human resources
• Program Innovations and Redesign
• Piloting, testing, and replicating innovative care models
• Quality Improvements
• Hospitals implementing clinical improvement interventions
• Population Focused Improvements
• Patient’s experience, effectiveness of care coordination,
prevention, and health outcomes of at-risk populations
Infrastructure Development
• Expand health access
• Primary, specialty, behavioral health, substance abuse
• Enhance HIE/HIT
• Focus: performance improvement and reporting capacity
• Implement/expand telehealth
• Develop a patient-centered Medical home model
infrastructure
• Enhance Public Health Preventative Services
• Implement a Disease Management Registry
Program Innovation & Redesign
• Strategies to impact Potentially Preventable Events
• Mechanisms to test provider financing models
• Health promotion and disease prevention models
• Innovations in provider training and capacity
• Behavioral/Substance Abuse care models
• Telehealth Innovations
• Strategies to reduce inappropriate Emergency
Department use
• Supportive care models
Quality Improvements
• Congestive Heart
Failure
• Asthma
• HIV
• SCIP
• Healthcare-acquired
Infections
• Perinatal Outcomes
• PPA/PPR
• Emergency Care
• MDROs/CDI
• Facility-acquired
pressure ulcers
• Birth Trauma
Population-focused Improvements
• At-risk populations
• Preventive Health
• PPAs/PPRs
• Patient-centered health care
• Cost Utilization
• Emergency Department
DSRIP Project Vision
Aim and Outcome
Deliver better
health and
improved care
At lower costs
Measurements
•
•
Secondary Drivers
Primary Drivers
Improved access to behavioral health services
through technology assisted services and
enhanced service availability.
Care Access
Patient Engagement (HCAHPS)
Patient Satisfaction (HCAPHPS)
Care Experience
Early Intervention Services
Appropriateness of Care
Care Utilization
Evidenced-based care
Care Coordination
Efficiency of service delivery
Care Quality
Preventative Services
Educational Services
Human Behaviors
Collaborate with community partners
Expand residency training slots
Expand behavioral health workforce
Develop training plan and curriculum
Workforce
Transformation
30 day readmission rates for behavioral health/substance abuse.
Admission rate for behavioral health /substance abuse.
Proposed Process & Timeline
• May 14th – June 1st
• County meetings with IGT entities and health care providers to identify
top 3 priorities
• June 11th
• Community priorities consolidated and DSRIP Projects selected
• June 25th
• Estimated cost of DSRIP projects made available
• July 13th
• Determine IGT available and health care providers participating
• July 23rd
• Draft RHP Plan available for local review by RHP participants
• August 1st
• Final plan posted for public comment (due to HHSC September 1st)
Who should participate?
• Local Government Partners
• Hospitals with significant Medicaid utilization
• Other providers with significant Medicaid
utilization
• Academic Health Science Centers
• Regional Public Health Directors
• County Medical Associations/Societies
• Children’s Hospitals
Next Steps
• TAMHSC
• Schedule county meetings
• Assemble data by community
• Email community data, assessment summaries, and full
DSRIP menu to county meeting participants
• Work with IGT Entities to finalize governance structure
and IGT/BVCOG to define fiscal agent role/responsibilities
• IGT Entities/Health Care Providers
• Send contact information to alaniz@tamu.edu
• Review data, assessment summaries, DSRIP menu
• Identify top 3 health priorities by community