HHSC Region 15 Meeting Minutes-072512 (00092157-2)

REGION 15-REGIONAL HEALTHCARE PARTNERSHIP

Wednesday, July 24, 2013 1:00 p.m. El Paso First Health Plans, Inc. 1145 Westmoreland Drive El Paso, Texas 79925

PRESENT PRESENT James N. Valenti, President & CEO, Region 15 Anchor Bruce Parsons, City of El Paso Health Department Cathy Gibson, CCO, Lead Waiver Representative-UMC Maj. Mike Morton, Salvation Army Frances Hanson, Gjerset & Lorenz, (Conference Call) Rene Navarro, EHN David Palafox, El Paso First Health Plan Michael Romano, M.D., TTUHSC Frank Dominguez, CEO, El Paso First Health Plan Oscar Perez, TTUHSC, Project Manager Sarah Allen, UMC Outpatient Clinics Laura Caldelas, TTUHSC Gloria Vega, UMC Cecilia De Vargas, TTUHSC, Psychiatry Dept. Blas Meza, UMC Cynthia D. Horton, VNA Moses Priego, UMC Donna M. Cowen, VNA Lorrie Giessel, UMC Ana McBirnie, UTEP Nursing Student Leticia Flores, UMC Jesus Rios, UMC SUPPORT STAFF Lisa Clarke, UMC Betsy Castillo, Executive Assistant, CEO David Smead, UMC Maria Luisa Escobar, Recording Secretary 1. CALL TO ORDER & WELCOME Mr. Valenti called the meeting to order at 1:10 p.m.

2. APPROVAL OF THE MINUTES FROM THE JUNE 28, 2013 MEETING. Mr. Valenti noted that the minutes were on the website at www.epchd.org and invited any comments from the audience. The minutes were adopted as presented.

3. CONFIRMATION OF PARTICIPANTS – ROLL CALL Mr. Valenti asked those present to introduce themselves as a manner of taking roll call for the meeting.

4. PRFORMANCE LOGIC-DSRIP TRACKING PROGRAM Mr. Valenti noted that the training session for Performance Logic was held at UMC and Ms. Gibson requested feedback on information disseminated at the training, adding that there was good representation from all the entities that would be utilizing the tracking tool. She inquired if any of the attendees had begun to enter data into the system and it was noted that additional training might be required via WebEx. Ms. Sarah Allen noted that the staff was very helpful in answering questions and she has begun to enter information into the system. Mr. Perez noted that Texas Tech would be exporting their data as they currently have it in a separate format. Mr. Parsons commended the professionalism of the staff providing the training. Mr. Valenti inquired on the expectation of each of the project’s RI and would they enter data periodically and Ms. Gibson explained that UMC purchased the tool as the anchor for the region and the only expectation is that the entities use the tool. She recommended that they enter each projects data to the system along with the financial piece because it would be very helpful when separating the IGT’s. Mr. Valenti added that a status report is due at the end of August to HHSC and as such UMC RI’s will be required to enter their information into the system prior to August 15. Any questions are encouraged to be directed to the Performance Logic representatives for a private session.

Ms. Flores inquired if the data entered into the system was intended to be utilized for the August reporting or the October reporting and Ms. Gibson responded that the initial reporting would be manual with the state and they have already sent a spreadsheet for everyone to utilize.

Dr. Romano inquired if the state comes back in August in terms to arbitrate for the region, can they still utilize the project management they are focusing on and Ms. Gibson responded that they could utilize whatever format they chose.

5. INITIALLY APPROVED PROJECTS FOR AUGUST, 2013 REPORTING: TEMPLATES AND PREPARATION. Ms. Gibson distributed a template to the attendees provided for the initial reporting in August. She explained the various sections of the handout. She referred to the online HHSC website with the various instructions adding that

of 4 July 24, 2013 they will be requiring a small “book report” type status of the projects with accomplishments, challenges, etc. Project reporting must include documentation that the metrics are being met for payment to be disbursed.

Dr. Romano expressed some concern on expectations from HHSC that the DSRIP projects have a timeline of completion by the end of the year however some of their projects involve the recruitment of providers and they may need to push the project out to next year. Ms. Gibson noted that Ms. Hanson from Gjerset and Lorenz would be joining the meeting shortly to answer questions related to that. Mr. Perez offered to share a project management template document for general utilization and offered to do a workshop.

Ms. Gibson inquired of Ms. Hanson on the carry over period because at least one of the entries they will not be able to meet the deadline to provide the narrative. Ms. Hanson stated that this has not been discussed as to how they plan to achieve the matrix by the end of the next demonstration year. The August reporting will be of those projects that have been fully approved.

6. TABLE 6 AND 7 PROJECT APPROVALS: CURRENTLY IN PROCESS FOR APPROVAL BY OCTOBER. Ms. Gibson presented information on how HHSC is requiring that they identify the attachments submitted as an entity. The two meetings per month will have to be identified and submitted in chronological order. She presented information to meet the incentive payment requirements and the templates that have been provided. There are two reporting schedules for August and October. For August reporting it would be October 1, 2012 through July 31, 2013 and that is due August 31, 2013 and the second reporting period September 30 through October 30, 2013. Category I & II it is all or nothing and there are no partial milestones and Ms. Hanson explained that if you have multiple metrics and you meet one but not the second metric you could paid 50%. Dr. Romano inquired if that was a change in policy and Ms. Gibson responded that it was in the initial rules that there would be partial payment. Ms. Gibson added that once the templates are received in August they will be reviewed and if approved it will go on for payment in November 2013. If additional information is required the anchor will be notified after 30 days. In response to Dr. Romano’s question, Ms. Gibson explained that those items that have not yet been approved must be approved by October 2013 reporting and the review of those items is currently taking place but only those that have been approved will be reported in August.

7. UC AND DSRIP PAYMENT TIMELINES. Ms. Gibson provided an overview of the payment timelines as they appear in the presentation on the RHP website. Mr. Nuñez stated that for DY 2 UC the IGT will go out July 29, 2013 and the IGT agency will get their payment first between the week of August 5, 2013 and all other entities the week to ten days after that.

8. LEARNING COLLABORATIVE TOPIC FOR REGION 15-TEXAS TECH: ESTABLISHING A CHILD PSYCHIATRY FELLOWSHIP PROGRAM. Dr. De Vargas presented information on the initiative to establish a child psychiatry fellowship program. She stressed the importance of having providers within the community to decrease wait times. She added that they have been successful in the recruitment of one fellow for the program. She reiterated the need to increase clinic volumes and patient encounters. Some of the process improvements are documented by the clinicians for tracking as to the number of ideas discussed.

Dr. De Vargas explained that the various fellows will take different community agencies such as the Children's Hospital, EHN, Ysleta School District, EPPC where they have an inpatient unit and the El Paso Child Guidance Center where they recently applied for a grant.

They provide both inpatient and outpatient services such as assessments, crisis stabilization, and medication monitoring and management. Also, they provide psychotherapy and consultation and they will be tracking the number of encounters.

There are several goals of this program 1) increase the number of faculty members, 2) increase the non-faculty affiliation here in El Paso, 3) working to identify income sources, and increase the services to the community.

Dr. Romano explained that one of the challenges of that psychiatry program is that most of the departments look for support through grants and contacts. He noted that whereas departments such as pediatrics, family medicine, etc. there is what is called a Primary Care Exception established by Medicaid to pay for visits. It says that the teaching faculty does not necessarily need to be in the room continuously while the resident is providing service. The resident can do his/her work, come out and present to the faculty member or if over a certain level of experience, can supervise at the end of the day. If the resident can supervise up to four residents in a session that makes the economies more sensible. This does not exist in psychiatry and so in order to fill a Medicaid visit the faculty member has to be in for a substantial portion of the visit and the numbers become problematic to support the clinic volume. In

2 the medication services side when you look at therapy the situation is worse because these are for 45 minutes to an hour and you have to be directly supervising either in the room or through a two way mirror.

Ms. Horton inquired on the availability of these services to foster care children and it was noted that Texas Tech does not contract with these agencies.

9. COMPREHENSIVE LEARNING COLLABORATIVE FOR REGION 15: DIABETES Ms. Gibson noted that Diabetes was selected as learning collaborative for this month as it is prevalent and it is one of the community needs identified. She added that there is a Diabetes Symposium put on by the entire community that will be coming in October and RHP 13 has been invited.

Ms. Giessel explained that UMC has been working on this learning collaborative for over a year and the individuals involved in this are many different entities with Texas Tech coming on board two years ago by providing medical education to the physicians. This learning collaborative provides education to healthcare professionals on the Diabetes topic. Mr. Moses Priego, Manager of the Diabetes Management Program and Patient Education Department, also certified diabetes educator introduced the collaborative. He noted that when the collaborative first started there were 25 people/entities involved and now there are 300-400 people involved. It is a national symposium held in El Paso where physicians can take advantage of the educational credits without having to leave town. He encouraged everyone’s participation.

Ms. Giessel noted that she was working with various agencies to educate them so that they can in turn utilize the information to address patient outcomes of the various community locations. Ms. Gibson stressed the need to document this as well as the patient outcomes due to the education provided.

Mr. Valenti inquired as to how this project would evolve in the eyes of CMS as learning collaborative because their definition would involve more action and not just learning. It was discussed that a committee needs to be formed that will track the concentrated efforts and outcomes of the education disseminated community wide that is tied to the Waiver. A recommendation was made to go before the committee that plans the symposium to appeal to them on adding Region 15 as a sponsor of the initiative or something similar.

Ms. Giessel shared that for nursing they have to prove that participants in the program three to six months later have applied their new knowledge or practice over work environment and through a survey they can quantify the outcomes. There was additional discussion on the development of a method to fulfill the requests by CMS. Ms. Hanson recommended that Region 15 sponsor a “Lunch and Learn” and invite the other agencies to share their outcomes.

Ms. Horton added that they need to involve the other hospitals and could be increased to a larger scope whereas the RHP could increase communication and infra structure to facilitate programs such as this. There is a fragmented system and there are numbers documenting the improvements from 10 years ago. If the regional collaborative works together they could increase the numbers fivefold.

10. ROUNDTABLE DISCUSSION Ms. Gibson stated that she has requested clarification as to what would be required to get a number of projects approved that are pending. She is hopeful that this meeting could be one to serve the purpose of justifying the requirements of two meetings per month.

Providers in attendance shared ideas and challenges and timelines of their projects with other members of the RHP in focused breakout sessions.

Mr. Parsons stated that part of the struggle at this time is a clear definition of collaboration as what one person might foresee coordination amongst those present, other people may not see this as that. It would be good to develop partnerships and assemble activities around the definition of collaboration. He added that collaboration is new formations that come from partners that are offering something of value on a particular subject.

Mr. Valenti offered that they need to include the Paso del Norte Foundation as they are very involved in the community’s health. He requested that Ms. Giessel and Mr. Priego get with Dr. Fancher to work on this to take this towards a fulfillment of a collaborative.

Ms. Allen noted that most collaboratives have a team of people that is responsible for gathering data from all the participants and tracking with feedback as to where everyone is at. She inquired whether CMS provided the infrastructure to do all that in the building of collaboratives and follow the set process expected by CMS. Page 3 of 4 July 24, 2013 Mr. Valenti also recommended that they interface with Ms. Myrna Deckert from the Paso del Norte Foundation.

Mr. Smead and Maj. Morton shared with the attendees positive results they are beginning to see as a result of the DSRIP projects that are underway with between their agencies. He added VNA representatives are offering seniors in the community around the Salvation Army the advantage of the healthcare provided at the shelter versus having to go from their homes to access care.

A monthly agenda items will be placed on the update of the collaborative and progress made to document results.

11. NEXT MEETING DATE- RHP Region 15 will meet on August 28, 2013 at 2:00 p.m.

12. ADJOURNMENT Mr. Valenti adjourned the meeting at 2:45 p.m.

______Mr. James N. Valenti, Region 15 Waiver Anchor