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, September 6, 2017: Lakes Regional Community Center . Register at https://rhp9roadshowlakesregional.eventbrite.com
Tuesday, September 19, 2017: RHP 9 Technology in Healthcare . Register at https://rhp9technologyinhealthcare.eventbrite.com
November 2017: Regional Community Needs Assessment due.  
Tuesday, December 5, 2017: RHP 9 Rapid Cycle Improvement Cohort.  Register at https://rhp9rapidcycleimprovement.eventbrite.com


Making a Difference

Measure Bundle Protocol
  • The full protocol was submitted to CMS by the end of July as planned. HHSC is targeting September for CMS approval of the Measure Bundle Protocol.
  • The updated version of the proposed DSRIP DY7-8 Measure Bundle Protocol that was sent on Monday was missing some information.  Attached is the Measure Bundle Protocol with complete information. 
    • On page 19, the table and text under 4.b.iii, 4.b.iv and 4.c were all added. These sections were inadvertently left off of the previous version.
    • On page 62, measure M1-305 Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment (SRA-CH) was added to the CMHC Measure Menu.
  • Based on the changes to the Measure Bundle Protocol, HHSC has also updated the Program Funding and Mechanics (PFM) Protocol and highlighted the changes in yellow. See attached. 
  • The Minimum Point Threshold file has also been updated to reflect the changes.  See attached.  
  • HHSC has developed proposed rules for DSRIP DY7-8 that are intended to reflect the DY7-8 policy outlined in the PFM protocol and the Measure Bundle Protocol. However, due to timing issues and recent changes to the protocols, the rules will not reflect the most recent DY7-8 policy outlined in the protocols.
  • HHSC will present the overall DSRIP DY7-8 policy outlined in the protocols at the following meetings:
    • Hospital Payment Advisory Committee (HPAC) meeting on August 17 at 1:30 pm;
    • Medical Care Advisory Committee (MCAC) meeting on August 24 at 9:00 am;
    • HHSC Executive Council meeting on September 7 at 10:00 am; and
    • DSRIP DY7-8 Rules Public Hearing on September 21 at 9:30 am.
  • HHSC anticipates that the rules will be published as proposed for public comment in the Texas Register in late August/ early September.
  • HHSC anticipates that the rules will be effective December 1, 2017.
Waiver Negotiations Update
  • Communications are still ongoing (weekly calls) and updates will be provided as they are available, including timelines. 
  • Yesterday we had a EWC (Executive Waiver Committee) meeting.  Attached is the presentation.  
Measure Bundle Protocol feedback and HHSC responses
  • Attached is the summary/feedback response document. 
  • The format is like the feedback summary for the PFM, with stakeholder comments/questions grouped by category and similarity. 
  • Below is a summary of significant changes to Category C based on stakeholder feedback and HHSC direction - some, but not all, of these are also described in the feedback document.

·         In the Program Funding and Mechanics Protocol, HHSC made the following changes:

o   Clarified milestone valuation for measures with multiple parts

o   Raised the valuation limit for bundles K1 and K2 from $2 million to $2.5 million.

o   Added an exception to the 3 point measure selection requirement for CMHCs and LHDs with less than or equal to $2.5 million in valuation, and added a requirement that CMHCs and LHDs must select and report at least two unique measures.

o   Added goal setting options for certain QISMC process measures with 0 numerator cases at baseline so that goals for DY7 and DY8 goal achievement milestones will be based on pre-defined benchmarks.

o   Clarified that the goals for measures with an Improvement Over Self goal setting formula will not exceed an HPL to be defined in the Category C Measure Specifications.

o   Amended the performance measurement periods for measures approved to use a delayed baseline so that performance year reporting aligns with measures with a standard baseline measurement period.

o   The MPT cap for LHDs is 20.

o   The MPT for hospitals with a state ratio greater than 10 and a valuation less than $15 million will not exceed 40.

·         In the Measure Bundle Protocol, HHSC made the following changes:

o   Allowed for grandfathering of P4P measures for LHDs.

o   Clarified that certain bundles, if selected together, would have lower point values because of duplicative required measures.

o   Added measure M1-305 Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment (SRA-CH) that was inadvertently left off of the initial draft Measure Bundle Protocol.

o   Added additional points for measures on the CMHC menu that are a state priority.

o   Made an additional measure required in the Hospital Safety bundle which results in an increase in point value.

·         In the Category C Specifications appendix to the MBP (Appendix A), HHSC will include the following items related to feedback received in response to the Measure Bundle Protocol:

o   Allowance for sampling methodology for reporting measures.

o   A High Performance Level for measures that are Improvement Over Self.

o   A 75th percentile for QISMC measures that are eligible to report a baseline numerator of 0.

October DY6 Reporting
  • The Sustainability Planning Template and Sustainability Template Reporting Companion are attached.