Region 15
Regional Healthcare Partnership
Orientation Meeting
Wednesday, April 25, 2012
University Medical Center
of El Paso
1
Confirmation of Participants
2
Regional Healthcare Partnership (RHP)
Regions
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Regional Healthcare Partnership – RHP
Region 15
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Culberson
El Paso
Hudspeth
Jeff Davis
Presidio
Sample Letter
5
Current HHSC Information
6
Brief Review
Texas Healthcare Transformation and Quality
Improvement Program 1115 Waiver
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Managed care expansion
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Hospital financing component
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Allows statewide Medicaid managed care services.
Includes legislatively mandated pharmacy carve-in and dental
managed care.
Preserves upper payment limit (UPL) hospital funding under a
new methodology.
Creates Regional Healthcare Partnerships (RHPs).
Five Year Waiver 2011 – 2016
Brief Review
Under the waiver, trended historic UPL funds and
additional new funds are distributed to hospitals
through two pools:
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Uncompensated Care (UC) Pool
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Delivery System Reform Incentive Payments
(DSRIP)
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Costs of care provided to individuals who have no third
party coverage for the services provided by hospitals or
other providers (beginning in first year).
Support coordinated care and quality improvements through
Regional Healthcare Partnerships (RHPs) to transform care
delivery systems (beginning in later waiver years).
Impact on Local Entities
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The waiver provides ways for local entities to access
additional federal funding:
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Through a program and process that is transparent and
accountable for public funds.
To help pay for health-care services to individuals who are
uninsured.
To help pay for “incentive” payments (DSRIP) for health-care
related projects and investments to increase:
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Access to health-care services.
Quality of health-care and health systems.
Cost effectiveness of services and health systems.
Regional collaboration and coordination.
RHP Principles
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RHPs are formed around the hospitals currently receiving UPL and
one of these would serve as an anchor.
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Anchors serve as the single point of contact, coordinate RHP
activities, and serve administrative functions.
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Develop plans to address local delivery system concerns with a focus
on improved access, quality, cost-effectiveness, and coordination.
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RHP regions should reflect delivery systems and geographic proximity.
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UC and DSRIP pools are dependent on RHP plan participation.
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Waiver funds still go directly to hospitals (not to counties).
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The anchor does not make decisions regarding other entities’ funds.
With an exception for regions without a public hospital.
RHP Stakeholder Participation
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RHPs shall provide opportunities for public
input in plan development and review.
HHSC is seeking broad local plan
engagement including:
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County medical associations/societies.
Local government partners.
Other key stakeholders.
RHPs and DSRIP
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RHP Plans include:
– Regional health assessments.
– Participating local public entities.
– Identification of hospitals receiving incentives and
of yearly performance measures.
– Incentive projects by DSRIP categories.
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RHPs and RHP plans do not:
– Require four-year local funding commitments.
– Determine health policy, Medicaid program policy,
regional reimbursement, or managed care
requirements.
Pool Funding Distribution
DY = Demonstration Year
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Contact Information
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Waiver website:
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Waiver email address:
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http://www.hhsc.state.tx.us/1115-waiver.shtml
TXHealthcareTransformation@hhsc.state.tx.us
Role of the Anchor
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Role of the Anchor
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Anchors serve as RHP Facilitators.
Single Point of Contact, Coordinate RHP
activities and serve administrative functions.
Bring RHP participants and stakeholders
together to develop plans for public input and
review.
Each RHP will have one anchor.
Waiver defines anchor as the public hospital.
Anchors do not control IGT funding.
HHSC to approve anchor by May 1st, 2012.
Community Needs
Assessment
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Regional Strategic Health Framework
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Phase 1 – Needs Assessment Report
Phase 2 – Priority Ranking
Paso del Norte Blue Ribbon Committee
Incorporate Other Needs Assessments
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Hudspeth County Needs Assessment
Presidio County Needs Assessment
Jeff Davis County Needs Assessment
Culberson County Needs Assessment
Uncompensated Care (UC)
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Chapters
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University Medical Center of El Paso
Affiliated Private Hospitals
Region 15 County Hospitals
Other Entities
DSRIP Menu Outline – HHSC
(See Handouts)
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I. Infrastructure Development
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9.
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Expand Primary Care Access
Expand Specialty Care Access
Expand Behavioral Healthcare Access
Enhance Health Information Exchange and Health
Information Technology for Performance Improvement and
Reporting Capacity (meaningful use)
Implement and/or Expand Telehealth
Implement Disease or Care Management Registry
Develop Patient Centered Medical Home Infrastructure
Enhance Public Health Preventive Services
Improve or Expand Emergency Medical Services
II. Program Innovation and Redesign
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8.
9.
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Reduce Potentially Preventable Admissions/Readmissions
(PPA/PPR)
Test Financing Mechanisms for Providers
Develop Innovations in Health Promotion/Disease Prevention
Develop Innovation for Provider Training and Capacity
Enhance Behavioral Health Services
Innovate in Telehealth
Innovate in Supportive Care
Reduce Inappropriate Emergency Department Use
Improve Patient Experience of Care
III. Quality Improvements
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2.
3.
4.
5.
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Chronic Disease (congestive heart failure, asthma,
HIV)
Healthcare Acquired Conditions (surgical site
infections, MRSA, VRE, pressure ulcers)
Perinatal Outcomes
Potentially Preventable Admissions/Readmissions
Emergency Care (admit decision time to ED
departure time for inpatient admissions)
IV. Population-based Improvements
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2.
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6.
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At-risk Populations
Preventive Health
Potentially Preventable
Admissions/Readmissions
Patient-centered Health Care (patient
satisfaction, medication management)
Cost Utilization (outpatient imaging)
Emergency Department
RHP Document
Table of Contents
(See Handout)
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Table of Contents
Page
28
1
1
2
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2
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PART ONE: INTRODUCTION
Section 1.01
Regional Healthcare Partnership as Association
Section 1.02
Purpose of Regional Healthcare Partnership
Section 1.03
Mission of Regional Healthcare Partnership
Section 1.04
HIPAA Compliance
Section 1.05
No Participation of Those Barred From Federal Healthcare Programs
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PART TWO: GOVERNANCE OF RHP
ARTICLE I. ANCHOR
Section 1.01
Role of Anchor
Section 1.02
Cooperation with Other Governmental Entities
ARTICLE II. ORGANIZERS
Section 2.01
Qualification and Designation as an Organizer
Section 2.02
Termination of Organizer Designation
Section 2.03
Role of Organizers
Section 2.04
Independent Parties
Table of Contents (con’t.)
29
Page
5 ARTICLE III. REGIONAL PANEL
5 Section 3.01
Number and Powers
6 Section 3.02
Term of Service
6 Section 3.03
Resignation and Replacement
6 Section 3.04
Place of Meetings
6 Section 3.05
Quarterly Meetings
6 Section 3.06
Special Meetings
6 Section 3.07
Quorum
6 Section 3.08
Regional Panel Compensation
6 Section 3.09
Telephonic or Consent Meetings
7 Section 3.10
Eligibility for Uncompensated Care Pool Payments
7 Section 3.11
Eligibility for Delivery System Reform Incentive Payment Pool
Payments.
7 Section 3.12
Discretion to Allocate Public Revenue to Uncompensated Care Pool
and Delivery System Reform Incentive Payment Pool
8 ARTICLE IV. MEMBERS
8 Section 4.01
Number, Powers and Duties
Table of Contents (con’t.)
Page
9 PART THREE: PARTICIPATION IN WAIVER POOLS
9 Overview of UC and DSRIP Pools
9 CHAPTER I. EL PASO COUNTY COMMUNITY NEEDS
9 Section 1.01
El Paso County Needs Generally
12 CHAPTER II. [EXAMPLE: PRESIDIO COUNTY COMMUNITY NEEDS]
12 CHAPTER III. [EXAMPLE: JEFF DAVIS COUNTY COMMUNITY NEEDS]
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13 PART FOUR: PARTICIPATION IN UNCOMPENSATED CARE POOL
13 CHAPTER I. CURRENT EFFORTS TO ADDRESS COMMUNITY NEEDS IN EL
PASO COUNTY
13 Section 1.01
UC Pool Payments to University Medical Center of El Paso
13 Section 1.02
UC Pool Payments to Private Hospitals Affiliated with District and
Participating in this Regional Healthcare Partnership
14 Section 1.03
Efforts to Address Needs of El Paso County During the Waiver.
14 CHAPTER II. [EXAMPLE: CURRENT EFFORTS TO ADDRESS COMMUNITY
NEEDS IN HUDSPETH COUNTY]
14 CHAPTER III. [EXAMPLE: CURRENT EFFORTS TO ADDRESS COMMUNITY
NEEDS IN JEFF DAVIS COUNTY]
Table of Contents (con’t.)
Page
15 PART FIVE: PARTICIPATION IN DELIVERY SYSTEM REFORM INCENTIVE
PROGRAM POOL
15 CHAPTER I. EL PASO COUNTY DSRIP POOL
16 Section 1.01
Infrastructure Development Projects for UMC El Paso
20 Section 1.02
Infrastructure Development Projects Available to Private Hospitals
24 Section 1.03
Innovation and Redesign Projects for UMC El Paso
24 Section 1.04
Section Innovation and Redesign Projects Available for Private
Hospitals.
27 Section 1.05
Improve Post-Hospitalization Care to Minimize Incidents of Repeat
Hospitalizations of Low-Income Residents.
29 Section 1.06
Quality Improvement Projects.
31 Section 1.07
Improvement in Population-Focused Projects.
33 Section 1.08
Allocation of Funding for DSRIP Projects.
33 CHAPTER II. [EXAMPLE: CULBERSON COUNTY DSRIP POOL]
33 Section 2.01
Infrastructure Development Projects for Culberson County.
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Table of Contents (con’t.)
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36 PART SIX: WAIVER POOL FUNDING ALLOCATIONS
36 CHAPTER I.
EL PASO COUNTY FUNDING ALLOCATIONS
36 Section 1.01
District Revenue Available for Support of Uncompensated Care
Pool and Delivery System Reform Incentive Payment Pool.
36 Section 1.02
District Discretion to Allocate Tax Revenue.
36 CHAPTER II. [EXAMPLE: HUDSPETH COUNTY FUNDING ALLOCATIONS]
36 Section 1.03
County Revenue Available for Support of Uncompensated
Care Pool and Delivery System Reform Incentive Payment Pool.
37 Section 1.04
County Discretion to Allocate Tax Revenue.
38 PART Seven: CERTIFICATION38
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Medicaid Waiver Timelines
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Medicaid Waiver Timeliness
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July 15 – Submit RHP Chapters to Anchor
Sept. 1 – Submit RHP to HHSC
Oct. 31- HHSC Submit Final RHP to CMS
Roundtable
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Contact Information
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Waiver website:
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Waiver email address:
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http://www.hhsc.state.tx.us/1115-waiver.shtml
TXHealthcareTransformation@hhsc.state.tx.us