In December 2011, Texas received approval from the Centers for Medicare and Medicaid Services (CMS) for a waiver that allows the state to expand Medicaid managed care while preserving hospital funding, provide incentive payments for healthcare improvements, and direct more funding to hospitals that serve large numbers of uninsured patients.
How Funds are Distributed
Under the Texas Healthcare Transformation and Quality Improvement Program (1115 Waiver), supplemental payment funding, managed care savings, and negotiated funding will go into two statewide pools now worth $29 billion over five years. Funding from the pools will be distributed to hospitals and other providers to support the following objectives:
- an uncompensated care (UC) pool to help offset the costs of uncompensated care provided by the hospital or other providers
- a Delivery System Reform Incentive Payment (DSRIP) pool to incentivize hospitals and other providers to transform their service delivery practices to improve quality, health status, patient experience, coordination, and cost-effectiveness
Partnerships that Improve Health Services
Eligibility to get UC or DSRIP payments requires community and hospital participation in a Regional Healthcare Partnership (RHP) that supports more localized health care solutions. Within a partnership, participants include governmental entities providing public funds known as intergovernmental transfers (IGT), Medicaid providers and other stakeholders. These partnerships work together to identify ways of improving health services that address the specific needs of the region, promoting system transformation and innovative solutions to local healthcare delivery challenges.
Each partnership must have one anchoring entity, which acts as a primary point of contact for HHSC in the region and is responsible for seeking regional stakeholder engagement, coordinating development of a regional plan, and reporting the progress of the entire region to HHSC and CMS. UT Health Northeast serves as the anchor for 28 counties that make up Region 1, including:
- Red River
- Van Zandt
More Information about the Waiver
Each Regional Healthcare Partnership must have one anchoring entity to convene stakeholders, guide the development of the RHP plan, and report on the progress of the entire region to HHSC and CMS. UT Health Northeast serves as the anchor for 28 counties that make up Region 1. This includes:
- Red River
- Van Zandt
RHP Plan Development
Multiple public meetings and public hearings were held in Region 1 throughout the development of the regional plan. Meetings were open to the public, recorded, and the video and presentations from the meetings are archived here.
A regional health plan for the 28 county region in Northeast Texas was developed and submitted to CMS for their formal review in March 2013. View the RHP 1 Plan.
Since submission of the March 2013 plan, further review and implementation has resulted in numerous plan modifications, refinement of outcome measures, and other improvements. During fall 2013, eligible performing providers were afforded one final opportunity to propose additional DSRIP projects to be implemented on a three-year basis. RHP 1 followed the process outlined by HHSC for the review and approval for eight additional projects. Following a mid-point assessment in spring 2014, ten projects were formally withdrawn from the RHP 1 Plan.
Updated documents to reflect these changes can be downloaded here:
RHP 1 Providers and Stakeholders
- Paris-Lamar County Health Department
- Northeast Texas Public Health District
- Andrews Center
- Burke Center
- Community Healthcore
- Lakes Regional MHMR Center
- Texoma Community Center
- East Texas Medical Center
- Christus St. Michael Health System
- Good Shepherd Health System
- Hopkins County Memorial Hospital
- Houston County Medical Center
- Hunt Regional Healthcare
- Longview Regional Medical Center
- Palestine Regional Medical Center
- Red River Regional Hospital
- Rusk State Hospital
- Titus Regional Medical Center
- Trinity Mother Frances
- Wadley Regional Medical Center
- UT Health Science Center at Tyler
A community needs assessment, drawing from data collected from federal and state governmental agencies, academic studies, and local providers, was completed to highlight the region’s most pressing needs. After considering the data available to the region, stakeholders agreed that the most pressing community needs in Northeast Texas are the following:
- Insufficient access to primary and specialty health care services
- Insufficient access to mental and behavioral health services
- High rates of chronic disease, including diabetes, heart disease, asthma, obesity, and cancer
- High costs due to potentially preventable hospitalizations
- Inappropriate emergency department utilization
- Efficiency in and effectiveness of health care delivery
View the complete Community Needs Assessment, as submitted in the RHP 1 Plan.
RHP 1 stakeholders are encouraged to review the helpful links and documents below to learn more about the 1115 Waiver and access most recent Waiver-related materials.
The following updated document was made available by HHSC on 6/5/14:
Individual sections can be viewed by downloading the PDFs below:
Helpful Links and Documents
What is a Learning Collaborative?
A Learning Collaborative helps multiple provider teams implement the Model for Improvement.
The Change Package on our improvement topic includes proven best practices for us to try out in our settings. The methodology for change, or the Model for Improvement including the PDSA (Plan-Do-Study-Act) Cycle, gives us the structure and tools to make changes in our work in a scientific and sustainable way. This Learning Collaborative approach has been proven effective nationally and internationally since 1994. It was developed by the Institute for Healthcare Improvement and is also called the Breakthrough Series model.
How Does a Learning Collaborative Work?
The Learning Collaborative model organizes multiple groups with varying needs into a process of group learning, where all teams use the Model for Improvement and learn from each other’s successes and challenges. The main elements of the program model are the following:
- A pre-work period in which teams get organized to improve care
- A series of Learning Sessions where experts share information and approaches to improvement changes (participating teams will serve as experts later in the collaborative)
- Action periods, following each learning session, in which changes are tested and implemented by the teams
- A congress where teams share results and lessons learned of the collaborative