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Wednesday, February 26, 2014University Medical Center of El

PasoAnchor Hospital

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Roll Call

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$23 Million to redistribute to all regions in left over funds for 3 year projects

Assign New Values to all Category 3

Total amount for Category 3 Outcomes will be provided and Providers must re-allocate percentages to each measure

There will be a minimum percentage assigned by Provider

There may also be exceptions to using certain percentages

This will be performed in the spreadsheet tool 4

DY3

April, 2014 – payment based on status narrative report of establishing baseline

October, 2014 – payment based on submitting baseline A signed certification will be required with

submission of baseline rates by an executive of your entity

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Measure Type – You must review the new measures and if you can find a P4P measure to fit, use it. HHSC will be sending measures back where the choice is P4R and they find a P4P that fits.

P4P P4R

Stretch Activities or Population Focused Activities in DY5

Standalone (SA) or Non-Standalone (NSA)

Measure Specifications Setting – Inpatient, Ambulatory, ED, Both

Prior Authorization (PA)

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Benchmark Measurements

QSMIC – Quality Improvement System for Managed Care

High Performance Levels (HPL) – 90th Percentile If your baseline is above the HPL, you cannot use the measure

Minimum Performance Levels (MPL) – 10th Percentile If baseline is at MPL or above:

DY4 – 10% gap reduction to HPL DY5 – 20%

Improvement Over Self (IOS) 5% improvement in DY4 10% improvement in DY5

Numerator / Denominator New materials list detailed elements required Subsets – Can measure based on:

Payor Race Gender Facility Age

You cannot choose to measure only the patients enrolled in your project

CMS wants broader results8

P4P OUTCOME MEASURES P4R OUTCOME MEASURES (REQUIRES PRIOR AUTHORIZATION

DY4 50% P4R 50% P4P

If improvement goal is not achieved, then partial payments can apply

DY5 100% P4P

If improvement goal is not achieved, then partial payments can apply

DY4 100% P4R

DY5 50% P4R 50% P4P on

Population-focused priority measure or stretch activity

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Priority Population Focused Measures Spreadsheet posted on website

Stretch Activities SA1- Validation of P4R measure SA2- Apply for National Quality Forum (NQF) Endorsement SA3- Alternative Approaches to Program and Outcome

Linkages SA4- Emergency Department Improvements SA5- Regional exchange of public health surveillance data SA6- Community surveillance for at-risk and disparity groups SA7- Texas HIE participation SA-8- Data Governance Structure

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Selection Tool – Partial Data Sent 2/26/14 Companion – not posted yet Compendium – not posted yet Decision Tree – HHSC PPT Risk Adjusting Document – not posted yet Denominator One Pager – ?? Reporting Templates for DY3 – not posted

yet

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Title by: Category 3 – Selection tool Category 3 – Select measures to fit cat 1 or 2 Category 3 – population-focused priority

measures Category 3 – stretch activities Category 3 – achievement methodology Category 3 – data collection processes Category 3 – tools/surveys Category 3 - other

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February 28, 2014 (delayed since Feb. 7) – October Reporting NMI Eligible for April Reporting

Soon – Replacement Projects March 10, 2014 –Category 3 measures due to HHSC

Providers send to HHSC and cc Anchor By March 14, 2014 – HHSC submits New 3-Year Projects to CMS

Late April, 2014 – Results from CMS on New 3-Year Projects April 2014, probably later – Full RHP Plan submission to HHSC April 30, 2014 – April DY3 Reporting and Semi-Annual Progress Reports

due from providers Early June 2014 – HHSC approves April reports or NMI July 9, 2014 – Estimate IGT due date for April DY3 milestone/metric achievement Mid-July 2014 – Providers supply additional information if necessary following April DY3

reporting July 31, 2014 – HHSC reviews and approves or disapproves additional information

submitted by providers following April DY3 reporting. July 31, 2014 – Estimated payment date for April DY3 reporting June 30, 2014 – Plan Modifications for DY4-5.

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DSRIP Project Discussions

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Waiver Website & Email Address: http://www.hhsc.state.tx.us/1115-waiver.shtml TXHealthcare Transformation@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