HOSPITAL MEETING Friday, November 3, 2017 9:00 AM – 12:00 PM Location: The Department of Health Care Policy & Financing, 303 East 17 th Avenue, Denver, CO 80203. 11 th Floor Rooms A&B. Conference Line: 1-877-820-7831 Passcode: 294442# For more information contact: Elizabeth Quaife at elizabeth.quaife@state.co.us 1
Overview of Meetings • General Hospital Meeting 9:00-10:00 • Break 10 min. • General Hospital Meeting cont’d 10:10-12:00 • Lunch Break 12:00-1:00 • Specialty Hospital Meeting 1:00-2:00 • EAPG Engagement Meeting 2:00-4:00 2
3 Colorado Department of Health Care Policy and Financing
GROUND RULES FOR WEBINAR • WE WILL BE RECORDING THIS WEBINAR • PLEASE MUTE YOUR LINE UNLESS SPEAKING • Please speak clearly when asking a question and give your name and hospital • We are going to try to avoid muting the phone lines to encourage conversation, so please don’t: • Put us on hold • Drive in your car w/window open while listening • Sit in a noisy location • Be cautious of side conversations and language (we can hear you and it is being recording) 4
Welcome & Introductions • Thank you for participating today! • We are counting on your participation to make these meetings successful 5
Dates for Future Hospital Engagement Meetings in 2017 The agenda for upcoming meetings will be • 3/3/2017 available on our external website in advance of each meeting. https://www.colorado.gov/hcpf/inpatient- • 5/5/2017 hospital-payment Registration links for each session during the day • 7/7/2017 will also be available prior to the meeting. Just click on the links to register for each session • and you will receive the link to connect to the 9/1/2017 webinar. • Meetings will now begin at 9am starting with 11/3/2017 11/3/2017 meeting 6
Future Hospital Engagement Meetings in 2018 Engagement Meeting Dates for 2018 01/12/2018 07/13/2018 03/02/2018 09/07/2018 05/04/2018 11/02/2018 • Meetings are from 9:00am-12:00pm • Please Note: Starting January 12, 2018, Engagement Meetings will be moved to 303 East 17 th Avenue, Denver Conference Room 7B & 7C 7
Colorado Hospital Transformation Program Matt Haynes Special Finance Projects Manager 8
Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 9
Our Vision The Coloradans we serve will have integrated health care and enjoy physical, mental and social well-being. 10
Today’s Meeting • Building on Enterprise Legislation Hospital Transformation Program (HTP) Overview • HTP Timeline • Community and Health Neighborhood Engagement • • Discussion and Questions Next Steps • 4
On the Road to Better Health How the Department of Health Care Policy and Financing is Driving Improved Health Care Delivery and Payment Systems in Colorado 1 H Taxpayers Clients Specialists FQHCs L TSS RAEs PCPs 2 3 WHY? Because almost one of four WHO? HCPF Coloradans is covered by Health First partners with Colorado, HCPF has the ability to key stakeholders. move the market. Quadruple Aim • Lowered Costs Payment Reform Models • Improved Quality • Improved Health 1 2 3 4 Desired Outcome • Provider Satisfaction 5 4 DESTINATION? HOW? HCPF works with stakeholders System Transformation. to build a value-based system.
Who Gets Payments for Services 13 6 FY15-16 data
Building on Enterprise Legislation • The Enterprise legislation approval – moving toward value. Legislation calls for an implementation date of October 1, • 2019 for an 1115 waiver focusing on adding value into our delivery system. • The Hospital Transformation Program (HTP) will be phased in to provide adequate time for us to work in partnership. 7
SB 17-267 - Enterprise • Establishes the Provider Fee program as a state enterprise • Directive to pursue Delivery System Reform Incentive Payments • Planning Phase • Goals • Focus Areas 15
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. • 9
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. 17
HTP Priorities The HTP envisions transforming care across the following six priority areas: Care Coordination and Care Transitions • Complex Care Management for Targeted Populations • • Behavioral Health and SUD Coordination Perinatal Care and Improved Birth Outcomes • Recognizing & Addressing Social Determinants • • Reduce Total Cost of Care 11
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 12
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. 13
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. • 14
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. 15
Community and Health Neighborhood Engagement 11/3/2017 23
Questions and Discussion 24
Contact Information Matt Haynes Special Finance Projects Manager Matt.Haynes@state.co.us 25
Claim Escalation Process What Rates is receiving during escalations: Can you look at Claim number XXXXXXXXX. Can you help me with EAPGs The information is vague and we are having to do a full analysis with the claim or go back and forth with Provider to get more information on what is going on. This is taking up Analyst’s and Provider’s time unnecessarily. Impacting other tasks such as coordinating Mass Adjustments or writing of Transmittals. Questions on claims or system should go through DXC first prior to escalation with few exceptions. DXC Provider Services Call Center: 1-844-235-2387 26
Claim Escalation Process (cont) Escalate Claims if: 1. Contacted DXC and received conflicting information from either DXC rep to DXC rep or State and DXC rep, obtain CTNs (call tracking number) 2. Contacted DXC and unable to resolve issue, obtain CTN (call tracking number) 3. Department has asked for specific case examples. Can bypass DXC and contact representative specified for topic 4. Issue previously escalated to Department and not resolved • Example: Part of Mass Adjustment Test. Test went through and another denial has occurred and reporting back to Department results of Mass Adjustment. 5. Topics generally outside of Rates Department (if received, typically forwarded to correct Department) • Timely Filing • Enrollment • Portal issues Transportation • **Note: If escalated to Rates Department, issue may be forwarded to a different department to obtain resolution if outside of Rates’ knowledge. Example: Issues with the Portal will be forwarded to Systems** 27
Provider Checklist for Escalation: When escalating a claim make sure to: 1. Check Known Issues Page 2. Confirm that no one else in Provider Hospital is escalating the same claim/question 3. Provide CTN (Call Tracking Number) from DXC 4. Provide advice received from DXC 5. Provide ICN /Claim number 6. Provide explanation for the escalation • Claim under/over paid • Claim denied. What was the denial reason? • Responding to a previous issue 7. Provider’s calculation of the claim, what was paid vs what should have been paid. OR Denial codes received OR Steps taken to resolve previously escalated claim with new denial code(s)/reason(s) for re-escalation 28
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