Welcome to RHP 9 – Transforming Healthcare Now

Waiver Information

  • Five-year demonstration waiver that began on September 1, 2011
  • Aligns with the Triple Aim of the Centers for Medicare and Medicaid Services (CMS): Improve the experience of care, Improve the health of populations, and Reduce the per capita costs of healthcare without compromising quality.
  • Creation of Regional Healthcare Partnerships (RHP) that support coordinated, efficient delivery of quality care, and a plan for system transformation that is driven by the needs of the community.
  • Provides incentive payments for quality improvement and healthcare delivery system reform

Quick Facts on RHP 9:

  • 3 Counties: Dallas, Denton, & Kaufman
  • 2,530 square miles
  • Population of 3.1 million
  • 40% are low income
  • 25 providers participating in Delivery System Reform Incentive Payment (DSRIP) projects
  • Needs assessment: Gaps in access, behavioral health, and overall care coordination.
  • 129 DSRIP projects
    • 46 Infrastructure Development projects (Category 1)
    • 83 Program Innovation and Redesign projects (Category 3)
    • 200 Plus Outcome Measures (Category 3)

Wednesday, February 22 and Thursday, February 23, 2017: 

RHP 9 & 10 Collaborative Connections: Impacting Care Learning Collaborative.  Register at:  RHP 9 & 10 Learning Collaborative Event

Friday, February 24, 2017: HHSC and CMS will approve / deny NMI.  Metrics approved will be included in payment for the next DSRIP payment period (July 2017).  
November 2017: Regional Community Needs Assessment due.  

 

Making a Difference

Waiver Renewal / Draft DY7-8 PFM Protocol
  • We had an Executive Waiver Committee meeting in Austin this week.  Attached is the EWC presentation. Page 16 gives an example of the minimum point threshold.  HHSC said that the maximum number of points would be closer to 65, not 100 that is listed as an example. Also attached is a 4-page summary of the protocol we put together. It helps to simplify the draft, breaks it down a little more clearly, and highlights the important pieces.
  • Reminder, webinar next Thursday, February 9, 2:30-4pmThe webinar outlook was sent earlier this week. Will update it when HHSC provides the log in details.
  • Please hold off on sending questions/comments to HHSC until after the webinar.  HHSC will be soliciting feedback on all areas of the draft Protocol, in particular:
    • Definition of provider “system”
    • Factors/weights to determine minimum point thresholds for hospitals and physician practices
    • Requirements for LHDs
    • Uses of remaining funds ($25m per DY)
  • See estimated timeline of draft PFM dates
  • Some important points about the DY7-8 PFM Protocol (also see attached 4 page summary)
    • For CF of DY6 metrics in to DY7, the PFM for DY6 remains in effect
    • Categories

     

     

    DY7

    DY8

    Category A required reporting

    0%

    0%

    Category B MLIU PPP

    10%

    10%

    Category C Measure Bundles

    80 or 85%

    80 or 85%

    Category D Statewide Reporting Measure Bundle

    5 or 10%

    5 or 10%

     

    • Even though Cat A has no money tied to it, it must be completed to be eligible for payment for Cat B-D
    • The concept of "replacement projects" changes to allow providers additional flexibility. Providers will have the funds planned for replacement projects allocated to use for the proposed new structure.  Existing projects can continue under the new structure. The projects would represent "core activities." The "core activities" should represent initiatives that assist providers to meet measures that are included in the measure bundles.
    • HHSC is working on the "factors" that will be used for providers to know their "minimum point threshold." Tentative minimum point threshold for measure bundle selection should be by the end of March when the PFM is submitted to CMS for approval.
    • HHSC will be also working with the Texas Council on a CMHC workgroup and a LHD workgroup on the measure bundles. 
    • Under the current proposal, of the timing of milestone payments shifts to account for data lags (see page 10 of the draft PFM, Section 15.e., related to Category B: MLIU Patient Population by Provider (PPP):
      • Category B: The DY7 Category B PPP milestone will be for maintenance of PPP in the DY7 measurement period, and will be reported in DY8 R1. The DY8 PPP milestone will be for maintenance of PPP in the DY8 measurement period and reported in DY9 R1.
      • Category C:
        • P4P measures are reported on the Calendar year.
        • The DY7 valuation for a P4P measure will be split between baseline (25%), PY1 reporting (25%), and PY1 achievement milestones (50%). The baseline measurement period is CY2017 and the DY7 baseline reporting milestone can be reported beginning in DY7 R1. The PY1 measurement period is CY2018 and the PY1 reporting and achievement milestones can be reported beginning in DY8 R1.
        • The DY8 valuation for a P4P measure will be split between PY2 reporting (25%) and PY2 achievement (75%). The PY2 measurement period is CY2019 and the PY2 reporting and achievement milestones can be reported beginning in DY9 R1.
        • P4R measures are reported with DY measurement years.
        • The DY7 valuation for a P4R measure will be 100% reporting of Reporting Year 1 (RY1). The RY1 measurement period is DY7 and the DY7 reporting milestone can be reported beginning in DY7 R2.
        • The DY8 valuation for a P4R measure will be 100% reporting of RY2. The RY2 measurement period is DY8 and the DY8 reporting milestone can be reported beginning in DY8 R2.
Category 3 Measure Survey
HHSC will be sending a brief survey to selected providers regarding feedback on current measure selections.  Survey will be due by Friday, February 24.  
Compliance Monitoring
  • Cat 1 and 2. MSLC provided HHSC with the result of its review of the first group of Round 2 projects with DY3 carryforward metrics requiring additional validating. Providers should have received preliminary MSLC review results from MSLC and will receive final MSLC review result notification early next week. HHSC will be reaching out to providers where DY3 carryforward achievement was not confirmed. MSLC will start reaching out to the next group of providers with identified DY3 carryforward issues that just recently resubmitted their QPI templates to HHSC. Providers should respond to MSLC requests in timely manner in order for all work to be completed by April reporting.
  • There is one outstanding project from previous round of review (Round 2) where the information was not submitted to MSLC. HHS will be reaching out to that provider.
  • Random sampling selection of the projects for Round 3 review will be done next week. Once MSLC has the list of projects to review, MSLC or HHSC will update anchors about timelines of the review.
Category 3
  • Interim Corrections: The DY6 R1 Interim Corrections template is posted to the waiver website, along with an updated Category 3 Summary & Goal Calculator and updated Category 3 Updated RHP Summary. Providers that need to submit a correction to prior reporting and are eligible to submit a DY6 R1 Interim Corrections template should submit a completed template to the waiver website by February 19th.
  • Providers that submitted a correction through an NMI response to not nee dot submit an additional correction at this time. HHSC will update the Category 3 summary documents with NMI submissions in the coming weeks.
October DY5 Reporting Dates
  • January 19, 2017 - October reporting DY5 DSRIP payments for transferring hospitals and the top 14 IGT entities were processed.
  • January 31, 2017 - Remaining DSRIP payments (DY4 payments for all providers and DY5 payments for remaining providers that were not paid on January 19) will be processed.  Note that there are separate transactions for each payment for each DY.
  • February 24, 2017 - HHSC and CMS will approve or deny the additional information submitted in response to HHSC's "Needs More Information" (NMI) requests from October reporting.