Consumer Perspective on Hospital Transformation Program (HTP) November 27,2018 CHASE Board
HTP • New way to distribute provider fee dollars. • Must seek federal authority through an 1115 waiver. • HQIP remains in place ($97.6 M). • Will put all other non-eligibility related payments (except for DSH) at risk. • No payment through provider fee if don’t participate. • Statute says must start program “no earlier than” October 1, 2019. (SB17-267) 2 www.cclponline.org
HTP Payments 3 www.cclponline.org
DSRIP (HTP) Goals • Moving states to new care delivery and payment models • Pay for performance – moving to value based payment. • Broad population and care coordination goals. • Generally paired with managed care. • Uncertain how payment will work. 4 www.cclponline.org
Questions • What is different about this new program? • How does it fit with other initiatives? • What do we expect to achieve? • How does payment work? • What is the incentive for broader participation? • Where is the accountability for performance? 5 www.cclponline.org
Coordination- Other Initiatives – HQIP- how will this be coordinated so there are not duplicate payments? – ACC/RAEs – no hospital payment in ACC but RAEs and hospitals encouraged to work together to benefit both. – Are metrics sufficient to ensure that we know what changes are influencing quality/performance? – SIM- where is this headed? Global payment? – Community benefit obligations – how do 6 www.cclponline.org investments tie in with HTP?
Coordination 7 www.cclponline.org
Incentives • Provider fee $ earned through performance (no new money). • Program success based, in part, on community support, participation, investment. – Who makes up front investment(s)? – Who realizes benefits of investments? • RAEs? • Hospitals? • Other? 8 www.cclponline.org
Oversight/Participation • 1115 Waiver – Public comment process • HQIP sub-committee – Hospitals, CHA and HCPF. Develop and oversee performance metrics and payment. • HTP – Rural/urban hospital subcommittees in place – metrics and overall plan. – Requirement of community consultation/engagement in planning phase and development of action plan. Specific requirement to engage RAEs. • ACC- – PIAC – state and regional and MIAC. 9 www.cclponline.org
Going Forward • Role of the Board: – How will oversight work going forward? – Who will be engaged in subcommittee work? – Development of metrics and payment methodology? – Coordination with other efforts- how will payment transformation be integrated? – Community/consumer participation – particularly important given community based nature of project. 10 www.cclponline.org
Contact information Elisabeth Arenales, Esq. Health Care Program Director Colorado Center on Law and Policy earenales@cclponline.org; (303) 573-5669 x 302 11 www.cclponline.org
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