TEXAS HEALTH AND HUMAN SERVICES COMMISSION



TEXAS HEALTH AND HUMAN SERVICES COMMISSIONValue-Based Payment and Quality ImprovementAdvisory CommitteeDRAFT Meeting MinutesTuesday, May 8, 201810:00 a.m.Brown-Heatly Building Public Hearing Room 4900 North Lamar Boulevard Austin, Texas 78751Table SEQ Table \* ARABIC 1: Value-Based Payment and Quality Improvement Advisory Committee member attendance at the Tuesday, May 8, 2018 meeting.MEMBER NAMEYESNOMEMBER NAMEYESNOBerkowitz, Steven M., MDXMcNabb, Benjamin, Pharm. D.XBose, Sarojini, MDXPeterson, Mary Dale, MDXFullerton, Cliff, MDPSowell, VincentPGanduglia Cazaban, Cecilia, MD, PhDXStanley, Michael, MDXGarrett, Adam M.XTaylor Calhoun, RoseXHaney-Urrea, AngiePIsaac, Daverick (Ex-Officio)XHardy-Decuir, Beverly, DNPXKirsch, Lisa C. (Ex-Officio)XKeller, Andy, PhDPRamon, Joseph, III, R. Ph. (Ex-Officio)XLee, KathyPYes: Indicates attended the meeting. No: Indicates did not attend the meeting. P: Indicates member participated by phone. Welcome and IntroductionsThe Value-Based Payment and Quality Improvement (VBPQI) Advisory Committee meeting convened at 10:03 a.m., with Dr. Mary Dale Peterson, Vice-Chair, welcoming participants to the meeting. Table 1 notes committee member attendance at the meeting; it was noted a quorum was present. Mr. Jimmy Blanton, Director, Health Quality Institute, HHSC, announced the appointments of four new members to the VBPQI.Voting members: Benjamin McNabb, Pharm. D., Eastland; and, Michael Stanley, M.D., Dallas.Ex-Officio members: Daverick Isaac, Austin; and, Joseph Ramon III, R.Ph., McAllen. Agenda Item 2: Review and approval of minutes from February 16, 2018Dr. Peterson referred members to the minutes from the February 16, 2018, meeting.Motion: Dr. Cliff Fullerton moved to accept the minutes. Dr. Sarojini Bose seconded the motion. The minutes were unanimously approved by roll call vote with no nays nor abstentions.Agenda Item 3: Bylaws statusMr. Blanton advised HHSC is standardizing all advisory councils’ bylaws around best practices, noting the VBPQI Advisory Council’s bylaws will have a few changes made in the areas members’ terms and responsibilities, and staff roles. Mr. Blanton noted members will receive the revised bylaws to review prior to scheduling a vote to adopt at the next meeting.Agenda Item 4: Quality and program improvement staff update 1115 Transformation Waiver. Mr. John Scott, Interim Director, Healthcare Transformation Waiver, Medicaid and CHIP Services, HHSC, provided members an update on the 1115 Transformation Waiver. Highlights of the presentation included:Waiver Renewal -- Delivery System Reform Incentive Payment (DSRIP);DSRIP DY7-8 Structure;Regional Healthcare Partnership (RHP) Plan Updates for DY7-8;RHP Plan Updates for DY9-10; and,DSRIP Transition Plan.Study of value-based models for pharmacy. Ms. Stacey Johnston, Program Manager, Pharmacy Program and Project Management, Vendor Drug Division, Medicaid and CHIP Services, HHSC, delivered a presentation on the HHSC contract with the University of Massachusetts (UMASS) to conduct a review of value-based purchasing models for pharmacy. Ms. Johnston advised HHSC anticipates the UMASS report will identify opportunities Managed Care Organizations (MCOs) may consider for implementation, and provide information on impacts to members. Ms. Johnston noted the study will be completed by June 2018.CMS Innovator Accelerator Program, Home and Community-Based Services track. Ms. Kate Layman, Long-Term Services and Supports (LTSS) Policy Lead, Medicaid and CHIP Services, HHSC, reported that Texas was selected by the Centers for Medicare and Medicaid Services (CMS) as an “Innovation Accelerator Program for VBP for Home and Community-based Services (HCBS)” track. Ms. Layman noted the program is intended to address the key elements of designing VBP initiatives for HCBS, including: stakeholder engagement; measures selection; identifying accountable entities; data analytics; and, the development of alternative payment models relevant to HCBS populations. Ms. Layman advised the project duration runs from April 2018 through February 2019. Managed Care Organization alternative payment models. Mr. Matt Ferrara, Director, Quality Oversight, Quality and Program Improvement, Medicaid and CHIP Services, HHSC, provided members an update on the MCO alternative payment models. Highlights of the presentation included:Key HHS value based purchasing programs;VBP Targets and other efforts to support VBP FY2018 MCO contracts;MCO progress; and, Key issues going forward.Agenda Item 5: Legislative update on interim hearings related to improving quality and efficiency in publicly funded health programsMs. Lisa Kirsch provided an update on the legislative interim committees’ hearings related to the work of the VBPQI Advisory Committee. Ms. Kirsch reported there had been multiple hearings on managed care contract oversight and HHSC monitoring of MCOs, adding there had been related hearings on opioids and behavioral health. Ms. Kirsch advised that 92 percent of Medicaid clients are being served in managed care plans, and costs continue to be a major focus for the legislative leadership.Agenda Item 6: Draft recommendation options for the 2018 legislative reportMr. Blanton referred to the Power Point slide, “2018 Milestones Legislative Report Timeline,” and reviewed for members the tasks remaining in order to issue the report in early September 2018. Mr. Blanton noted a key task was the members’ discussion and vote today on the draft recommendations, and the Power Point slide, “2018 Legislative Report Recommendation Options: Questions to Consider.” Dr. Peterson advised members that each recommendation would be handled individually, with a short overview and discussion, followed by a vote to adopt.Dr. Cecilia Ganduglia Cazaban presented Recommendation 1 and 2, followed by members’ discussion and suggested revisions to each recommendation. Recommendation 1:The Legislature should direct HHS to develop a comprehensive initiative to leverage enhanced federal matching funds to improve the integration and usability of HHS system data sources, including by building capacity to incorporate clinical and other data available through electronic health records (EHR) systems.Recommendation 2:HHSC should work with stakeholders to better leverage the Texas Healthcare Learning Collaborative portal (and other tools as appropriate) to increase data available to health plans and providers for core metrics, analytics, and care coordination to support value-based purchasing and quality improvement.Motion:Dr. Peterson moved to adopt by acclamation Recommendations 1 and 2 with noted revisions. Motion carried by unanimous acclamation of members present and through roll call of members participating by phone.Ms. Kirsch presented Recommendation 3; members offered no comments following the draft presentation.Recommendation 3:HHSC should develop guidance for MCOs and providers on how to leverage the Quality Improvement cost strategy available in managed care to provide patient navigation services to patients with high needs and utilization patterns.Dr. Peterson requested a motion to adopt Recommendation 3 as presented.Motion: Dr. Michael Stanley moved to adopt Recommendation 3. Ms. Rose Taylor Calhoun seconded the motion. Motion carried by unanimous acclamation of members present and through roll call of members participating via phone. Ms. Kirsch presented Recommendation 4, followed by members’ discussion of suggested revisions, including the drafting of a separate recommendation regarding inter-conception care and uninsured women of child-bearing age.Recommendation 4:HHSC should work with stakeholders to develop a maternity/newborn episode of care payment bundle (and/or other maternity/newborn VBP approaches) to present to Texas leadership for endorsement.Dr. Peterson requested a motion to adopt Recommendation 4 with noted revisions.Motion: Ms. Taylor Calhoun moved to adopt Recommendation 4 with noted revisions. Dr. Stanley seconded the motion. Motion carried by unanimous acclamation of members present and through roll call of members participating phone.Action Item:Ms. Kirsch will draft a recommendation regarding inter-conception care and uninsured women of child-bearing age.Ms. Kirsch presented Recommendation 5, followed by members’ discussion of suggested revisions.Recommendation 5:HHSC should develop value-based purchasing strategies to sustain strong behavioral health-related DSRIP work such as integrated behavioral health/primary care. The current development of Certified Community Behavioral Health Clinics (CCBHC) could be included as a sustainability strategy.Dr. Peterson requested a motion to adopt Recommendation 5 with noted revisions.Motion: Dr. Ganduglia Cazaban moved to adopt Recommendation 5 with noted revisions. Ms. Taylor Calhoun seconded the motion. Motion carried by unanimous acclamation of members present and through roll call of members participating phone.Ms. Kirsch presented Recommendation 6, followed by members’ discussion of suggested revisions.Recommendation 6: HHSC should develop VBP models for opioid treatment, including to increase access to medication-assisted treatment (MAT) through a bundled rate, to present to State leadership.Public Comment:Ms. Audra Conwell, Chief Executive Officer, Alliance of Independent Pharmacists, addressed the Committee regarding the role of pharmacy as related to opioid and substance abuse treatment, and expressed support for the revised recommendation.Dr. Peterson requested a motion to adopt Recommendation 6 with noted revisions.Motion:Dr. Stanley moved to adopt Recommendation 6 with noted revisions. Dr. Ganduglia Cazaban seconded the motion. Motion carried by unanimous acclamation of members present and through roll call of members participating phone.Ms. Kirsch presented Recommendation 6, followed by members’ discussion.Recommendation 7: HHSC should clarify that MCO APMs with providers may include models that reduce administrative burden for high-performing providers as a non-financial incentive. This may require changes to the Uniform Managed Care Contract (UMCC) and/or Uniform Managed Care Manual (UMCM), including the Value Based Contracting Data Collection Tool.Dr. Peterson requested a motion to adopt Recommendation 7.Motion: Ms. Taylor Calhoun moved to adopt Recommendation 7. Dr. Stanley seconded the motion. Motion carried by unanimous acclamation of members present and through roll call of members participating phone.Agenda Item 7: Next steps for legislative reportMr. Blanton referred to the Power Point slides, “Next steps for the legislative report” and “2018 Legislative Report Toolkit,” explained that staff will work with VBPQI Advisory Committee members regarding development of narratives to support the approved recommendations, including background information with relevant performance data. Mr. Blanton advised the next draft will be circulated in July for members to review and comment, with the final draft posted online by late July for the public to review and provide comment on at the VBPQI Advisory Committee meeting on August 7, 2018. Mr. Blanton noted the final report is targeted to begin the HHSC internal review process at the beginning of September.Action Item:Mr. Blanton and Ms. Kirsch will reach out for stories on current value-based programs with specific results. Agenda Item 8: Future direction for improving quality and efficiencyMr. Blanton discussed with members possible future topics the Committee may consider developing as a specific project and/or to prepare priorities for the next round of legislative reports, including:Quality plan and dashboard.Reporting of data and information.Administrative simplification.Continuing education possibilities.Possible quality improvement focus areas.Members discussed the five topical areas, with the most interest focused on administrative simplification and claims data. Members requested future presentations on current value-based model programs.Agenda Item 9: Action items for staff or member follow-upAction items include:Follow-up with members to clarify the revised recommendations language.Calls with the workgroup leads to continue development of the legislative report.Follow-up on members’ request regarding future presentation topics.Agenda Item 10: Public CommentNo public comment was offered.Agenda Item 11: Adjourn Dr. Peterson thanked meeting participants, and adjourned the meeting at 1:53 p.m. ................
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