1115 Waiver, Version 2.0

Mar 19, 2018, 19:16 PM by KirstiAnn Clifford
Texas 1115 Waiver
With just days to spare, UTMB leaders and participating health care providers were informed that a program providing funding for critical services for underserved patients will be extended another five years.

Texas’ 1115 Medicaid Waiver program, which was set to expire on Jan. 1, will now continue through Sept. 30, 2022. The agreement reached between the Texas Health and Human Services Commission and the federal Centers for Medicare and Medicaid Services includes $25 billion in Medicaid funding over the next five years to continue providing innovative patient care across the state.

“Financially, the waiver is important to all providers, UTMB included—but it’s more than just the dollars at stake,” said Craig Kovacevich, UTMB’s associate vice president for Waiver Operations and Community Health Plans. “The waiver as a whole has given organizations like UTMB the ability to really influence health outcomes and expand programs that, without this waiver, they would have never been able to do. When you look at the number of folks who have been impacted, it’s incredible.”

The waiver was originally granted to Texas as a five-year program in 2011, providing $29 billion in incentives to health care providers for improving patient care for all, with a special emphasis on Medicaid and uninsured patients. In 2016, it was extended an additional 15 months while negotiations took place regarding a longer continuation of the program. UTMB serves as the anchor institution for Region 2, which comprises 16 counties in east and southeast Texas.

Kovacevich said the waiver has two big parts: funding for uncompensated care to help providers offset the cost of providing care to uninsured or low-income patients, and funding for hundreds of Delivery System Reform Incentive Payment (DSRIP) projects—many of which have already proved successful by helping patients control chronic diseases, reduce hospital readmissions and much more.

“The DSRIP projects have been a big success for UTMB—we’ve achieved upwards of 90 percent of our metric goals, which is incredible,” said Kovacevich, noting that the waiver has contributed $56 million to UTMB’s efforts through the end of FY17. “But I’m most proud of how the waiver has brought people together as part of a learning collaborative to work toward the ‘triple aim’ of health care: to improve the experience of care, improve the health of populations and reduce per capita costs of health care.”

As the program enters this new phase, Kovacevich said UTMB will take the lessons learned over the last six years from specific DSRIP projects and apply them institution-wide to influence a broader range of outcomes among a larger population. The various larger-scale initiatives, known as DSRIP “bundles,” will group together metrics that share a unified theme, such as chronic disease management, maternal safety or integration of behavioral health in a primary care setting.

“The original projects-based waiver was really an incubator for larger-scale transformation,” said Kovacevich. “For example, we had DSRIP projects focused on controlling diabetes in specific clinics or with specific subsets of our patient population, but that will now be evolving. Under the new waiver, we will be taking the best practices learned from those specific projects and embed them system-wide to improve health of patients with diabetes. It’s no longer a siloed approach.”

Craig Kovacevich (left) joins the care management team to discuss transitions of care. Care Management will continue playing a large role in the success of the 1115 Waiver. In the coming months, UTMB will be convening a multidisciplinary advisory group to select five to seven bundles that will have the largest impact on the patient population across the institution. Kovacevich said care management and patient navigation, while no longer continuing as DSRIP projects, will influence and enhance every larger-scale initiative.

“It’s critical for us to look at the ‘whole’ patient, including social aspects that may hinder their access to care,” said Kovaceivch. “Our patient navigation DSRIP projects proved that helping patients with things like transportation, housing and other issues influences overall health outcomes. Care management and patient navigation will continue to grow and will touch every single bundle we choose to pursue.”

With the change from project-based to system-wide initiatives, Kovacevich said accurate data collection and reporting will be crucial for tracking progress and receiving federal match payments. Providing education on the new waiver and its rules to providers and staff across UTMB will be another key to its success.

While there will be challenges, Kovacevich said there is a huge opportunity to build upon the hard work that’s already been done in hopes of true transformation. Like with Best Care—which is focused on delivering the best care to every patient, every time—it will take everyone working together.

“This is no longer something that physicians can do alone—or that the support staff in a clinic can do alone,” said Kovacevich. “It really takes everyone getting on board, understanding the initiative and asking themselves, ‘What is my role and how can I influence and help the organization reach its goals?’”