HOSPITAL ENGAGEMENT MEETING Friday, July 13, 2018 9:00 AM – 10:30 AM Location: The Department of Health Care Policy & Financing, 303 East 17 th Avenue, Denver, CO 80203. 7 th Floor Rooms B&C. Conference Line: 1-877-820-7831 Passcode: 294442# For more information contact: Elizabeth Quaife at elizabeth.quaife@state.co.us 1
Overview of Today’s Meetings • General Hospital Meeting 9:00-10:30 • Break 10:30-11:00 • EAPG Engagement Meeting 11:00-12:30 **Special Note: The webinar room will change for the EAPG meeting. The link to EAPG Webinar room is shared under ‘Shared Links’ on the right side of this webinar room. Please log in during the break if you wish to stay for the EAPG portion of the day. 2
End of the Meeting • Recording and Audio will stop at the end of the meeting. • The Webinar room will remain open for participants wishing to attend the EAPG Meeting can select the shared link • The Webinar room will close at 10:50am. 3
HOSPITAL ENGAGEMENT MEETING TOPICS 7/13/2018 9am-10:30am - Specialty Hospital Update - Items Pending Additional Research/Action - Hospital Transformation Project Update - Impacts of Submitting Medicare as Other Insurance - Observation 24-48 hours prior to Inpatient Stay - FY 2018-19 Hospital Base Rates Update - Mass Adjustment Updates (INPATIENT ONLY) - Inpatient Future Plans/Goals 4 Colorado Department of Health Care Policy and Financing
GROUND RULES FOR WEBINAR • WE WILL BE RECORDING THIS WEBINAR • ALL LINES ARE MUTED. PRESS *6 IF YOU WISH TO UNMUTE. PARTICIPANTS CAN ALSO UTILIZE THE WEBINAR CHAT WINDOW • Please speak clearly when asking a question and give your name and hospital If background noise and/or inappropriate language occurs all • lines will be hard muted. Thank you for your cooperation 5
Welcome & Introductions Thank you for participating today! • We are counting on your participation to • make these meetings successful 6
Dates for Future Hospital Engagement Meetings in 2018 1/12/2018 • 3/2/2018 • The agenda for upcoming meetings will be available on our 5/4/2018 • external website in advance of each meeting. https://www.colorado.gov/pacifi 7/13/2018 • c/hcpf/hospital-engagement- meetings 9/7/2018 • 11/2/2018 • 7
EAPG Monthly Meetings 2018 Meetings, Conference Room 7B, 11:00am-12:30pm 07/13/2018 09/07/2018 11/2/2018 8
Agenda Items If you wish to request a topic for our next meeting. Please submit the request by the week prior to the meeting to ensure enough time is allowed to gather correct personnel and information on the topic. If a topic is submitted the week of the meeting, we cannot guarantee enough research will be completed to present at the meeting. However it will be carried over to the following meeting and any actionable items will be followed up with the Provider as soon as possible. Send all requests to Elizabeth Quaife at elizabeth.quaife@state.co.us The Meeting Agenda is posted on Monday the week of the meeting to our Hospital Engagement Meeting Website. 9
Specialty Hospital Meetings Meetings for the Budget Neutral Per Diems have concluded and any additional status updates for implementation will be provided through email . The Department wishes to pick up meetings by the end of the year to begin discussing future components of Specialty Per Diems such as quality measures, rebasing per diems and adding a severity of illness component. These meetings will be announced in advanced via Hospital Engagement Meeting, Provider Bulletin, Hospital Engagement Meeting Website AND Email. 10
Specialty Hospital Per Diem CLASSIFICATION T1 Days Tier 1 Rate T2 Days Tier 2 Rate T3 Days Tier 3 Rate T4 Days Tier 4 Rate LTAC 1-21 $2,125.50 22-35 $2,019.22 56 $1,918.26 >56 $1,822.35 REHAB 1-6 $985.71 7-10 $936.42 11-14 $936.42 >14 $845.12 SPINE 1-28 $2,807.61 29-49 $2,667.23 50-77 $2,533.87 >77 $2,407.17 FINAL RATE CLASSIFICATION T1 Days Tier 1 Rate T2 Days Tier 2 Rate T3 Days Tier 3 Rate T4 Days Tier 4 Rate LTAC 1-21 $2,176.81 22-35 $2,067.97 36-56 $1,964.57 >56 $1,866.34 REHAB 1-6 $1,009.50 7-10 $959.03 11-14 $911.08 >14 $865.52 SPINE 1-28 $2,875.38 29-49 $2,731.61 50-77 $2,595.03 >77 $2,465.28 ***Final Draft: Awaiting Department Approval 11
Pending Additional Research and/or Actions The following items have been discussed at previous meetings and are pending while additional research and/or processes are being completed. • System Request for 12X Crossover and Medicare Part A Exhaust Pending with DXC • System Request for IPP-LARC Carveout Pending with DXC • Removing Baby from Mom’s Claim 12
Colorado Hospital Transformation Program Matt Haynes Special Finance Projects Manager 13
Today’s Meeting • Hospital Transformation Program (HTP) Update HTP Timeline • Community and Health Neighborhood Engagement • Discussion and Questions • 4
Hospital Transformation Program (HTP) Overview • The Hospital Transformation Program (HTP) is a critical step toward adding value into the system over time. Delivery system transformation continues to be a central • goal of HCPF. • Tied to the existing supplemental payments Focus on Community Engagement. • 7
HTP Goals • Improve patient outcomes through care redesign and integration of care across settings; • Improve the patient experience in the delivery system by ensuring appropriate care in appropriate settings; • Lower Health First Colorado (Colorado’s Medicaid Program) costs through reductions in avoidable hospital utilization and increased effectiveness and efficiency in care delivery; • Accelerate hospitals’ organizational, operational, and systems readiness for value-based payment; and • Increase collaboration between hospitals and other providers. 16
HTP Focus Populations & Priorities The HTP envisions transforming care across the following populations and priority areas: High Utilizers • Vulnerable Populations (including pregnant women and • the elderly) Behavioral Health and SUD Coordination • • Clinical and Operational Efficiencies Community Development Efforts to Address Population • Health and Total Cost of Care 9
HTP Hospital Role Colorado’s hospitals have a critical role to play in the HTP, and will be asked to: Engage with community partners • Recognize and address the social determinants of health • • Prevent avoidable hospital utilization • Ensure access to appropriate care and treatment Improve patient outcomes • Ultimately reduce costs and contribute to reductions in total cost • of care 10
HTP Framework 19
HTP Framework (cont’d) 20
HTP Framework (cont’d) 21
HTP Framework (cont’d) 22
HTP Framework (cont’d) 23
HTP Timeline August, 2017 – October, 2018 – Planning period • The Department will host a series of workgroup meetings with urban and rural providers to finalize the HTP. The Department will be engaged with providers and • organizations throughout the spectrum of the delivery system for input and feedback that will inform program development This period will also include time for hospitals to develop • processes for engaging with their communities. We will also be drafting the waiver during this period. • 16
HTP Timeline October, 2018 – October, 2019 – Ramp-up period This pre-waiver period will serve as a ramp-up in alignment • with the provider fee year to establish critical relationships and identify HTP initiatives. • Hospitals will begin an in-depth community engagement process to further determine the needs of the community and the roles hospitals can play to support those needs. • Hospitals will begin developing project ideas for the program application Waiver negotiations with CMS will occur. • 17
HTP Timeline October 1, 2019 – HTP implementation As the Enterprise legislation outlines, we will be moving • forward with an 1115 Waiver with an implementation date beginning October 1, 2019. 18
Community and Health Neighborhood Engagement Hospitals must engage stakeholders in their HTP planning • • Engagement should be: • Meaningful • Evidence-based and data- driven Inclusive • Not duplicative • 27
Community and Health Neighborhood Engagement: Stakeholders • Stakeholders can assist planning efforts by providing: Data and expertise about the community the hospital serves • Information about and connections to available community • resources • Ideas and support for HTP initiatives Stakeholders include: • RAEs FQHCs • • LPHAs Health Neighborhood • • providers Health Alliances • Health First advocates • 28
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