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)

November 2017: Regional Community Needs Assessment due.  
Tuesday, December 5, 2017: RHP 9 Rapid Cycle Improvement Cohort.  Register at https://rhp9rapidcycleimprovement.eventbrite.com
Wednesday, October 4, 2017: HHSC October DY6 webinar 


Making a Difference

October DY6 Reporting
  • Reminder, October DY6 Reporting Webinar.  Will update Outlook invite once details received from HHSC.
  • Will send separate email with October DY6 reporting templates/documents. 
  • Deadlines to submit October reporting questions to the HHSC box are October 20th for Cat 3 and October 25th for Cat 1, 2, and 4 issues.  
Compliance Monitoring
  • Category 1 and 2 Round 2 MSLC review:  With the exception of one provider, all providers should have either preliminary or final notifications about recoupment last Friday. HHSC is making sure all other providers received notification from HHSC about results of HHSC review.
  • Category 1 and 2 Round 3 MSLC review. HHSC did the initial review of MSLC results from Round 3. Some providers will start receiving HHSC communication starting this week. For some projects where results were Not-Validated or Metric-Not-Achieved HHSC requested additional work from MSLC. Providers should respond to MSLC for questions about these projects.
  • HHSC is finalizing Category 3 Recoupments for MSLC Round 2 reviews.
  • Next Round of Reviews: MSLC is getting ready for the next round of Categories 1 and 2, and Category 3 reviews. Providers should expect to receive MSLC communication in early October, however, they will not need to provide data and respond to questions until November, since October is a reporting month. Providers impacted by Hurricane Harvey, if selected for the next round of reviews, could request a delay in the review. MSLC will provide additional information in the communication to providers.
Category C
  • Updated DRAFT Category C Measure Specifications are attached. HHSC will post a survey next week and have additional instructions for feedback and questions at that time. The specifications are posted in four word documents. Please note the "Introduction" section includes detailed instructions on payer-type reporting and sampling. HHSC has also included an updated excel version of the specifications.
  • This draft does include some limited changes to the measures due to lack of specifications availability or clinical support. In places where these changes impacted bundle point values, HHSC has included some replacement measures, and will send an updated Category C section of the draft Measure Bundle Protocol.
  • HHSC is particularly interested in feedback on measure settings, the draft instructions for determining payer-type, sampling methodology, and currently included DSRIP specific modifications to measures.
  • HHSC has received feedback on settings for measures in the palliative care bundle and are currently reviewing the clinical appropriateness of expanding the settings beyond what has been included by the measure steward.
  • Removed Measures – see Anchor Notes for specifics
    • A2-104, M1-104:  Medical Assistance with Smoking and Tobacco Use Cessation
    • H3-197:  Use of Opioids at High Dosage
    • A2-206:  Cholesterol Management for Patients with Cardiovascular Conditions
    • A1-208, A2-208, M1-208:  Comprehensive Diabetes Care LDL-C Screening
    • B2-246:  Reduce ED Visits for Selected Condition or Conditions
    • D4-249:  Pediatric/Young Adult Asthma ED Visits
    • B2-250:  Reduce Low Acuity ED Visits
    • B2-251:  ED Visits where Patients Left Without Being Seen
    • C2-274:  Mammography Follow-up Rate
    • C2-275:  Abnormal Pap Test Follow-up Rate
    • H2-316, M1-316: Alcohol Screening and Follow-up for Patients with SMI
    • K1-358:  Health Literacy Measure derived from the Health Literacy Domain of the C-CAT
    • E1-378:  Appropriate Prophylactic Antibiotic Received within 1 Hour prior to Surgical Incision – Cesarean Section
  • Added Measures  - see Anchor Notes for specifics
    • A2-105:  Preventative Care & Screening:  Tobacco Use:  Screening & Cessation Intervention
    • B2-387:  Reduce ED Visits for BHSA (2 rates)
    • M1-390:  Time to Initial Evaluation:  Mean Day to Evaluation
    • B2-392:  Reduce ED Visits for Acute ACSC
    •  B2-393:  Reduce ED Visits for Dental Conditions
    • D1-400:  Tobacco Use & Help with Quitting Among Adolescents (Identified by HHSC to increase points available to children’s hospitals and is a companion to the adult version already in the Adult primary care bundle.)
    • M1-400:  Tobacco Use & Help with Quitting Among Adolescents (Added as a companion to the adult version already in the CMHC measure set.)
    • I1-400:  Tobacco Use & Help with Quitting Among Adolescents (Added as a companion to the adult version already in the LHD measure set.)
    • H3-401:  Opioid Therapy Follow-up Evaluation
    • H3-402:  Documentation of Signed Opioid Treatment Agreement
    • H3-403:  Evaluation or Interview for Risk of Opioid Misuse
    • A2-404:  Statin Therapy for the Prevention & Treatment of Cardiovascular Disease
    • H2-405:  Bipolar Disorder & Major Depression:  Appraisal for Alcohol or Chemical Substance Use
    • M1-405:  Bipolar Disorder & Major Depression:  Appraisal for Alcohol or Chemical Substance Use
    • A2-407:  Functional Status Assessments for CHF
Waiver Negotiations Update
  • Communications are still ongoing with CMS and updates will be provided as they are available, including timelines.
  • HHSC’s original timeline for RHP Plan Updates assumed that CMS would approve the proposed DSRIP protocols by September 30, 2017.
  • Because CMS has not yet approved the protocols, anchors and providers will need additional time to analyze data and select measure bundles and measures once the protocols and measure specifications are approved.
  • HHSC will adjust the due date for RHP Plan Updates to allow rolling submission of the plans, so that RHPs submit their RHP Plan Updates no later than April 30, 2018. Delaying plan submission beyond January 31, 2018, will mean that providers will not be able to report their Category C baselines or Category D Statewide Reporting Bundles in April 2018. However, providers will still receive the planned 20% payment for the plan update in July 2018 along with any DY6 carryforward reported and approved in April.  As a region we will need to decide if we want to submit our plans by January 31, 2018 or delay until April 2018.  Providers cannot submit individually.  Delaying beyond January 31, 2018 will push back reporting of Cat C baselines. 
  • Note that the standard Category C baseline measurement period will remain calendar year (CY) 2017, but if the RHP submits plan after January 31, 2018, baselines could not be reported in April because HHSC needs time after plan submission to review selection of measure bundles and measures, request additional information from providers if necessary, finalize milestone allocations, and develop Category C reporting templates that pull in the approved measures for each provider. The 20% payment for plan submission is slightly more than has been paid historically during the July payment cycle.
  • With delayed submission of RHP Plan Updates by April 30, 2018, HHSC approval of plans would occur no later than June 30, 2018. This means that providers would have only 6 months remaining in calendar year 2018 after plan approval. Because CY18 is the measurement period for Category C Performance Year (PY) 1, and providers could have only 6 months after plan approval to implement activities for improvement over CY17 baselines, HHSC will discuss with CMS the possibility of adjusting PY1 goals accordingly.
Hurricane Response
  • Applies to RHPs 2, 3, 4, 7, and 17 in the FEMA designated disaster counties.
  • See attached Anchor Notes for reporting flexibility details due to Hurricane Harvey for the affected RHPs as well as the approval letter from CMS.