Loading...
HomeMy WebLinkAboutResolution - 2013-R0152 - 1115 Healthcare Transformation Services Agreement - LRMHMRC Dba Starcare - 05/09/2013Resolution N0. 2013-80152 May 9, 2013 Item No.5.12 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, a 1115 Healthcare Transformation Services Agreement by and between the City of Lubbock and Lubbock Regional Mental Health Mental Retardation Center DBA StarCare Specialty Health System, and related documents. Said Agreement is attached hereto and incorporated in this resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council on May 9, 2013 GPKC. ROBERTSON, MAYOR ATTEST: RebelVa Garza, City Seer t APPROVED AS TO Manager Community Services APPROVED AS TO FORM: �4k-t,4� Chad Weaver, Assistant City Attorney v :ecdocs/RES.Agrmt-StarCare May 2, 2013 StarCare Specialty Health System 1115 Healthcare Transformation Services Agreement City of Lubbock THIS AGREEMENT is entered into by and between the entities shown below: Lubbock Regional Mental Health Mental Retardation Center DBA StarCare Specialty Health System (StarCare) P.O. Box 2828 Lubbock, Texas 79408-2828 City of Lubbock P.O. Box 2000 Lubbock, Texas 79401 BACKGROUND: In December 2011, Texas received federal approval of an 1115 Healthcare Transformation waiver that would allow for managed care expansion to additional areas of the state. Under the 1115 Transformation Waiver, supplemental payment funding, managed care savings, and negotiated funding will go into 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. Eligibility to get DSRIP payments required participation in a regional healthcare partnership. Within a partnership, participants include governmental entities providing public funds known as intergovernmental transfers (IGT), Medicaid providers and other stakeholders. Participants were required to develop a regional plan identifying partners, community needs, the proposed projects, and funding distribution. Each partnership must have one anchoring entity, which acts as a primary point of contact for the Health and Human Services Commission (HHSC) in the region and is, responsible for seeking regional stakeholder engagement and coordinating development of a regional plan. The following agencies established the Regional Healthcare Partnership 12 (RHP 12) and submitted a RHP Plan to expand services in Lubbock, Randall and Potter counties: University Medical Center (UMC), the City of Lubbock and StarCare. UMC is the designated anchoring entity and acts as the primary point of contact for the Health and Human Services Commission (HHSC). The entities enter into this agreement FOR THE PURPOSE OF COLLABORATION in the Texas Healthcare Transformation and Quality Improvement (1115 Transformation Waiver) Program. STATEMENT OF SERVICES TO BE PERFORMED: The City of Lubbock Health Department in collaboration with StarCare will utilize funds received from the 1115 Transformation Waiver Program to open a new indigent dental clinic (Dental Project) in Lubbock, Texas. The goal of the Dental Project is to establish a new dental clinic, to provide routine and urgent dental services to people who would not otherwise receive them and to avoid exacerbation of health problems. City of Lubbock/Dental Project Letter of Agreement OBLIGATIONS OF THE CITY OF LUBBOCK • The City of Lubbock is an Intergovernmental Transfer (IGT) Entity in the Regional Healthcare Partnership 12 —University Medical Center (RHP 12) and as such will provide the state match for the 1115 Transformation Waiver in order to receive supplemental DSRIP payments from HHSC through the intergovernmental transfer process (See Exhibit B: DSRIP Pool - Funding Flow chart.) • The City of Lubbock is also a Performing Provider in RHP 12 and agrees to perform as the fiscal agent and receive DSRIP funds from HHSC through electronic transfer. • The City of Lubbock agrees to work collaboratively with StarCare for the duration of the 1115 Transformation Waiver to ensure compliance with the milestones, metrics and outcomes as outlined in the RHP 12 Plan submitted to HHSC, which is incorporated herein by reference. (See Exhibit C.) • When DSRIP payments (inclusive of the Federal incentive payment and the City of Lubbock's IGT/match portion) are made to the City of Lubbock, the City of Lubbock will retain its IGT/match amount and send the Federal incentive payment to StarCare, in consideration of the obligations undertaken by StarCare (in accordance with the terms attached as Exhibit A.) The City of Lubbock agrees StarCare bears total financial burden or benefit associated with the Dental Project and is not entitled to any financial benefit therefrom. • The City of Lubbock agrees to follow the schedule for funds submission/receipt as outlined in the HHSC 1115 Transformation Waiver Program Funding and Mechanics Protocol located at http://www.hhsc.state.tx.us/1115-docs/TX-DSRIP-Protocol-Approval.pdf which is incorporated herein, by this reference. At the time of this writing the IGT/Incentive Payment for DSRIP Year 1 is scheduled to be: IGT submission on May 14, 2013, with IGT return and Incentive Payment receipt approximately June 30, 2013. For DSRIP Years 2-5, the IGT/Incentive Payments are estimated to occur on a quarterly or semi-annual basis. OBLIGATIONS OF STARCARE SPECIALTY HEALTH SYSTEM • StarCare agrees to either provide directly or sub -contract for all aspects of the Dental Project, as outlined in the RHP 12 Plana StarCare agrees that anywhere written in the RHP 12 Plan that the City of Lubbock Health Department will provide, hire, train, etc. it is assumed to mean that the City of Lubbock has engaged StarCare to provide, hire, train, etc. either directly or through sub -contract. • StarCare agrees to accept the entire, Federal portion of funds received by the City of Lubbock for the Dental Project as payment in full for its obligations under this Letter of Agreement; StarCare agrees the City of Lubbock bears no additional financial burden for the Dental Project. • Unless in the case of negligence or error on the part of the City of Lubbock, StarCare agrees it bears total financial burden or benefit associated with the Dental Project and will not seek to share any financial burden with the City of Lubbock. • StarCare agrees to work collaboratively with the City of Lubbock for the duration of the 1115 Transformation Waiver to ensure compliance with the milestones, metrics and outcomes as outlined in the RHP 12 Plan submitted to HHSC, which is incorporated herein by reference. THE UNDERSIGNED AGENCIES have read this Letter of Agreement and by signing agree to all the terms and provisions made between StarCare and the City of Lubbock as outlined. City of Lubbock/Dental Project Letter of Agreement TERM AND TERMINATION This Agreement is effective May 9, 2013 and is automatically renewable on a yearly basis upon mutual agreement and acceptable performance. Any amendments to the terms of the agreement will be made in writing and agreed upon by both agencies prior to implementation of changes. Both agencies mutually agree that either agency may terminate this agreement with ninety (90) day written notice. Each entity is a Governmental Entity and hereby understands that any liability arising from this Agreement shall be home by the responsible entity. Each entity shall be responsible for its own defense and resolution of any claim against that entity. THE UNDERSIGNVAG CIES have read this Letter of Agreement and by signing agree to all the terms and provisions ad etwee 5 arCare and the City of Lubbock as outlined. StarCare Sp t ' altb ystem: City of Lubb k: Cathy Pope Date Gle . obe t Date Chief Executive Officer Mayor Approved as to Form: Chad Weaver Date Assistant City Attorney Approved as to Content: V Y1 Scott Snider Date Assistant City Manager Attest: Bec Garza Date City ecretary City of Lubbock/Dental Project Letter of Agreement EXHIBIT A FUNDS TRANSFER 1) The City of Lubbock agrees to transfer to StarCare the entire Federal portion of funds received from the 1115 Transformation Waiver/Dental Project. While the exact dates of receipt and exact amounts of funding are yet to be determined good faith estimates are as follows: DSRIP Year (DY) Federal Portion of Funds (to be transferred in full from the City of Lubbock to StarCare) State Portion of Funds (to be used as IGT to draw down Federal Funds 1 251,080 172,326 2 1,371,959 984,549 3 1,581,843 1,135,167 4 1,681,787 1,206,888 5 1,819,434 1,305,668 Total $6,455,023 $4,632,272 Exact dates and amounts will be given to the City of Lubbock and StarCare from RHP 12. DY1 funds are expected to be paid in one, lump sum; DY2-5 funds are expected to be paid quarterly or semi-annually.* 2) Upon receipt of funds, the City of Lubbock will transfer the Federal Portion, in full, electronically to StarCare. StarCare will ensure the City of Lubbock is given all information necessary to make the electronic funds transfer. *NOTE: In the HHSC 1115 Transformation Waiver Program Funding and Payment Protocol, payment for partial milestone, metric and outcome achievement is possible. For example, if actual performance is 95% of planned performance, then only 95% of the IGT shown above will be needed to draw down 95% of the incentive payment. htip://www.hhsc.state.tx.us/1115-docs/TX-DSRIP-Protocol-Approval.pdf City of Lubbock/Dental Project Letter of Agreement EXHIBIT B - DSRIP Pool - Funding Flow DSRIP Pool — Funding Flow • Public Hospital • In areas with no public hospital: • Hospital District • Hospital Authority • County • State University with HSC or medical school rR..P Admtrativeinls -RepoNng C Functions l O 0 Performing Provided Reports performance'. i Examples Exams Public Hospital --------------- Public Hospital Public Hospital ------------ - Private Hospital Public Hospital -------- ---- Private Hospital ------------ Clinic LMHA LMHA u 0 0 fGT Entity c Ides IGT to State a LL Qd5 Approves federal matchandsendsw HHSC n e m E m 6 L Performing Performing Provider i bcanMiLuVaRor Receives payments Draft as of 04/02/12 EXHIBIT C City of Lubbock Health Department - RHP 12 Plan Project Option: 1.8.6 - The expansion of existing dental clinics, the establishment of additional dental clinics or the expansion of dental clinic hours. Performing Provider: City of Lubbock Health Department/135103304.1.1 Unique Project ID. 135103304.1.1 PROVIDER: The City of Lubbock, Texas is currently home to over 229,000 residents. The City of Lubbock Health Department's mission is to protect the health, safety and welfare of citizens through: 1. Preventing epidemics and the spread of disease; 2. Educating and empowering people to adopt health and responsible behaviors; 3. Promoting the quality and accessibility of health services; and 4. Developing new Insights and Innovative solutions to health problems. INTERVENTIONS: The City of Lubbock Health Department will expand dental services, through the establishment of a new dental clinic. NEED FOR THE PROJECT, The City of Lubbock selected this project because it directly addresses Region 12 Community Needs Assessment ID# CN13 (Important Need): there Is a shortage of dental care, and IN CN3 (Urgent Need): Poor Insurance support or uninsured. The City of Lubbock does not currently operate a dental clinic; therefore, this will be a new endeavor. TARGET POPULATION: The target population for this project includes people who don't historically have access to or avail themselves of dental care: people with mental illness, substance abuse Issues, intellectual disabilities, people who are homeless, people struggling with the challenges of aging, veterans, people living In poverty, etc. Estimates are that 95% of the people served in this new clinic will be Medicaid funded or Indigent. CATEGORY 1 EXPECTED PATIENT BENEFITS: During DY3 the City of Lubbock will hire and train staff, develop all operational protocols and clinical guidelines and develop a baseline from which to calculate system improvements. The City of Lubbock hopes to provide at least 600 office visits during DY4 and to provide at least 750 office visits In DY5. Conceivably, over 350 people per year could be impacted by this project. The City of Lubbock will focus upon special needs patients, pregnant women and/or the elderly hoping for a 1096 increase over baseline in OY4 and 15% over baseline In DY5. CATEGORY 3 OUTCOMES: (IT — 7.7)The goal of this project is to decrease the number of older adults 65 years or older with urgent dental care needs by 10% from baseline In DY4 and 15% from baseline In DY5. City of Lubbock Health Department - RHP 12 Plan Page 1 of 26 Project Option: 1.8.6 - The expansion of existing dental clinics, the establishment of additional dental clinics or the expansion of dental clinic hours. Performing Provider: City of Lubbock Health Department/135103304.1.1 Unique Project ID: 135103304.1.1 Project Description: Dental health is a key component of overall health. Oral disease can lead to poor nutrition; serious systemic Illnesses and conditions such as poor birth outcomes, diabetes and cardiovascular disease; and a diminished quality of life and life expectancy. Inadequate access to oral health services compounds other health issues. can result In untreated dental disease that not only affects the mouth, but can also have physical, mental, economic and social consequences. Fortunately, many of the adverse effects associated with poor oral health can be prevented with quality regular dental care, both at home and professionally. Increasing, expanding and enhancing oral health services will Improve health outcomes. The Texas Dental Association (TDA) looked carefully at the economic, medical and social consequences of untreated oral disease in Texas. It reviewed the current systems of oral health care delivery, assessed payment structures, and studied the oral health status of Texans in general and analyzed the oral health disparities that exist In the state. Then TDA made specific and practical policy recommendations to expand access to oral health care In Texas, Including: Identifying a "dental home" for every citizen; creating new programs to encourage general dentists and specialists to practice In underserved areas and to treat underserved populations; developing a comprehensive oral health public awareness and education campaign; and expanding access to oral health services for older citizens. This project focuses upon all of these state priorities by establishing a new dental clinic, targeting people who don't historically have access to or avail themselves of dental care: people with mental Illness, substance abuse issues, intellectual disabilities, people who are homeless, people struggling with the challenges of aging, veterans, people living in poverty, etc. The City of Lubbock Health Department (City of Lubbock) does not have adequate resources to meet the demand for dental services in Lubbock, especially for populations with special needs. This project sets forth collaboration with the Local Mental Health Authority (StarCare Specialty Health System "StarCare") and a Federally Qualified Health Center (the Texas Tech School of Nursing's Federally Qualified Health Center, The Larry Combest Center for Health and Wellness "Combest") to obtain synergy, economies of scale and to increase access for preventative dental visits impacting the severity of going to the dentist as a last resort. This project will help divert patients from more expensive, less effective treatment of extreme dental procedures. In the first stage of this project, the City of Lubbock will partner with StarCare and Combest to engage a Lubbock Oral Health Project Coordinator to conduct a city- wide needs assessment related to citizens of all ages, to perform a gap analysis and to develop a dental coalition of all providers of dental services to people with low income. In addition, the coalition will develop a Lubbock Oral Health Plan and begin Implementation of the Lubbock Oral Health Program. Next, the City of Lubbock, StarCare and Combest will partner to open a new dental clinic, to Include the development of policies and procedures and hiring and training staff. The initial plan Is to co -locate with a new integrated physical and behavioral health clinic In StarCare's Psychiatric Emergency Service Center in order to improve access to marginalized populations. The City of Lubbock hopes to provide at least 600 office visits during DY4 and to provide at least 750 office visits In DY5. Conceivably, over 350 people per year could be impacted by this project. The City of Lubbock will focus upon special needs patients, pregnant women and/or the elderly hoping for a 10% increase over baseline in DY4 and 15% over baseline in DYS. Goal of Project: The primary goals of this project are to: close gaps/disparities in access to dental care services and to enhance the quality of dental care provided. Challenges: Challenges associated with the successful Implementation of this project are: lack of qualified dental providers, patient transportation and low oral health literacy. The City of Lubbock will work with its project partners to develop and implement a comprehensive provider recruitment effort and public information campaign. The dental clinic will likely provide bus passes to patients to help address issues related to transportation. S -Year Expected Outcome for Performing Provider and Patients: Performing Provider Perspective — improved healthcare Infrastructure that better serves the Medicaid -funded and uninsured residents of our counties; coordinated care delivery system; improved efficiency and cost growth containment. • Patient Perspective — high quality, patient -centered care; improved access to coordinated healthcare; improved health outcomes. Relationship to Regional Goals: Commissioned by the Regional Healthcare Partnership (RHP), the West Texas Area Health Education Center conducted an assessment of the healthcare -related needs in Region 12. The resulting document ranked the needs in tiers, according to the availability of evidence documenting each need. Tier one included the two (2) most pressing needs in RHP 12:1) a severe lack of primary care access including provider shortages, financial barriers, wait times, and length of time to get an appointment; and 2) a lack of mental health services including lack of available appointments, insurance coverage, and emergency room usage for mental health issues. Tier two Identified other priority Issues as: 1) uninsured and underinsured; 2) high incidence of obesity, diabetes, and heart disease; 3) need for specialty care; and 4) need for cancer screenings; and 5) insufficient maternal and prenatal care. The goals of Region 12 are to address as many identified community needs as possible, focusing on those Identified as "critical" and "urgent," including increased access to care, increased prevention and early detection activities and quality/performance Improvement. This project is directly related to the Region 12 goals of increased access to care and increased prevention and early detection activities. This project will transform healthcare delivery from a disease -focused model of episodic care to a patient centered, coordinated delivery model that Improves patient satisfaction and health outcomes, reduces unnecessary or duplicative services and builds on the accomplishments of our existing healthcare system. Starting Point/Baseline: The City of Lubbock does not currently operate a dental clinic; therefore, the starting point/baseline for the number of people to be assisted is zero. Reason/Rationale for Selecting Measure: Poor oral health affects more than just the mouth. It can seriously compromise a person's general health, quality of fife and life expectancy. Oral diseases can and do lead to systemic problems — damaging other parts of the body and resulting in the need for expensive emergency department visits, hospital stays and medications. The consequences of poor oral health, however, go for beyond damaging medical effects. oral disease can also wreak economic havoc — keeping children out of school and adults home from work — not to mention lower productivity of workers in pain. Untreated oral diseases can also drive up heaith care costs in general. The good news is that with proper oml healthcare, both at home and in professional settings, many of the negative consequences associated with poor oral health can be prevented.' htt::7wwtiv.buildin«hetteroralheahh.or* m • iaiTDA fall re ort. df City of Lubbock Health Department - RHP 12 Plan Page 2 of 26 The number of emergency -room visits for patients seeking dental treatment has Increased, mostly because of problems that could have been prevented with regular dental visits, according to the Pew Center on the States. Most cases are in rural areas, which have a shortage of dentists. Nationwide, the number of ER dental visits increased 16 percent from 2006 to 2009, and the center suggests the trend is continuing. Visiting the ER for dental treatment can be 10 times more expensive than preventive care. Many visits Involve the same patients seeking more care because emergency rooms aren't staffed by dentists. Doctors can offer pain relief, but not much more, and many patients can't afford follow-up treatment or can't find a dentist. "Emergency rooms are really the canary in the coal mine. If people are showing up in the ER for dental care, then we've got big holes In the delivery of care," said Shelly Gehshan, director of Pew's chlld-dentistry campaign. 'it's Just like pouring money down a hole." The Center analyzed information from 24 states, the Federal Agency for Healthcare Research and Quality and dental care studies. It found that in 2009, 56 percent of children with Medicaid didn't receive dental care, ER visits for dental care increased by almost 60 percent In South Carolina, and there were 55,000 dental -related ER visits in Tennessee hospitals. Part of the problem Is that few dentists participate In Medicaid programs, The Associated Press reports. The center is working with states to develop dental hygienists training programs and train non -dentists to treat cavities and other uncomplicated procedures. More than 830,000 visits to emergency rooms nationwide In 2009 were for preventable dental problems. Dental disease Is the No. i chronic childhood disease, sending more children In search of medical treatment than asthma. In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay. 2 The following Project Option and Project Components were selected because they directly address Region 12 Community Needs Assessment IDN CN13 (important Need): There is a shortage of dental care; and IDN CN3 (Urgent Need): Poor Insurance support or uninsured. Project Option 1.8: Increase and expand services by increasing clinics, clinic hours, using satellite mobile clinics with an affiliated fixed -site dental clinic location, school-based/school-linked health centers or other approaches to increase oral health services to underserved populations. Project Component: 1.8.6 Establish a new dental clinic. The City of Lubbock will conduct Continuous Quality Improvement (CQI) activities using methods such as rapid cycle Improvement. Activities may Include, but are not limited to, identifying project impacts, identifying "lessons learned," opportunities to scale all or part of the project to a broader patient population and identifying key challenges associated with expansion of the project, including special considerations for safety -net populations. Our RHP will encourage participation by all our partners In a Leaming Collaborative that will meet annually to discuss local disparities In care and the ways they have successfully gathered relevant data and ultimately better served the populations In their projects. In addition to the face-to-face meeting, we will have an open forum on our website that will foster communication amongst our partners with related projects. Unique Community Need IDN: CN13 There is a shortage of dental services and CN3 Poor insurance support or uninsured. Milestones & Metria: The milestones and metrics (1.8.6— P-4,4.1; P-10,10.1; and 1.14,14.1) selected for this project directly address CNN13&3 outlined In the Region 12 Community Needs Assessment. Related Category 3 Outcome Measure: OD -7 Oral Health; IT -7.7 Urgent Dental Care Needs in Older Adults: Proportion of older adults aged 65 and older with urgent dental care needs (standalone measure) Reason/Rationale for Selection: According to the Region 12 Community Needs Assessment, there Is a shortage of dental services and a high prevalence of people with poor insurance support or who are uninsured. According to the TDA, services for older Texans is a priority. Explanation of how focusing on the outcomes will help Improve the health of low -Income populations: Establishment of a new dental clinic focusing services upon people who are under- or uninsured will directly help Improve the health of low -Income populations. Relationship to Other Projects: This project relates to the City of Lubbocles Pass 2 project (135103304.1.2 — expand access/hours in dental clinic) in that it is the foundation project that opens a new dental clinic. These projects are all related in that they are aimed to increasing access to needed health care in the most appropriate setting. Relationship to Other Performing Providers' Projects in RHP & Plan for teaming Collaborative: This project relates to StarCare's Pass 1 and Pass 2 projects (084897001.1.1 and 084897001.1.2) - to open a Psychiatric Emergency Service Center and adolescent crisis respite unit — In that this clinic will be housed within the same facility. Our RHP will encourage participation by all our partners in a "teaming collaborative" that will meet annually to discuss local disparities in care and the ways they have successfully gathered relevant data and ultimately better served the populations in their projects. In addition to the face-to-face meeting, we will have an open forum on our website that will foster communication amongst Project Option: 1.8.6 - The expansion of existing dental clinics, the establishment of additional dental clinics or the expansion of dental clinic hours. Performing Provider. City of Lubbock Health Department/135103304.1.1 Unique Project ID: 135303304.1.1 PROVIDER: The city of Lubbock, Texas is currently home to over 229,000 residents. The City of Lubbock Health Department's mission is to protect the health, safety and welfare of citizens through: 1. Preventing epidemics and the spread of disease; 2. Educating and empowering people to adopt health and responsible behaviors; 3. Promoting the quality and accessibility of health services; and 4. Developing new Insights and innovative solutions to health problems. INTERVENTIONS: The City of Lubbock Health Department will expand dental services, through the establishment of a new dental clinic. NEED FOR THE PROJECT, The City of Lubbock selected this project because it directly addresses Region 12 Community Needs Assessment IDN CN23 (Important Need): There is a shortage of dental care,, and IDN CN3 (Urgent Need): Poor Insurance support or uninsured. The City of Lubbock does not currently operate a dental clinic; therefore, this will be a new endeavor. httnahvwH'.peHstates.ore/uploadeffile%TCS A,,setsi20l2!A ,;2OCostly o2ODciitall'2ODcstination(l ).pdf City of Lubbock Health Department - RHP 12 Plan Page 3 of 26 TARGET POPULATION: The target population for this project Includes people who don't historically have access to or avail themselves of dental care: people with mental illness, substance abuse Issues, intellectual disabilities, people who are homeless, people struggling with the challenges of aging, veterans, people living in poverty, etc. Estimates are that 95% of the people served In this new clinic will be Medicaid funded or indigent. CATEGORY 1 EXPECTED PATIENT BENEFITS: During DY3 the City of Lubbock will hire and train staff, develop all operational protocols and clinical guidelines and develop a baseline from which to calculate system improvements. The City of Lubbock hopes to provide at least 600 office visits during DY4 and to provide at least 750 office visits in DYS. Conceivably, over 350 people per year could be impacted by this project. The City of Lubbock will focus upon special needs patients, pregnant women and/or the elderly hoping for a 10% increase over baseline in DY4 and 1596 over baseline In DY5. CATEGORY 3 OUTCOMES: (IT — 7.7)The goal of this project is to decrease the number of older adults 65 years or older with urgent dental care needs by 10% from baseline in DY4 and 15% from baseline in DY5. City of Lubbock Health Department - RHP 12 Plan Page 4 of 26 Project Option: 1.8.6 - The expansion of existing dental clinics, the establishment of additional dental clinics or the expansion of dental clinic hours. Performing Provider: City of Lubbock Health Department/135103304.1.1 Unique Project ID: 135103304.1.1 Project Description: Dental health is a key component of overall health. Oral disease can lead to poor nutrition; serious systemic illnesses and conditions such as poor birth outcomes, diabetes and cardiovascular disease; and a diminished quality of life and life expectancy. Inadequate access to oral health services compounds other health issues. can result in untreated dental disease that not only affects the mouth, but can also have physical, mental, economic and social consequences. Fortunately, many of the adverse effects associated with poor oral health can be prevented with quality regular dental care, both at home and professionally. Increasing, expanding and enhancing oral health services will improve health outcomes. The Texas Dental Association (TDA) looked carefully at the economic, medical and social consequences of untreated oral disease in Texas. It reviewed the current systems of oral health care delivery, assessed payment structures, and studied the oral health status of Texans in general and analyzed the oral health disparities that exist In the state. Then TDA made specific and practical policy recommendations to expand access to oral health care in Texas, including: identifying a "dental home" for every citizen; creating new programs to encourage general dentists and specialists to practice In underserved areas and to treat underserved populations; developing a comprehensive oral health public awareness and education campaign; and expanding access to oral health services for older citizens. This project focuses upon all of these state priorities by establishing a new dental clinic, targeting people who don't historically have access to or avail themselves of dental care: people with mental Illness, substance abuse issues, intellectual disabilities, people who are homeless, people struggling with the challenges of aging, veterans, people living in poverty, etc. The City of Lubbock Health Department (City of Lubbock) does not have adequate resources to meet the demand for dental services in Lubbock, especially for populations with special needs. This project sets forth collaboration with the Local Mental Health Authority (StarCare Specialty Health System "StarCare") and a Federally Qualified Health Center (the Texas Tech School of Nursing's Federally Qualified Health Center, The Larry Combest Center for Health and Wellness "Combest") to obtain synergy, economies of scale and to increase access for preventative dental visits impacting the severity of going to the dentist as a last resort. This project will help divert patients from more expensive, less effective treatment of extreme dental procedures. In the first stage of this project, the City of Lubbock will partner with StarCare and Combest to engage a Lubbock Oral Health Project Coordinator to conduct a city- wide needs assessment related to citizens of all ages, to perform a gap analysis and to develop a dental coalition of all providers of dental services to people with low income. In addition, the coalition will develop a Lubbock Oral Health Plan and begin implementation of the Lubbock Oral Health Program. Next, the City of Lubbock, StarCare and Combest will partner to open a new dental clinic, to include the development of policies and procedures and hiring and training staff. The initial plan is to co -locate with a new Integrated physical and behavioral health clinic in StarCare's Psychiatric Emergency Service Center In order to Improve access to marginalized populations. The City of Lubbock hopes to provide at least 600 office visits during DY4 and to provide at least 750 office visits in DYS. Conceivably, over 350 people per year could be impacted by this project. The City of Lubbock will focus upon special needs patients, pregnant women and/or the elderly hoping for a 10% increase over baseline in DY4 and 15% over baseline in DYS. Goal of Project: The primary goals of this project are to: close Saps/disparities in access to dental care services and to enhance the quality of dental care provided. Challenges: Challenges associated with the successful implementation of this project are: lack of qualified dental providers, patient transportation and low oral health literacy. The City of Lubbock will work with its project partners to develop and implement a comprehensive provider recruitment effort and public information campaign. The dental clinic will likely provide bus passes to patients to help address Issues related to transportation. S -Year Expected Outcome for Performing Provider and Patients: Performing Provider Perspective — Improved healthcare Infrastructure that better serves the Medicaid -funded and uninsured residents of our counties; coordinated care delivery system; improved efficiency and cost growth containment. • Patient Perspective— high quality, patient -centered care; improved access to coordinated healthcare; improved health outcomes. Relationship to Regional Goals: Commissioned by the Regional Healthcare Partnership (RHP), the West Texas Area Health Education Center conducted an assessment of the healthcare -related needs In Region 12. The resulting document ranked the needs In tiers, according to the availability of evidence documenting each need. Tier one included the two (2) most pressing needs in RHP 12:1) a severe lack of primary care access including provider shortages, financial barriers, wait times, and length of time to get an appointment; and 2) a lack of mental health services including lack of available appointments, insurance coverage, and emergency room usage for mental health issues. Tier two Identified other priority issues as: 1) uninsured and underinsured; 2) high incidence of obesity, diabetes, and heart disease; 3) need for specialty care; and 4) need for cancer screenings; and 5) insufficient maternal and prenatal care. The goals of Region 12 are to address as many Identified community needs as possible, focusing on those identified as "critical" and "urgent," Including Increased access to care, increased prevention and early detection activities and quality/performance Improvement. This project is directly related to the Region 12 goals of increased access to care and increased prevention and early detection activities. This project will transform healthcare delivery from a disease -focused model of episodic care to a patient centered, coordinated delivery model that improves patient satisfaction and health outcomes, reduces unnecessary or duplicative services and builds on the accomplishments of our existing healthcare system. Starting Point/Baseline: The City of Lubbock does not currently operate a dental clinic; therefore, the starting point/baseline for the number of people to be assisted is zero. Reason/Rationale for Selecting Measure: Poor oral health affects more than Just the mouth. It can seriously compromise a person's general health, quality of live and life expectancy. oral diseases can and do lead to systemic problems — damaging other parts of the body and resulting in the need for expensive emergency department visits, hospital stays and medications. The consequences of poor oral health, however, go for beyond damaging medical effects. oral disease con also wreak economic havoc —keeping children out of school and adults home from work —not to mention lower productivity of workers in pain. Untreated oral diseases can also drive up health care costs in general. The good news is that with proper oral health care, both at home and in professional settings, many of the negative consequences associated with poor oral health can be prevented.' 3 httn:Hwww.buildingbetteioralhcalth.or,, inedia/'T'DA full report.ndf City of Lubbock Health Department - RHP 12 Plan Page 5 of 26 The number of emergency -room visits for patients seeking dental treatment has Increased, mostly because of problems that could have been prevented with regular dental visits, according to the Pew Center on the States. Most cases are in rural areas, which have a shortage of dentists. Nationwide, the number of ER dental visits increased 16 percent from 2006 to 1009, and the center suggests the trend is continuing. Visiting the ER for dental treatment can be 10 times more expensive than preventive care. Many visits involve the same patients seeking more care because emergency rooms aren't staffed by dentists. Doctors can offer pain relief, but not much more, and many patients can't afford follow-up treatment or can't find a dentist. "Emergency rooms are really the canary In the coal mine. If people are showing up in the ER for dental care, then we've got big holes In the delivery of care," said Shelly Gehshan, director of Pew's child -dentistry campaign. "It's just like pouring money down a hole." The Center analyzed Information from 24 states, the Federal Agency for Healthcare Research and Quality and dental care studies. It found that in 2009, 56 percent of children with Medicaid didn't receive dental care, ER visits for dental care increased by almost 60 percent in South Carolina, and there were 55,000 dental -related ER visits to Tennessee hospitals. Part of the problem is that few dentists participate in Medicaid programs, The Associated Press reports. The center is working with states to develop dental hygienists training programs and train non -dentists to treat cavities and other uncomplicated procedures. More than 830,000 visits to emergency rooms nationwide In 2009 were for preventable dental problems. Dental disease Is the No.1 chronic childhood disease, sending more children In search of medical treatment than asthma. In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay.' The following Project Option and Project Components were selected because they directly address Region 12 Community Needs Assessment ID# CN13 (Important Need): There is a shortage of dental care, and ID# CN3 (Urgent Need): Poor insurance support or uninsured. Project Option 1.8: increase and expand services by increasing clinics, clinic hours, using satellite mobile clinics with an affiliated fixed -site dental clinic location, school-based/school-Ilnked health centers or other approaches to increase oral health services to underserved populations. Project Component: 1.8.6 Establish a new dental clinic. The City of Lubbock will conduct Continuous Quality Improvement (CQI) activities using methods such as rapid cycle Improvement. Activities may include, but are not limited to, identifying project Impacts, Identifying "lessons learned," opportunities to scale all or part of the project to a broader patient population and identifying key challenges associated with expansion of the project, Including special considerations for safety -net populations. Our RHP will encourage participation by all our partners In a Learning Collaborative that will meet annually to discuss local disparities in pre and the ways they have successfully gathered relevant data and ultimately better served the populations in their projects. In addition to the face-to-face meeting, we will have an open forum on our website that will foster communication amongst our partners with related projects. Unique Community Need IDN: CN13 There is a shortage of dental services and CN3 Poor Insurance support or uninsured. Milestones & Metria: The milestones and metria (1.8.6 — P-4, 4.1; P-10,10.1; and 1-14, 14.1) selected for this project directly address CN#13&3 outlined in the Region 12 Community Needs Assessment. Related Category 3 Outcome Measure: OD -7 Oral Health; IT -7.7 Urgent Dental Care Needs in Older Adults: Proportion of older adults aged 65 and older with urgent dental care needs (standalone measure) Reason/Rationale for Selection: According to the Region 12 Community Needs Assessment, there is a shortage of dental services and a high prevalence of people with poor insurance support or who are uninsured. According to the TDA, services for older Texans Is a priority. Explanation of how focusing on the outcomes will help Improve the health of lowdncome populations: Establishment of a new dental clinic focusing services upon people who are under- or uninsured will directly help Improve the health of low -Income populations. Relationship to Other Projects: This project relates to the City of Lubbock's Pass 2 project (135103304.1.2 — expand access/hours in dental clinic) in that it is the foundation project that opens a new dental clinic. These projects are all related In that they are aimed to increasing access to needed health care in the most appropriate setting. Relationship to Other Performing Providers' Projects in RHP & Plan for learning Collaborative: This project relates to StarCaWs Pass 1 and Pass 2 projects (084897001.1.1 and 084897001.1.2) - to open a Psychiatric Emergency Service Center and adolescent crisis respite unit — In that this clinic will be housed within the same facility. Our RHP will encourage participation by all our partners in a "learning collaborative" that will meet annually to discuss local disparities in care and the ways they have successfully gathered relevant data and ultimately better served the populations in their projects. In addition to the face-to-face meeting, we will have an onpn fnrum on our wphtite that will foster rnmmunlratinn amnnast our nartners with relatpd nroiprts. Prolact Valuation: Criteria Narrative Score Achieves This project is designed to achieve, to the greatest extent possible, the Texas Healthcare Transformation and Quality Improvement Waiver (1115 Waiver) goals of 1. Improved patient care experlence; 2. Improved health; and 3. Reduced cost of healthcare, without Goals compromised quality. In order to achieve alignment with this triple aim, the primary goal of this project Is to ensure people receive Scale: coordinated, timely and site -appropriate healthcare services. The City of Lubbock hopes to address the healthcare disparity of s 1 to 5 unequal access for people with low-income. This project will transform healthcare delivery from a disease -focused model of episodic 5 Greatest care to a patient centered, coordinated delivery model that Improves patient satisfaction and health outcomes, reduces unnecessary or duplicative services and builds on the accomplishments of our existing healthcare system. Addresses Commissioned by the Regional Healthcare Partnership (RHP), the West Texas Area Health Education Center conducted an assessment of the healthcare -related needs In Region 12. The goals of Region 12 are to address as many Identified community needs as possible, Community Need(s) focusing on those Identified as "critical" and "urgent," including increased access to care, increased prevention and early detection activities and quality/performance improvement. The following Project Option and Project Components were selected because they S Scale: directly address Region 12 Community Needs Assessment ION CN13 (Important Need): There is a shortage of dental care, and ID# CN3 ito5 5 Greatest (Urgent Need): Poor Insurance support or uninsured. The lack of available appointments for people without money or Insurance, results in the need to use emergency rooms for initial contact. blip:: �rw��.iic���tates.or uploadcdFilesiPC5 Assets/2012/..%'ko2OCostly4o2ODental°',20Des(ination( 1).pdf City of Lubbock Health Department - RHP 12 Plan Page 6 of 26 Project The City of Lubbock hopes to provide at least 600 office visits during DY4 and to provide at least 750 office visits in DYS. Scope/Size Conceivably, over 350 people per year could be Impacted by this project. The City of Lubbock will focus upon special needs patients, pregnant women and/or the elderly hoping for a 1095 increase over baseline In DY4 and 15% over baseline in DYS. when considering 4 1 to 5 the impact upon each person's care experience, his/her health and the reduced cost upon the community's healthcare delivery 5 Greatest system, the scope and size of this project will be fairly great. This project will be managed by highly trained staff who specialize In linkage to the right care In the right setting. Project The City of Lubbock's investment In this project will be fairly significant. Staffing will include a Program Director, Dentist(s), Licensed Investment Hygienists, Dentals Technicians, office personnel, etc. (Some administrative staff will be shared with StarCare and Combest in order to 4 Scale: obtain economies of scale.) Other investments include physical space, furnishings and equipment, computer hardware/software, etc. 1 to 5 As one might Imagine, dental equipment can be very expensive. 5 Greatest City of Lubbock Health Department - RHP 12 Plan Page 7 of 26 135303304.1.1 1.8.6 n/a The expansion of existing dental ciinlcs, the establishment of addlelonal dental clinics or the expansion of dental clinic boors. tl of Lubbock Health De rtment 135103304 Related Category 30utcome 135103304.3.1 IT,]) Urgent Dental Care Need in Older Adults: Proportion of older Measum(s): I I adults aged 65 and older with urgent dental care needs Milestone 1:1P-101: Participate in face-to-face teaming Il, meetings or seminars) at least twice per year with other provitlers and the RHP to promote collaborative learning around shared or similar projects. At each face-to-face meeting. all providers shall Identify and agree upon several Improvement (simple Initiatives mat all providers an do to "raise the floor for performance.) Each participating provider should publicly commit to Implementing these Improvements. McVic(s): IP -10.11 Panicipate in sembannual (aceta face meetings or seminars organized by the PHP. Baseline/Goal: Particlpate In face-to-face meetings Data Source: Documentation of well annual meetings, Including meeting agendas, slides from presentations, and/or meeting notes. Milestone 1 Estimated Incentive Payment: $1,941,214 Participate In face to face learning I.e. meetings or seminars) at least twice per year with other providers antl the RHP to promote collaborative learning around shared or similar projects. At each face to. face meeting, all providers shall Identify and agree upon several Improvement (simple Initiatives that all providers can do to "raise the fWr for performance.) Each Participating provider should publicly commit to Implementing thew Improvements. Metric(,): IP -10.11 Participate In worbannual face-taface meetings or seminars organized by the RHP. Baseline/Gwl: Participate In faceo-toface meetings Data Source: Documentation of send - annual meetings, Including meeting agendas, slides from presentations, and/or meeting notes. Milestone 3 Estimated Incentive Payment: $1,066,396 Milestone 3: IP -31 Increase Interdisciplinary (IDTI training and education for dental and other health care providers to promote an 10 Team approach to addressing oral health. Metric(,): IP3.11 City of Lubbock will hold quarterly (4/year) grand rounds, Imservlce tralnings and continuing education that focus on oral health Issues and Implications as related to chronic diseases, such as diabetes and cardiovascular disease and pregnancy. Goal: City of Lubbock call I hold quarterly (4/year) grand rountls, n-servlce comings and continuing education that focus on oral health Issues and Implications as related to chronic diseases, such as diabetes and cardiovascular disease and pregnancy. Data Source: Attendance rosters, Power point presentations, sign In sheets, etc. Milestone 3 Estimated Incentive Payment: $1,066,395 [itv of Lubbock Health Department - RHP exating/reladte dental care clinics or space. Metak(sI: IP 4.11 Number of additional clinics. expanded space, or existing available space used to capacity. 8arellne/Goal: Add 1 new clime Data Source: Tax IDN Milestone 4 Estimated Incentive Payment; 5760,530 Milestone S; JP -31 Increase lnterdlstlplmary(IDT)training and education for dental and other health care providers to promote an ID Team approach to addressing oral health. MetrMs): IP3.11 City of Lubbock will hold quarterly (4/year) grand round , in-service tralnings and continuing education that (OCL' on oral health issues and Impllatlons as related to chronic diseases, such as diabetes and cardiovascular disease and pregnanry. Goal: City of Lubbock will hold quarterly (4/year) grand rounds, In-service tralnings and continuing education that focus on oral health Issues and Implications as related to chronic diseases, such as diabetes and cardiovascular disease and pregnancy. Data Source: Attendance rosters, power point presentations, sign In sheets, etc. Milestone 5 Estimated Incentive Payment: $160,530 Milestone 6: 14141 Increase number of special population members that access dental services Metricls): 11-14.11 10% Increase over baseline In the number of children, special needs patients, pregnant women and/or the elderly accessing dental services. Goal: 10% Increase over baaMe In the number of children, special needs patients, pregnant women and/or the elderly accessing dental services. Data Soudan Claims, encounter and members that access dental services Metro): p-14.1) 15% Increase from baseline In the number of children, special needs patients, pregnant women and/or the elderly accessing dental services. Bauline/Goal: 1091increase over baseline in the number of Children, special needs patients, pregnant women and/or the elderly accessing dental seances. Data Source: Claims, encounter and clinical record dark Milestone 6 Estimated Incentive Payment: $1,101,118 Milestone 7: IP -31 Increase Interdisciplinary LDT) training and education for dental and other health are providers to promote an IO Team approach to addressing out health. Metrift IP3.11 City of Lubbock will hold quarterly (4/year) grand rounds, In service trainings and continuing education that focus on oral health issues and Implications as related to chronic diseases, such as diabetes and cardiovascular disease and pregnanry. Goal: City of Lubbock will bold quarterly (4/year) grand rounds, in- service tralnings and continuing education that focus on oral health Issues and implications as related to chronic diseases, such as diabetes and cardiovascular disease and pregnancy. Data Source: Attendance rosters, power point presentations, sign In sheets, etc. Milestone 7 Estimated Incentive Payment:.$1,102,217 Pape 9 of 26 City of Lubbock Health Department - RHP 12 Plan Page 9 of 26 Milestone 6 Estimated Incentive Payment: $760,530 DY 2 Estimated Milestone Bundle DY 3 Estimated Milestone Bundle DY4 Estimated Milestone Bundle DY5 Estimated Milestone Bundle Amount: $1,942,214 Amount: $2,132,791 Amount: $2,281,590 Amount: $2,204,435 TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD (add milestone bundle amounts over Years Z-5):$8,561,029 City of Lubbock Health Department - RHP 12 Plan Page 9 of 26 Project Option: 1.8.6 - The expansion of existing dental clinics, the establishment of additional dental clinics or the expansion of dental clinic hours. Performing Provider: City of Lubbock Health Department/135103304 Unique Project ID: 135103304.1.2 — "PASS 2" PROVIDER: The City of Lubbock, Texas is currently home to over 229,000 residents. The City of Lubbock Health Department's mission is to protect the health, safety and welfare of citizens through: 1. Preventing epidemics and the spread of disease; 2. Educating and empowering people to adopt health and responsible behaviors; 3. Promoting the quality and accessibility of health services; and 4. Developing new insights and Innovative solutions to health problems. INTERVENTIONSThe City of Lubbock Health Department will expand dental services, through the establishment of a new dental clinic. NEED FOR THE PROJECT: The City of Lubbock selected this project because It directly addresses Region 12 Community Needs Assessment IDA CN13 (Important Need): There is a shortage of dental care,• and ID# CN3 (Urgent Need): Poor Insurance support or uninsured. The City of Lubbock does not currently operate a dental clinic; therefore, this will be a new endeavor. TARGET POPULATION: The target population for this project Includes people who don't historically have access to or avail themselves of dental care: people with mental illness, substance abuse issues, intellectual disabilities, people who are homeless, people struggling with the challenges of aging, veterans, people living In poverty, etc. Estimates are that 95% of the people served in this new clinic will be Medicaid funded or indigent. CATEGORY 1 EXPECTED PATIENT BENEFITS: During DY3 the City of Lubbock will hire and train staff, develop all operational protocols and clinical guidelines and develop a baseline from which to calculate system Improvements. With Pass 1 funding, the City of Lubbock plans to provide at least 600 office visits in DY4 and to provide at least 750 office visits in DY5, serving 350 people per year. Pass 2 funding will allow the City of Lubbock to provide an additional 250 office visits each year in DY4 and DYS, with capacity to serve 147 more people each year. The City of Lubbock will focus upon special needs patients, pregnant women and/or the elderly hoping for a 10% increase over baseline in DY4 and 15% over baseline in DYS. CATEGORY 3 OUTCOMES: (IT — 7.7) The goal of this project is to decrease of older adults 65 years or olderwith urgent dental care needsby 10% from baseline in DY4 and 15% from baseline In DYS. City of Lubbock Health Department - RHP 12 Plan Page 10 of 26 Project Option: 1.8.6 - The expansion of existing dental clinics, the establishment of additional dental clinics or the expansion of dental clinic hours. Performing Provider: City of Lubbock Health Department/135103304 Unique Project ID: 135103304.1.2 - "PASS 2" Project Description: During Pass 2, the City of Lubbock will expand Its Pass 1 project (which was to establish a new dental clinic) in two (2) ways: 1. Serve more people than possible with Pass 1 funding alone and 2. Expand dental clinic hours from those anticipated with Pass 1 funding. Dental health is a key component of overall health. Oral disease can lead to poor nutrition; serious systemic Illnesses and conditions such as poor birth outcomes, diabetes and cardiovascular disease; and a diminished quality of life and life expectancy. Inadequate access to oral health services compounds other health Issues. can result in untreated dental disease that not only affects the mouth, but can also have physical, mental, economic and social consequences. Fortunately, many of the adverse effects associated with poor oral health can be prevented with quality regular dental care, both at home and professionally. Increasing, expanding and enhancing oral health services will Improve health outcomes. The Texas Dental Association (TDA) looked carefully at the economic, medical and social consequences of untreated oral disease in Texas. It reviewed the current systems of oral health care delivery, assessed payment structures, and studied the oral health status of Texans in general and analyzed the oral health disparities that exist in the state. Then TDA made specific and practical policy recommendations to expand access to oral health care in Texas, including: Identifying a "dental home" for every citizen; creating new programs to encourage general dentists and specialists to practice In underserved areas and to treat underserved populations; developing a comprehensive oral health public awareness and education campaign; and expanding access to oral health services for older citizens. This project (in combination with the City of Lubbock's Pass 1 project) focuses upon all of these state priorities by establishing a new dental clinic, targeting people who don't historically have access to or avail themselves of dental care: people with mental Illness, substance abuse Issues, Intellectual disabilities, people who are homeless, people struggling with the challenges of aging, veterans, people living In poverty, etc. The City of Lubbock Health Department (City of Lubbock) does not have adequate resources to meet the demand for dental services in Lubbock, especially for populations with special needs. This project sets forth collaboration with the Local Mental Health Authority (StarCare Specialty Health System "StarCare") and a Federally Qualified Health Center (the Texas Tech School of Nursing's Federally Qualified Health Center, The Larry Combest Center for Health and Wellness "Combese) to obtain synergy, economies of scale and to increase access for preventative dental visits impacting the severity of going to the dentist as a last resort. This project will help divert patients from more expensive, less effective treatment of extreme dental procedures. The City of Lubbock plans to partner with StarCare and Combest to engage a Lubbock Oral Health Project Coordinator to conduct a city-wide needs assessment related to citizens of all ages, to perform a gap analysis and to develop a dental coalition of all providers of dental services to people with low Income. In addition, the coalition will develop a Lubbock Oral Health Plan and begin implementation of the Lubbock Oral Health Program. Next, the City of Lubbock, StarCare and Combest will partner to open a new dental clinic, to Include the development of policies and procedures and hiring and training staff. The initial plan Is to co -locate with a new integrated physical and behavioral health clinic in StarCare's Psychiatric Emergency Service Center in order to improve access to marginalized populations. With Pass 1 funding, the City of Lubbock plans to provide at least 600 office visits in DY4 and to provide at least 750 office visits In DYS, serving 350 people per year. Pass 2 funding will allow the City of Lubbock to provide an additional 2S0 office visits each year In DY4 and DYS, with capacity to serve 147 more people each year. The City of Lubbock will focus upon special needs patients, pregnant women and/or the elderly hoping for a 10% Increase over baseline in DY4 and 1S% over baseline in DYS. Goal of Project: The primary goals of this project are to: close gaps/disparities In access to dental care services and to enhance the quality of dental care provided. Challenges: Challenges associated with the successful implementation of this project are: lack of qualified dental providers, patient transportation and low oral health literacy. The City of Lubbock will work with its project partners to develop and implement a comprehensive provider recruitment effort and public Information campaign. The dental clinic will likely provide bus passes to patients to help address Issues related to transportation. 5 -Year Expected Outcome for Performing Provider and Patients: Performing Provider Perspective —Improved healthcare Infrastructure that better serves the Medicaid -funded and uninsured residents of our counties; coordinated care delivery system; improved efficiency and cost growth containment. • Patient Perspective— high quality, patient -centered care; improved access to coordinated healthcare; improved health outcomes. Relationship to Regional Goals: Commissioned by the Regional Healthcare Partnership (RHP), the West Texas Area Health Education Center conducted an assessment of the healthcare -related needs In Region 12. The resulting document ranked the needs In tiers, according to the availability of evidence documenting each need. Tier one Included the two (2) most pressing needs in RHP 12:1) a severe lack of primary care access including provider shortages, financial barriers, wait times, and length of time to get an appointment; and 2) a lack of mental health services including lack of available appointments, insurance coverage, and emergency room usage for mental health issues. Tier two Identified other priority issues as: 1) uninsured and undertnsured; 2) high Incidence of obesity, diabetes, and heart disease, 3) need for specialty care; and 4) need for cancer screenings; and S) Insufficient matemal and prenatal care. The goals of Region 12 are to address as many Identified community needs as possible, focusing on those identified as "critical" and 'urgent," including Increased access to care, increased prevention and early detection activities and quality/performance Improvement. This project is directly related to the Region 12 goals of increased access to care and Increased prevention and early detection activities. This project will transform healthcare delivery from a disease -focused model of episodic care to a patient centered, coordinated delivery model that Improves patient satisfaction and health outcomes, reduces unnecessary or duplicative services and builds on the accomplishments of our existing healthcare system. Starting Point/Baseline: The City of Lubbock does not currently operate a dental clinic; therefore, the starting point/baseline for the number of people to be assisted is zero. Reason/Rationale for Selecting Measure: Poor oral health affects more than just the mouth. It can seriously compromise a person's general health, quality of fife and fife expectancy. Oral diseases can and do lead to systemic problems — damaging other parts of the body and resulting /n the need for expensive emergency department visits, hospital stays and medications. The consequences of poor aro/ health, however, go for beyond damaging medical effects. Oral disease can also wreak economic havoc — keeping children out of school and adults home from work — not to mention lower productivity of workers in pain. Untreated oral diseases can also drive up healthcare costs /a general. The good news is that with proper oro/ healthcare, both at home and in professional settings, many of the negative consequences associated with poor oral health can be prevented.' S littn://www.buildingbeuemrallicalth.or,,Jtnedia/-rDA full report.ndf City of Lubbock Health Department - RHP 12 Plan Page 11 of 26 The number of emergency -room visits for patients seeking dental treatment has Increased, mostly because of problems that could have been prevented with regular dental visits, according to the Pew Center on the States. Most cases are in rural areas, which have a shortage of dentists. Nationwide, the number of ER dental visits increased 16 percent from 2006 to 2009, and the center suggests the trend is continuing. Visiting the ER for dental treatment can be 10 times more expensive than preventive care. Many visits involve the same patients seeking more care because emergency rooms aren't staffed by dentists. Doctors can offer pain relief, but not much more, and many patients can't afford follow-up treatment or can't find a dentist. "Emergency rooms are really the canary In the coal mine. If people are showing up in the ER for dental care, then we've got big holes In the delivery of care," said Shelly Gehshan, director of Pew's child -dentistry campaign. "It's Just like pouring money down a hole." The Center analyzed Information from 24 states, the Federal Agency for Healthcare Research and Quality and dental care studies. It found that in 2009, 56 percent of children with Medicaid didn't receive dental care, ER visits for dental care increased by almost 60 percent In South Carolina, and there were 55,000 dental -related ER visits in Tennessee hospitals. Part of the problem is that few dentists participate In Medicaid programs, The Associated Press reports. The center Is working with states to develop dental hygienists training programs and train non -dentists to treat cavities and other uncomplicated procedures. More than 830,000 visits to emergency rooms nationwide in 2009 were for preventable dental problems. Dental disease is the No.1 chronic childhood disease, sending more children In search of medical treatment than asthma. In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay. 6 The following Project Option and Project Components were selected because they directly address Region 12 Community Needs Assessment IDN CN13 (Important Need): There is a shortage of dental core, and IDA CN3 (Urgent Need): Poor Insurance support or uninsured. Project Option 1.8: Increase and expand services by Increasing clinics, clinic hours, using satellite mobile clinics with an afRliated fixed -site dental clinic location, school-based/school-linked health centers or other approaches to Increase oral health services to underserved populations. Project Component: 1.8.6 Expansion of dental clinic hours The City of Lubbock will conduct Continuous Quality Improvement (CQI) activities using methods such as rapid cycle Improvement. Activities may include, but are not limited to, identifying project impacts, identifying "lessons learned," opportunities to scale all or part of the project to a broader patient population and Identifying key challenges associated with expansion of the project, including special considerations for safety -net populations. Our RHP will encourage participation by all our partners in a Learning Collaborative that will meet annually to discuss local disparities In care and the ways they have successfully gathered relevant data and ultimately better served the populations in their projects. in addition to the face-to-face meeting, we will have an open forum on our website that will foster communication amongst our partners with related projects. Unique Community Need IDA: CN13 There is a shortage of dental services and CN3 Poor insurance support or uninsured. Milestones & Metria: The milestones and metrics (1.8.6 — P-4, 4.1; P-10,10.1; and 1-14,14.1) selected for this project directly address CNA13&3 outlined In the Region 12 Community Needs Assessment. Related Category 3 Outcome Measure: OD -7 Oral Health; IT -7.7 Urgent Dental Care Needs in Older Adults: Proportion of older adults aged 65 and older with urgent dental care needs (standalone measure) Reason/RaUanale for Selection: According to the Region 12 Community Needs Assessment, there is a shortage of dental services and a high prevalence of people with poor insurance support or who are uninsured. According to the TDA, services for older Texans Is a priority. Explanation of how focusing on the outcomes will help Improve the health of low -Income populations: Establishment of a new dental clinic focusing services upon people who are under- or uninsured will directly help Improve the health of low-income populations. Relationship to Other Projects: This project relates to the City of LubbocVs Pass i project (135103304.1.1— expand access/hours in dental clinic) In that it allows the new clinic to be open longer hours than possible with only Pass 1 funding. These projects are all related in that they are aimed to Increasing access to needed health care in the most appropriate setting. Relationship to Other Performing Providers' Projects In RHP & Plan for Learning Collaborative: This project relates to StarCare's Pass 1 and Pass 2 projects (084897001.1.1 and 084897001.1.2) - to open a Psychiatric Emergency Service Center and adolescent crisis respite unit — in that this clinic will be housed within the same facility. Our RHP will encourage participation by all our partners In a "leaming collaborative" that will meet annually to discuss local disparities in care and the ways they have successfully gathered relevant data and ultimately better served the populations in their projects. In addition to the face-to-face meeting, we will have an open forum on our website that will foster communication amongst our partners with related projects. Proleet Valuation! Criteria Narrative Score This project is designed to achieve, to the greatest extent possible, the Texas Healthcare Transformation and Quality Improvement Achieves (1115 Waiver) goals of 1. Improved patient care experience; 2. Improved health; and 3. Reduced cost of healthcare, without Waiver Goals compromised quality. In order to achieve alignment with this triple aim, the primary goal of this project is to ensure people receive Scale: coordinated, timely and site -appropriate healthcare services. The City of Lubbock hopes to address the healthcare disparity of unequal 5 1 to 5 access for people with low-income. This project will transform healthcare delivery from a disease -focused model of episodic care to a 5 Greatest patient centered, coordinated delivery model that improves patient satisfaction and health outcomes, reduces un- necessary or duplicative services and builds on the accomplishments of our existing healthcare system. Commissioned by the Regional Healthcare Partnership (RHP), the West Texas Area Health Education Center conducted an assessment Addresses of the healthcare -related needs in Region 12. The goals of Region 12 are to address as many Identified community needs as possible, Community Need(s) focusing on those identified as "critical" and "urgent," including Increased access to care, increased prevention and early detection activities and quality/performance Improvement. The following Project Option and Project Components were selected because they S Scale: directly address Region 12 Community Needs Assessment IDN CN13 (important Need): There is o shortage of dental care; and IDN CN3 1 to 5 (Urgent Need): Poor insurance support or uninsured. The lack of available appointments for people without money or insurance, 5 Greatest results in the need to use emergency rooms for initial contact. 6 httn::i'www.ocwstates.orgluDloadcdl--ilesiP('S Assets/2012!A%2OCostiv' lo2ODental". 2ODestination(i ).pdf City of Lubbock Health Department - RHP 12 Plan Page 12 of 26 135103304.1.2 With Pass 1 funding, the City of Lubbock plans to provide at least 600 office visits in DY4 and to provide at least 750 office visits in DYS, n/a Project serving 350 people per year. Pass 2 funding will allow the City of Lubbock to provide an additional 250 office visits each year in DY4 135303304 scope/Size and DYS, with capacity to serve 147 more people each year. The City of Lubbock will focus upon special needs patients, pregnant Scale: women and/or the elderly hoping for a 10% increase over baseline in DY4 and 15% over baseline In DYS. When considering the impact 4 1 to S upon each person's care experience, his/her health and the reduced cost upon the community's healthcare delivery system, the scope 5 Greatest and size of this project will be fairly great. This project will be managed by highly trained staff who specialize in linkage to the right with urgent dental care needs core in the right setting. , Project The City of Lubbock's investment in this project will be fairly significant. Staffing will include a Program Director, Dentist(s), Licensed Milestone 2: [P-10): Investment Hygienists, Dentals Technicians, office personnel, etc. (Same administrative staff will be shared with StarCare and Combest in order to Scale: obtain economies of scale.) Other investments include physical space, furnishings and equipment, computer hardware/software, etc. 4 1 to 5 As one might Imagine, dental equipment can be very expensive. existingtrelocate dental care 5 Greatest with other providers and the RHP to 135103304.1.2 1.8.6 n/a The expansion of existing dental clinics, the establishment of additional dental clinics or the expansion of dental clinic hours. City of Lubbock Health Department 135303304 Urgent Dental Care Need In Related Category 3 Outcome Measure(s): 135103304.3.2 IT -7.7 Older Adults: Proportion of older adults aged 6S and older with urgent dental care needs , Milestone 2: [P-10): Milestone 4: (P-4): Milestone 6: (1-14) Participate in face-to-face teaming (i.e. Establish additional/expand Increase number of special meetings or seminars) at least twice per year existingtrelocate dental care population members that with other providers and the RHP to clinics or space. access dental services promote collaborative learning around shared or similar projects. At each fate -to- Metric(s): (P-4.11 Metric(s): (1-14.1) Milestone 1: (P-101: face meeting, ail providers shall identify and Number of additional clinics, 15% increase from baseline in Participate In face-to-face learning (i.e. agree upon several Improvement (simple "raise expanded space, or existing the number of children, special meetings or seminars) at least twice per Initiatives that all providers can do to available space used to capacity. needs patients, pregnant year with other providers and the RHP to the floor" for performance.) Each women and/or the elderly promote collaborative learning around participating provider should publicly Baseline/Goal: Add 1 new clinic accessing dental services. shared or similar projects. At each face -to- commit to Implementing these face meeting, all providers shall identify and Improvements. Data source: Tax IDII Baseline/Gos1:10%Increase agree upon several Improvement (simple Metric($): (P-10.1] Milestone 4 Estimated Incentive over baseline In the number of Initiatives that all providers can do to "raise Participate in semi-annual face-to-face Payment: $106,001 children, special needs the floor" for performance.) Each meetings or seminars organized by the RHP. patients, pregnant women participating provider should publicly and/or the elderly accessing commit to implementing these Base0ne/Goal: Participate in face-to-face Milestone S. (P-31 dental services. Improvements. meetings Increase Interdisciplinary (IDT) Metrigs): (P-10.1) training and education for dental Data source: Claims, Participate in semi-annual face-to-face Data source: Documentation of semi-annual and other health care providers encounter and clinical record meetings or seminars organized by the RHP. meetings, including meeting agendas, slides to promote an ID Team approach data from presentations, and/or meeting notes. to addressing oral health. Baseltne/Goal: Participate in face-to-face Milestone 2 Estimated Incentive Payment: Metrlc(s): (P3.1) Milestone 6 Estimated meetings $156,186 City of Lubbock will hold Incentive Payment: $147,698 Data Source: Documentation of semi- quarterly (4/year) grand rounds, annual meetings, including meeting Milestone 3: [P-31 In-service trainings and agendas, slides from presentations, and/or Increase Interdisciplinary (IDT) training and continuing education that focus Milestone 7: [P-31 education for dental and other health care on oral health issues and Increase Interdisciplinary (IDT) meeting notes. providers to promote an ID Team approach Implications as related to chronic training and education for Milestone 1 Estimated Incentive Payment: to addressing oral health. diseases, such as diabetes and dental and other health care $297,150 cardiovascular disease and providers to promote an ID Metric(s): (P3.1] pregnancy. Team approach to addressing City of Lubbock will hold quarterly (4/year) oral health. grand rounds, in-service trainings and continuing education that focus on oral Goal: City of Lubbock will hold Metric(s): [P3.11 health issues and implications as related to quarterly (4/year) grand rounds, City of Lubbock will hold chronic diseases, such as diabetes and in-service trainings and quarterly (4/year) grand cardiovascular disease and pregnancy. continuing education that focus rounds, In-service trainings and on oral health issues and continuing education that Goal: City of Lubbock will hold quarterly Implications as related to chronic 1 focus on oral health Issues and City of Lubbock Health Department - RHP 12 Plan Page 13 of 26 City of Lubbock Health Department - RHP 12 Plan Page 14 of 26 (4/year) grand rounds, in-service trainings diseases, such as diabetes and Implications as related to and continuing education that focus on oral cardiovascular disease and chronic diseases, such as health issues and implications as related to pregnancy. diabetes and cardiovascular chronic diseases, such as diabetes and disease and pregnancy. cardiovascular disease and pregnancy. Data Source: Attendance rosters, Goal: City of Lubbock will hold Data Source: Attendance rosters, power power point presentations, sign quarterly (4/year) grand point presentations, sign in sheets, etc. in sheets, etc. rounds, in-service trainings and continuing education that Milestone 3 Estimated Incentive Payment: focus on oral health Issues and $156,185 Milestone 5 Estimated Incentive Implications as related to Payment: $106,000 chronic diseases, such as diabetes and cardiovascular disease and pregnancy. Milestone 6: 11-141 Increase number of special Data Source: Attendance population members that access rosters, power point dental services presentations, sign in sheets, etc. Metric(s): (1-14.1) 10% Increase over baseline In the number of children, special Milestone 7 Estimated needs patients, pregnant women Incentive Payment: $147,698 and/or the elderly accessing dental services. Goal: 10% Increase over baseline In the number of children, special needs patients, pregnant women and/or the elderly accessing dental services. Data Source: Claims, encounter and clinical record data Milestone 6 Estimated Incentive Payment: $106,000 DY 2 Estimated Milestone Bundle Amount: DY 3 Estimated Milestone Bundle Amount: DY4 Estimated Milestone Bundle DY5 Estimated Milestone $297,150 $312,371 Amount: $318,001 Bundle Amount: $295,396 TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4 -YEAR PERIOD (add milestone bundle amounts over Years 2-5): $1,222,918 City of Lubbock Health Department - RHP 12 Plan Page 14 of 26 our nartners with related oroleets. Prolect Valuation: Criteria Narrative Score Achieves This project Is designed to achieve, to the greatest extent possible, the Texas Healthcare Transformation and Quality Improvement Walver Goals (1115 Waiver) goals of 1. Improved patient care experience; 2. Improved health; and 3. Reduced cost of healthcare, without Scale: compromised quality. In order to achieve alignment with this triple aim, the primary goal of this project is to ensure people receive I to 5 coordinated, timely and site -appropriate healthcare services. The City of Lubbock hopes to address the healthcare disparity of unequal s 5 Greatest access for people with low-income. This project will transform healthcare delivery from a disease -focused model of episodic care to a patient centered, coordinated delivery model that Improves patient satisfaction and health outcomes, reduces unnecessary or duplicative services and builds on the accomplishments of our existing healthcare system. Addresses Commissioned by the Regional Healthcare Partnership (RHP), the West Texas Area Health Education Center conducted an assessment Community of the healthcare -related needs In Region 12. The goals of Region 12 are to address as many Identified community needs as possible, Need(s) focusing on those identified as "critical" and 'urgent,' Including Increased access to care, Increased prevention and early detection activities and quality/performance improvement. The following Project Option and Project Components were selected because they 5 Scale: directly address Region 12 Community Needs Assessment IDN CN13 (Important Need): There is a shortage of dental care; and IDN CN3 1 to 5 (Urgent Need): Poor insurance support or uninsured. The lack of available appointments for people without money or insurance, 5 Greatest results in the need to use emergency rooms for Initial contact. Project The City of Lubbock hopes to provide at least 600 office visits during DY4 and to provide at least 750 office visits in DYS. Conceivably, Scope/Size over 350 people per year could be impacted by this project. The City of Lubbock will focus upon special needs patients, pregnant women and/or the elderly hoping for a 10% Increase over baseline in DY4 and 15% over baseline In DYS. When considering the Impact 4 Scale: upon each person's care experience, his/her health and the reduced cost upon the community's healthcare delivery system, the scope 1 to S and size of this project will be fairly great. This project will be managed by highly trained staff who specialize in linkage to the right 5 Greatest care in the right setting, Project The City of Lubbock's Investment in this project will be fairly significant. Staffing will Include a Program Director, Dentist(s), Licensed Investment Hygienists, Dentals Technicians, office personnel, etc. (Some administrative staff will be shared with StarCare and Combest in order to 4 Scale: obtain economles of scale.) Other Investments Include physical space, furnishings and equipment, computer hardware/software, etc. 1 to 5 As one might Imagine, dental equipment can be very expensive. 5 Greatest City of Lubbock Health Department - RHP 12 Plan Page 25 of 26 135103304.1.1 1.8.6 n/a The expansion of existing dental clinics, the establishment of additional dental clinics or the expansion of dental Clinic he... City of Lubbock Health Department 135103304 Urgent Dente) Gre Neetl In Related Category 3 Outcome Measurels): 135103304.3.1 IT-2.2 of sugaradltss:ged65 and older adult aged 65 and with urgent dental care ..ad, Milestone 3: [P10 : Milestone 4: Is 41. Milestone 6 T1-141 Participate In face to lace learning I.e. Establish addltlemal/expand Increase number f special meetings or seminars) at least twice peryear existing/relocate dental care population members that with other providers and the RHP to Oltdm or space. access dental services promote Collaborative learning around shared or similar projects. At each face-to- Mei [P-4.11 Metricsh [1-14.1] face meetln& all providers shall Identify and Number of addition[ 15% Increase from baseline In agree upon several Improvement (simple expanded space, or existing the number of children. special Initiatives that all providers can do to "raise available space used to capacity. needs patients, pregnant the Roof for performance.) Each women and/or the elderly participating provider should publicly Baseline/Goal: Add 1 new clinic accessing dental services. commit to Implementing these Improvements. Dale Source: Tax lop Milestone 1:(p-101: Bamllne/Goala0%Increase Participate In face-todace learning (i.e. Metric($):[P-10.11 Milestone Estimated Incentive over baseline In the number of meetings or seminars) at least twice per Participate In semi-annual face-to-face Payment: $7 0,530 children, special needs year with other providers and the RH P to meetings or seminars organized by the KH P. Milestone 5:(P-31 patients, pregnant women promote collaborative learning around I unease Indbudisupllnary(I DT) and/or he elderly accessing shared or similar projects. At each faceao, Baseline/Goal: Partldpate In face-to-face training and educaflon for dental dental services. face meeting, all providers shall identify and meetings and other health Care providers agree upon several improvement (simple to promote an lit Team approach Date Source: Claims, initiatives that all providers con do to"ralze Data Source: Documentation of semi-annual to addressing oral health. encounter and Clinical record the floor" for performance.) Each meetings, Including meeting agerl slides data particlpating provider should publicly from presentations, and/or meeting notes. sell IP3.11 commit to Implementing these City of Lubbock will hold improvement. Milestone 2 Estimated Incentive Payment: quarterly(4/year] grand rounds, Milestone 6 Estimated $1,066,396 in-service trainings and Incentive Payment Mei (P 10.11 continuing education that focus $1,102,218 Pamclpate in semi annual face-to-face Milestone 3:(P-3) on oral health Issues and MBeslone T. (P-31 meetings or seminarscIrganlzed by the RHP. Increase lnterdlsdpllnary(for) training and implications as related to Chronic Increase lnterdlscipllnary(for) education for Dental and other health Care diseases, such as diabetes and tralNng and education for providers to promote an to Team approach cardiovesmlar disease and dental and other health care Basellne/Goal: Participate In face-to-face to addressing oral health. pragmatics. providers to promote an to meetings Team approach to addressing Metrit[s1:[P3.11 Goal: City of Lubbock will hold oral health. Data source: Documentation of sem4 City of Lubbock will hold quarterly (4/year) quarterly(4/year) Wand rounds, annual meeting; including meeting grand rounds, in- service trainings and imsetvlm trainings and MCMHs): IP3.11 agendas, slides from presentations, and/or Continuing education that focus on oral continuing education that focus City of Lubbock will held meeting notes. health Issues and irnmil lops as related to on oral health Issues and quarterly(4/yead grand Chronic diseases, such as diabetes and Implications as rNated to chronic coupon, in-service tralnings and Milestone l Estimated Incentive Payment: Cardiovascular disease and pregnai diseases, such as diabetes and continuing education that $1,942,214 cardiovascular d"uesse and focus on oral health issues and Goal: City of Lubbock will hold quarterly pregnancy. implications as related to (4/yei grand rounds, in-service trainings chronic diseases, such as and Continuing education that focus on oral Data Source: Attendance rosters, diabetes and cardlovesmlar health issues and implications as related to power point presentations, sign disease and pregrucv. chronic diseases, such as diabetes and in sheets, etc. cardiovascular disease and pregnancy. Goal: City of Lubbock will hold Milestone S Estimated Incentive quarterly i4/yearl grand Data Scum: Attendance posters, power Payment: $260,530 pounds, In-service trainings and paint presentations, sign In sheets, etc. continuing education that Milectone6: [I-141 focus on oral health issues and Milestone 3 Estimated Incentive Payment: Increase number of special implications as related to $1,066,395 papulation members that access chronic d lseases, such as dental services diabetes and cardiovascular disease and pregnancy. Metral [1-14.11 10%increase mearbaselinelnthe Dat Sperm: Attendance City of Lubbock Health Department - RHP 12 Plan Page 16 of 26 City of Lubbock Health Department - RHP 12 Plan Page 17 of 26 number of children, special rosters, power point needs patients, pregnant women presentations, sign in sheets, and/or the elderly accessing etc. dental services. Goal: 10% Increase over baseline Milestone 7 Estimated In the number of children, special Incentive Payment: needs patients, pregnant women $1,102,217 and/or the elderly accessing dental services. Data Source: Claims, encounter and clinical record data Milestone 6 Estimated Incentive Payment: $760,530 DY 2 Estimated Milestone Bundle Amount: DY 3 Estimated Milestone Bundle Amount: DY4 Estimated Milestone Bundle DYS Estimated Milestone $1,942,214 $2,132,791 Amount: $2,281,590 Bundle Amount: $2,204,435 TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4 -YEAR PERIOD (add milestone bundle amounts over Years 2-5): $8,561,029 City of Lubbock Health Department - RHP 12 Plan Page 17 of 26 Project Option: 1.8.6 - The expansion of existing dental clinics, the establishment of additional dental cllnics or the expansion of dental clinic hours. Performing Provider: City of Lubbock Health Department/135103304 Unique Project ID:135103304.1.2 — "PASS r PROVIDER: The City of Lubbock, Texas Is currently home to over 229,000 residents. The City of Lubbock Health Department's mission is to protect the health, safety and welfare of citizens through: 1. Preventing epidemics and the spread of disease; 2. Educating and empowering people to adopt health and responsible behaviors; 3. Promoting the quality and accessibility of health services; and 4. Developing new insights and Innovative solutions to health problems. INTERVENTIONSThe City of Lubbock Health Department will expand dental services, through the establishment of a new dental clinic. NEED FOR THE PROJECT: The City of Lubbock selected this project because it directly addresses Region 12 Community Needs Assessment ID# CN13 (Important Need): There is a shortage of dental care; and ID# CN3 (Urgent Need): Poor insurance support or uninsured. The City of Lubbock does not currently operate a dental clinic; therefore, this will be a new endeavor. TARGET POPULATION: The target population for this project Includes people who don't historically have access to or avail themselves of dental care: people with mental illness, substance abuse Issues, intellectual disabilities, people who are homeless, people struggling with the challenges of aging, veterans, people living in poverty, etc. Estimates are that 95% of the people served in this new clinic will be Medicaid funded or indigent. CATEGORY 1 EXPECTED PATIENT BENEFITS: During DY3 the City of Lubbock will hire and train staff, develop all operational protocols and clinical guidelines and develop a baseline from which to calculate system Improvements. With Pass 1 funding, the City of Lubbock plans to provide at least 600 office visits In DY4 and to provide at least 750 office visits in DYS, serving 350 people per year. Pass 2 funding will allow the City of Lubbock to provide an additional 250 office visits each year in DY4 and DYS, with capacity to serve 147 more people each year. The City of Lubbock will focus upon special needs patients, pregnant women and/or the elderly hoping for a 10% increase over baseline in DY4 and 15% over baseline in DYS. CATEGORY 3 OUTCOMES: (IT — 7.7) The goal of this project is to decrease of older adults 65 years or olderwlth urgent dental care needsby 10% from baseline in DY4 and 15% from baseline In DYS. City of Lubbock Health Department - RHP 12 Plan Page 18 of 26 Project Option: 1.8.6 - The expansion of existing dental clinics, the establishment of additional dental clinics or the expansion of dental clinic hours. Performing Provider. City of Lubbock Health Department/135103304 Unique Project ID: 135103304.1.2 - "PASS 2" Project Description: During Pass 2, the City of Lubbock will expand Its Pass 1 project (which was to establish a new dental clinic) in two 12) ways: 1. Serve more people than possible with Pass 1 funding alone and 2. Expand dental clinic hours from those anticipated with Pass 1 funding. Dental health is a key component of overall health. Oral disease can lead to poor nutrition; serious systemic illnesses and conditions such as poor birth outcomes, diabetes and cardiovascular disease; and a diminished quality of life and life expectancy. Inadequate access to oral health services compounds other health issues. can result in untreated dental disease that not only affects the mouth, but can also have physical, mental, economic and social consequences. Fortunately, many of the adverse effects associated with poor oral health can be prevented with quality regular dental care, both at home and professionally. Increasing, expanding and enhancing oral health services will improve health outcomes. The Texas Dental Association (TDA) looked carefully at the economic, medical and social consequences of untreated oral disease in Texas. It reviewed the current systems of oral health care delivery, assessed payment structures, and studied the oral health status of Texans in general and analyzed the oral health disparities that exist in the state. Then TDA made specific and practical policy recommendations to expand access to oral health care In Texas, Including: Identifying a "dental home" for every citizen, creating new programs to encourage general dentists and specialists to practice in underserved areas and to treat underserved populations, developing a comprehensive oral health public awareness and education campaign; and expanding access to oral health services for older citizens. This project (in combination with the City of Lubbock's Pass 1 project) focuses upon all of these state priorities by establishing a new dental clinic, targeting people who don't historically have access to or avail themselves of dental care: people with mental Illness, substance abuse Issues, Intellectual disabilities, people who are homeless, people struggling with the challenges of aging, veterans, people living in poverty, etc. The City of Lubbock Health Department (City of Lubbock) does not have adequate resources to meet the demand for dental services in Lubbock, especially for populations with special needs. This project sets forth collaboration with the Local Mental Health Authority (StarCare Specialty Health System "StarCare") and a Federally Qualified Health Center (the Texas Tech School of Nursing's Federally Qualified Health Center, The Larry Combest Center for Health and Wellness "Combest") to obtain synergy, economies of scale and to Increase access for preventative dental visits Impacting the severity of going to the dentist as a last resort. This project will help divert patients from more expensive, less effective treatment of extreme dental procedures. The City of Lubbock plans to partner with StarCare and Combest to engage a Lubbock Oral Health Project Coordinator to conduct a city-wide needs assessment related to citizens of all ages, to perform a gap analysis and to develop a dental coalition of all providers of dental services to people with low income. In addition, the coalition will develop a Lubbock Oral Health Plan and begin implementation of the Lubbock Oral Health Program. Next, the City of Lubbock, StarCare and Combest will partner to open a new dental clinic, to include the development of policies and procedures and hiring and training staff. The initial plan is to co -locate with a new integrated physical and behavioral health clinic in StarCare's Psychiatric Emergency Service Center in order to Improve access to marginalized populations. With Pass 1 funding, the City of Lubbock plans to provide at least 600 office visits in DY4 and to provide at least 750 office visits in DYS, serving 350 people per year. Pass 2 funding will allow the City of Lubbock to provide an additional 250 office visits each year in DY4 and DYS, with capacity to serve 147 more people each year. The City of Lubbock will focus upon special needs patients, pregnant women and/or the elderly hoping for a 10% increase over baseline In DY4 and 15% over baseline in DYS. Goal of Project: The primary goals of this project are to: close gaps/disparities in access to dental care services and to enhance the quality of dental care provided. Challenges: Challenges associated with the successful implementation of this project are: lack of qualified dental providers, patient transportation and low oral health literacy. The City of Lubbock will work with its project partners to develop and implement a comprehensive provider recruitment effort and public information campaign. The dental clinic will likely provide bus passes to patients to help address Issues related to transportation. S -Year Expected Outcome for Performing Provider and Patients: Performing Provider Perspective — improved healthcare infrastructure that better serves the Medicaid -funded and uninsured residents of our counties; coordinated care delivery system; improved efficiency and cost growth containment. • Patient Perspective— high quality, patient -centered care; improved access to coordinated healthcare; improved health outcomes. Relationship to Regional Goals: Commissioned by the Regional Healthcare Partnership (RHP), the West Texas Area Health Education Center conducted an assessment of the healthcare -related needs In Region 12. The resulting document ranked the needs In tiers, according to the availability of evidence documenting each need. Tier one included the two (2) most pressing needs In RHP 12:1) a severe lack of primary care access including provider shortages, financial barriers, wait times, and length of time to get an appointment; and 2) a lack of mental health services including lack of available appointments, insurance coverage, and emergency room usage for mental health Issues. Tier two Identified other priority issues as: 1) uninsured and underinsured; 2) high incidence of obesity, diabetes, and heart disease; 3) need for specialty care; and 4) need for cancer screenings; and 5) insufficient maternal and prenatal care. The goals of Region 12 are to address as many identified community needs as possible, focusing on those identified as "critical" and "urgent," including Increased access to care, Increased prevention and early detection activities and quality/performance improvement. This project is directly related to the Region 12 goals of increased access to care and increased prevention and early detection activities. This project will transform healthcare delivery from a disease -focused model of episodic care to a patient centered, coordinated delivery model that Improves patient satisfaction and health outcomes, reduces unnecessary or duplicative services and builds on the accomplishments of our existing healthcare system. Starting Point/Baseline: The City of Lubbock does not currently operate a dental clinic; therefore, the starting point/baseline for the number of people to be assisted is zero. Reason/Rationale for Selecting Measure: Poor oral health affects more than just the mouth. It can seriously compromise a person's general health, quality of life and life expectancy. Oral diseases can and do lead to systemic problems — damaging other parts of the body and resulting in the need for expensive emergency department visits, hospital stays and medications. The consequences of poor oral health, however, go far beyond damaging medical effects. Oral disease con also wreak economic havoc — keeping children out of school and adults home from work — not to mention lower productivity of workers In pain. Untreated oral diseases can also drive up healthcare costs in general. The good news Is that with proper oral healthcare, both at home and in professional settings, many of the negative consequences associated with poor oral health can be prevented.7 lttn://WWW,bUildingbetterorallicallb.orginediaCj'DA full renort.pdf City of Lubbock Health Department - RHP 12 Plan Page 19 of 26 The number of emergency -room visits for patients seeking dental treatment has Increased, mostly because of problems that could have been prevented with regular dental visits, according to the Pew Center on the States. Most cases are In rural areas, which have a shortage of dentists. Nationwide, the number of ER dental visits increased 16 percent from 2006 to 2009, and the center suggests the trend is continuing. Visiting the ER for dental treatment can be 10 times more expensive than preventive care. Many visits involve the same patients seeking more care because emergency rooms aren't staffed by dentists. Doctors can offer pain relief, but not much more, and many patients can't afford follow-up treatment or can't find a dentist. "Emergency rooms are really the canary in the coal mine. if people are showing up in the ER for dental care, then we've got big holes In the delivery of care,' said Shelly Gehshan, director of Pew's child -dentistry campaign. "It's Just like pouring money down a hole." The Center analyzed Information from 24 states, the Federal Agency for Healthcare Research and Quality and dental care studies. It found that in 2009, 56 percent of children with Medicaid didn't receive dental pre, ER visits for dental care Increased by almost 60 percent in South Carolina, and there were 55,000 dental -related ER visits in Tennessee hospitals. Part of the problem Is that few dentists participate In Medicaid programs, The Associated Press reports. The center Is working with states to develop dental hygienists training programs and train non -dentists to treat cavities and other uncomplicated procedures. More than 830,000 visits to emergency rooms nationwide in 2009 were for preventable dental problems. Dental disease Is the No. l chronic childhood disease, sending more children in search of medical treatment than asthma. In a nation obsessed with high-tech medicine, people are not getting preventive care for something as simple as tooth decay. ° The following Project Option and Project Components were selected because they directly address Region 12 Community Needs Assessment ID# CN13 (Important Need): There is a shortage of dental care; and ID# CN3 (Urgent Need): Poor Insurance support or uninsured. Project Option 1.8: Increase and expand services by increasing clinics, clinic hours, using satellite mobile clinics with an affiliated fixed -site dental clinic location, school-based/school-linked health centers or other approaches to increase oral health services to underserved populations. Project Component: 1.8.6 Expansion of dental clinic hours The City of Lubbock will conduct Continuous Quality Improvement (CQI) activities using methods such as rapid cycle improvement. Activities may Include, but are not limited to, identifying project impacts, Identifying "lessons learned," opportunities to scale all or part of the project to a broader patient population and Identifying key challenges associated with expansion of the project, including special considerations for safety -net populations. Our RHP will encourage participation by all our partners in a Learning Collaborative that will meet annually to discuss local disparities In care and the ways they have successfully gathered relevant data and ultimately better served the populations In their projects. In addition to the face-to-face meeting, we will have an open forum on our website that will foster communication amongst our partners with related projects. Unique Community Need IDN: CN13 There is a shortage of dental services and CN3 Poor insurance support or uninsured. Milestones & Metria: The milestones and metria (1.8.6 — P-4, 4.1; P-10,10.1; and 1-14, 14.1) selected for this project directly address CN#13&3 outlined in the Region 12 Community Needs Assessment. Related Category 3 Outcome Measure: OD -7 Oral Health; IT -7.7 Urgent Dental Care Needs In Older Adults: Proportion of older adults aged 65 and older with urgent dental care needs (standalone measure) Reason/Rationale for Selection: According to the Region 12 Community Needs Assessment, there is a shortage of dental services and a high prevalence of people with poor insurance support or who are uninsured. According to the TDA, services for older Texans is a priority. Explanation of how focusing on the outcomes will help improve the health of low-income populations: Establishment of a new dental clinic focusing services upon people who are under- or uninsured will directly help Improve the health of low-income populations. Relationship to Other Projects: This project relates to the City of Lubbock's Pau 1 project (135103304.1.1— expand access/hours In dental clinic) in that it allows the new clinic to be open longer hours than possible with only Pass 1 funding. These projects are all related in that they are aimed to Increasing access to needed health care in the most appropriate setting. Relationship to Other Performing Providers' Projects In RHP & Plan for learning collaborative: This project relates to StarCare's Pass land Pass 2 projects (084897001.1.1 and 084897001.1.2) - to open a Psychiatric Emergency Service Center and adolescent crisis respite unit — In that this clinic will be housed within the same facility. Our RHP will encourage participation by all our partners in a'learning collaborative that will meet annually to discuss local disparities in care and the ways they have successfully gathered relevant data and ultimately better served the populations in their projects. In addition to the face-to-face meeting, we will have an open forum on our website that will foster communication amongst our partners with related projects. Prolect Valuation: criteria Narrative score This project is designed to achieve, to the greatest extent possible, the Texas Healthcare Transformation and Quality Improvement Achieves (1115 Waiver) goals of 1. Improved patient care experience; 2. Improved health; and 3. Reduced cost of healthcare, without Waiver Goals compromised quality. In order to achieve alignment with this triple aim, the primary goal of this project is to ensure people receive Scale: coordinated, timely and site -appropriate healthcare services. The City of Lubbock hopes to address the healthcare disparity of unequal S 1 to 5 access for people with low-income. This project will transform healthcare delivery from a disease -focused model of episodic care to a 5 Greatest patient centered, coordinated delivery model that improves patient satisfaction and health outcomes, reduces un- necessary or duplicative services and builds on the accomplishments of our existing healthcare system. Addresses Commissioned by the Regional Healthcare Partnership (RHP), the West Texas Area Health Education Center conducted an assessment of the healthcare -related needs in Region 12. The goals of Region 12 are to address as many Identified community needs as possible, Community Need(s) focusing on those Identified as "critical" and "urgent,' including Increased access to care, Increased prevention and early detection Scale: activities and quality/performance improvement. The following Project Option and Project Components were selected because they S directly address Region 12 Community Needs Assessment IDN CN13 (Important Need): There Is a shortage of dental core; and ID# CN3 I to 5 (Urgent Need): Poor Insurance support or uninsured. The lack of available appointments for people without money or insurance, 5 Greatest results in the need to use emergency rooms for initial contact. a http: ,"www.pewstates.oreluploadedFilesiPCS Assctsi20l2/A"o2OCostly°b2Ol)ental°o2ODeslinistian(1),I)df City of Lubbock Health Department - RHP 12 Plan Page 20 of 26 13 510 3 3 0 4.1.2 With Pass 1 funding the City of Lubbock plans to provide at least 600 office vlslts In DY4 and to provide at least 750 office visits In DY5, Ma Project serving 350 people per year. Pass 2 funding will allow the City of Lubbock to provide an additional 250 office vlslts each year In DY4 135103304 Snipe/Size and DY5, with capacity to serve 147 more People each year. The City of Lubbock will focus upon special needs patients, pregnant Scale: women and/or the elderly hoping for a l0% Increase over baseline In DY4 and 15% over baseline In OYS. When considering the Impact 4 l toy upon each person's care experience, his/her health and the reduced cost upon thecommunity's healthcare delivery system, the scope S Greatest and site of this project will be fairly great. This project will be managed by highly trained staff who specialize in linkage to the right older adults aged 65 and older core in the right setting. Project The City of Lubbock's investment In this project will be fairly significant. Staffing will Include a Program Director, Dentist($), Licensed a Investment Hygienists, Denials Technicians, office personnel, etc. (Some administrative staff will be shared with Startare and Compost in order to Scale: obtain economies of scale.] Other investments Include physlCal space. furnishings and equipmenC Computer hardware/software, etc 4 l to As one might Imagine, dental equipment can be ve ry expensive. Establishadditianebc.penp 5 Greatest meetings or seminars) at least tela per year 13 510 3 3 0 4.1.2 1.8.6 Ma The expanslon of existing dental clinics, the establishment of additional dental dinles or the expansion of dental clinic boon. C of Lubbock Health De a IT t 135103304 Urgent Dental Ore Need In Related Category 3Out come Meaure(sl: 1351033043.2 IT 7,7 Older Adults: Proportion of older adults aged 65 and older with ur ent dental care needs a Milestone 2: P 10I: Milestone 4: IR 4' Mllestene 6: lh14j Participate In faceioface learning (i.e. Establishadditianebc.penp Increase number of spacial meetings or seminars) at least tela per year existing/relocate dental cafe population members that with other Provides and the RHP to cllnlu or space. access dental services promote collaborative learning around Shared or similar proletts. At each face -to- Metai IP4.1] Metric(s): 1614.11 Milestone l:(P4o1: face meeMg all providers shall identify and Number of additional clinics, 15% Increase from baseline In Paract,ate In face -to face learning (i.e. agree upon several improvement(simple expanded space, or existing the number of children, special meetings orseminars)at leasttwlce per initiatives that all providers can do to 'raise available space used to capacity. needs patients, pregnant the Oao('for performance.) Each women antl/onhe elderly pcovl year with other ders and the RHP t0 participating provider should publicly Basellne/Gwl: Add l new clinic accessing dental services. promos collaborative At ach mit to implementing these eng projects. facround fcetrinihared or projects. eaNntify n face meeting all providers SM1all itlentify and ng, all shall Improvements. Data Source: Tax lop agree upon sawal Improvement (simple Baseline/Ga L• ase initiatives that all providers can do to "false 4611ma1ldincentive overren,spcia baseline In ihenumber of the number the fiooc for performance.) Each ParticMetHt(stein semi Payment•. 5106,001 PaymMilesent: children, eds partitlpaing provider should publicly meetings meetings or seminars organized by the RHP. organize by pregame women patients. pregnant women commit to Implementing these and/or she elderly accessing Improvements. asee/Goal: Participate In face to lace Blin Milestone 5: is 31 dental services. meati., Inc Increase lnnertllscipllnaryllDT) Mehk(sl:(P-30.11 training and Pat ucation for dental Data Source: Claims, Participate in semFannual faceterface Data Source: Documentation of semi-annual and other health care providers encounter and clinical record meetings or seminars organized by the RNP. m meetings, including meeting agendas, slides to promote an to Team approach data from presentations, and/or meeting notes. to addressing oral health. Basellne/Goal: Participate In taps -to dace Milestone 2 Estimated Incentive Payment Metai (P3.11 Milestone 6 Estimated meetings $1561 City of Lubbock will hold lacemiYe Payment: 5147,698 Data Source: Documentation dsemi- quarterly (4/year) grand Pounds, annual meetings, Actutling meeting Milestone 3:(P-31 In-service tralnings and agendas, slides from mesentatlons, and/or Increase Interdisciplinary UDT) training and continuing education that locus Milestone 7: IP a1 education for dental and other health care on oral health issues and Increase Interdisciplinary (IDT) agendas notes, provitlen to promote an to Team approach implications as human to chronic training and education for Milestone l Estimated incentive Payment: to addressing aal health. diseases, such psa diabetes and dental and other health cafe 5297,150 ardiovauular disease and providers to promote an lD Metds(sk (P3.11 pregnanry. Team approach to adtlressiPit City of Lubbock will hold quarterly (4/year) and health, Wand rounds, imseMep tainings and continuing education that focus on oral Goal: City of Lubbock will hold metal,): jP3.11 healtfllsmesand implications as related t0 quarterly (4/year) grand rounds, City of Lubbock will hold chronic diseases, such as diabetes and In servlce tralnings and quarterly (4/inar)gand cardiovascular disease and pregnanry, continuing education that focus rounds, In service tralnings and on oalM1eallM1 fusses antl Continuing education that Goal: Ci of Lubbock will hold quarterly Inv II<ationsasalaledto chronic hennson oral healthesues and City of Lubbock Health Department - RHP 12 Plan Page 21 of 26 City of Lubbock Health Department - RHP 12 Plan Page 22 of 26 (4/year) grand rounds, In-service trainings diseases, such as diabetes and implications as related to and continuing education that focus on oral cardiovascular disease and chronic diseases, such as health Issues and Implications as related to pregnancy. diabetes and cardiovascular chronic diseases, such as diabetes and disease and pregnancy. cardiovascular disease and pregnancy. Data Source: Attendance rosters, Goal: City of Lubbock will hold Data Source: Attendance rosters, power power point presentations, sign quarterly (4/year) grand point presentations, sign in sheets, etc. in sheets, etc. rounds, in-service trainings and continuing education that Milestone 3 Estimated Incentive Payment: focus on oral health Issues and $156,185 Milestone 5 Estimated Incentive Implications as related to Payment: $106,000 chronic diseases, such as diabetes and cardiovascular disease and pregnancy. Milestone 6: (1.14] Increase number of special Data Source: Attendance population members that access rosters, power point dental services presentations, sign in sheets, etc. Metric(s): (1-14.11 10% Increase over baseline In the number of children, special Milestone 7 Estimated needs patients, pregnant women Incentive Payment: $147,698 and/or the elderly accessing dental services. Goal: 10% increase over baseline in the number of children, special needs patients, pregnant women and/or the elderly accessing dental services. Data Source: Claims, encounter and clinical record data Milestone 6 Estimated Incentive Payment: $106,000 DY 2 Estimated Milestone Bundle Amount: DY 3 Estimated Milestone Bundle Amount: DY4 Estimated Milestone Bundle DY5 Estimated Milestone $297,150 $312,371 Amount: $318,001 Bundle Amount: $295,396 TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4 -YEAR PERIOD (add milestone bundle amounts over Years 2-5): $1,222,918 City of Lubbock Health Department - RHP 12 Plan Page 22 of 26 Outcome Measure Title: IT -7.7 Urgent Dental Care Needs In Older Adults Performing Provider. City of Lubbock Health Department/135103304 Unique RHP Outcome ID: 135103304.3.3 Outcome Domain: OD -7 Oral Health Outcome Measure Description: IT -7.7 - Urgent Dental Care Needs In Older Adults In order to achieve the goals and desired outcomes of this project, the following Process Milestones and Outcome Improvement Targets were selected: Process Milestones: Year DY2: Year DY3: Outcome Improvement Targets: Year DY4: Year DYS: Category 3— P-1: Project planning—engage stakeholders, Identify current capacity and needed resources, determine timeliness, and document Implementation plans. Data Source: Implementation plan Category 3 — P-2: Establish baseline rates Data Source: Performing Provider Utilization Data, Emergency Department Data IT -7.7: Urgent dental care needs in older adults Improvement Target: Decrease the number of older adults 65 years or older with urgent dental care needs by 10% from baseline Data Source: EHR, claims IT— 7.7: Urgent dental care needs In older adults Improvement Target: Decrease the number of older adults 65 years or older with urgent dental care needs by 1S% from baseline Data Source: EHR, claims Rationale: The above outcome measure, process milestones and outcome improvement targets were selected because they directly address Region 12 Community Needs Assessment IDN CN13 (important Need): There is a shortage of dental care, and IDN CN3 (Urgent Need): Poor Insurance support or uninsured. Establishment of a new dental clinic will allow people access to specialized Interventions, in order to avoid exacerbation of health problems. Outcome Measure Valuation: criteria Narrative Score Achieves This project is designed to achieve, to the greatest extent possible, the Texas Healthcare Transformation and Quality Improvement (1115 Waiver) goals of 1. Improved patient care experience; 2. Improved health; and 3. Reduced cost of healthcare, without Waiver Goals compromised quality. In order to achieve alignment with this triple aim, the primary goal of this project Is to ensure patients receive Scale- coordinated, timely and site -appropriate healthcare services. The City of Lubbock hopes to address the healthcare disparity of unequal 5 1 t05 access for people with low-income. This project will transform healthcare delivery from a disease -focused model of episodic pre to a 5 Greatest patient centered, coordinated delivery model that Improves patient satisfaction and health outcomes, reduces unnecessary or duplicative services and builds on the accomplishments of our existing healthcare system. Commissioned by the Regional Healthcare Partnership (RHP), the West Texas Area Health Education Center conducted an assessment Addresses of the healthcare -related needs in Region 12. The goals of Region 12 are to address as many Identified community needs as possible, Community Need(s) focusing on those identified as "critical' and "urgent," Including increased access to pre, increased prevention and early detection Scale: activities and quality/performance Improvement. The City of Lubbock's new dental clinic directly relates to the Region 12 Community 5 Needs Assessment IDN CN13 (Important Need): There is a shortage of dental care; and IDN CN3 (Urgent Need): Poor Insurance support 1 to 5 or uninsured. Establishment of a new dental clinic will allow people access to specialized interventions, In order to avoid exacerbation 5 Greatest of health problems. City of Lubbock Health Department - RHP 12 Plan Page 23 of 26 135303304.3.1 3.IT-7.7 Urgent dental care needs in older adults During DY3 the City of Lubbock will hire and train staff, develop all operational protocols and clinical guidelines and develop a baseline Related Category Project: Project from which to calculate system improvements. The City of Lubbock hopes to provide at least 600 office visits during DY4 and to To be determined In DY3 Scope/Size provide at least 750 office visits In DYS. Conceivably, over 350 people per year could be impacted by this project. The City of Lubbock Scale: will focus upon special needs patients, pregnant women and/or the elderly hoping for a 10% increase over baseline in DY4 and 15% 4 1 to 5 over baseline in DYS. in DY4, the City of Lubbock hopes to decrease the number of elderly adults with urgent care needs by 10% Outcome improvement Target 1: 5 Greatest under baseline and to decrease 15% under baseline in DYS.When considering the impact upon each person's care experience, his/her Establish baseline rates IT7.7: Urgent dental care needs in health and the reduced cost upon the community's healthcare delivery system, the scope and size of this project will be fairly great. stakeholders, identify current This project will be managed by highly trained staff who specialize In linkage to the right care in the rihtsettin . older adults Project The City of Lubbock's investment In this project will be fairly significant. Staffing will include a Program Director, Dentist(s), Licensed Investment Hygienists, Dentals Technicians, office personnel, etc. (Some administrative staff will be shared with StarCare and Combest in order to Scale: obtain economies of scale.) Other investments include physical space, furnishings and equipment, computer hardware/software, etc. 4 1 to 5 As one might imagine, dental equipment can be very expensive. Decrease the number of older adults 5 Greatest older with urgent dental care needs by 135303304.3.1 3.IT-7.7 Urgent dental care needs in older adults City of Lubbock, Health Department 135103304 Related Category Project: 135103304.1.1 Starting Point/Baseline: To be determined In DY3 Process Milestone 1: P-1 Process Milestone 2: P-2 Outcome improvement Target 1: Outcome Improvement Target 2: Project planning —engage Establish baseline rates IT7.7: Urgent dental care needs in 177.7: Urgent dental care needs In stakeholders, identify current older adults older adults capacity and needed resources, determine timeliness and document Improvement Target: Decrease the Improvement Target: implementation plans. number of older adults 65 years or Decrease the number of older adults older with urgent dental care needs by 65 years or older with urgent dental 10% from baseline care needs by 15% from baseline Data Source: Implementation Plan Data Source: PP Utilization Data, Data Source: PP Utilization Data, Data Source: PP Utilization Data, Clinic Utilization Data Clinic Utilization Data Process Milestone 1 Estimated Clinic Utilization Data Incentive Payment: $102,222 Estimated Outcome Improvement Estimated Outcome Improvement Process Milestone 2 Estimated i Target 1 Incentive Payment: $253,510 Target 2 Incentive Payment: $551,109 Incentive Payment: $236,977 DY 2 Estimated Outcome Amount: DY 3 Estimated Outcome Amount: DY4 Estimated Outcome Amount: DY S Estimated Outcome Amount: $102,222 $236,977 $253,510 $551,109 TOTAL ESTIMATED INCENTM PAYMENTS FOR 4 -YEAR PERIOD: $1,143,817 City of Lubbock Health Department - RHP 12 Plan Page 24 of 26 Outcome Measure Title: IT -7.7 Urgent Dental Care Needs In Older Adults Performing Provider: City of Lubbock Health Department/135103304 Unique RHP Outcome ID: 135203304.3.2 'PASS r Outcome Domain: OD -7 Oral Health Outcome Measure Description: IT -7.7 - Urgent Dental Care Needs in Older Adults In order to achieve the goals and desired outcomes of this project, the following Process Milestones and Outcome Improvement Targets were selected: Process Milestones: Year DY2: Year DY3: Outcome Improvement Targets: Year DY4: Year DYS: Category 3— P-1: Project planning— engage stakeholders, identify current capacity and needed resources, determine timeliness, and document implementation plans. Data Source: Implementation plan Category 3 — P-2: Establish baseline rates Data Source: Performing Provider Utilization Data, Emergency Department Data IT -7.7: Urgent dental care needs In older adults Improvement Target: Decrease the number of older adults 65 years or older with urgent dental care needs by 10% from baseline Data Source: EHR, claims IT— 7.7: Urgent dental care needs in older adults Improvement Target: Decrease the number of older adults 65 years or older with urgent dental pre needs by 15% from baseline Data Source: EHR, claims Rationale: The above outcome measure, process milestones and outcome Improvement targets were selected because they directly address Region 12 Community Needs Assessment IDB CN13 (Important Need): There is a shortage of dental care, and IDB CN3 (Urgent Need): Poor Insurance support or uninsured. Establishment of a new dental clinic will allow people access to specialized interventions, in order to avoid exacerbation of health problems. Outcome Measure Valuation: Criteria Narrative Score Achieves This project is designed to achieve, to the greatest extent possible, the Texas Healthcare Transformation and Quality Improvement Waiver Goals (1115 Waiver) goals of 1. Improved patient care experience; 2. Improved health; and 3. Reduced cost of healthcare, without Scale: compromised quality. In order to achieve alignment with this triple aim, the primary goal of this project Is to ensure patients receive coordinated, timely and site -appropriate healthcare services. The City of Lubbock hopes to address the healthcare disparity of unequal 5 I to 5 access for people with low-income. This project will transform healthcare delivery from a disease -focused model of episodic care to a 5 Greatest patient centered, coordinated delivery model that Improves patient satisfaction and health outcomes, reduces unnecessary or duplicative services and builds on the accomplishments of our existing healthcare system. Addresses Commissioned by the Regional Healthcare Partnership (RHP), the West Texas Area Health Education Center conducted an assessment Community of the healthcare -related needs in Region 12. The goals of Region 12 are to address as many identified community needs as possible, 'critical' 'urgent," Need(s) focusing on those identified as and including increased access to care, Increased prevention and early detection Scale: activities and quality/performance improvement. The City of Lubbodes new dental clinic directly relates to the Region 12 Community 5 Needs Assessment IDB CN23 (Important Need): There is o shortage of dental core; and IDB CN3 (Urgent Need): Poor Insurance support I to 5 or uninsured. Establishment of anew dental clinic will allow people access to specialized interventions, in order to avoid exacerbation 5 Greatest of health problems. During DY3 the City of Lubbock will hire and train staff, develop all operational protocols and clinical guidelines and develop a baseline from which to calculate system Improvements. With Pass 1 funding, the City of Lubbock plans to provide at least 600 office visits in DY4 and to provide at least 750 office visits in DYS, serving 350 people per year. Pau 2 funding will allow the city of Lubbock to Project Scope/Size provide an additional 250 office visits each year In DY4 and DYS, with capacity to serve 147 more people each year. The City of Scale: Lubbock will focus upon special needs patients, pregnant women and/or the elderty hoping for a 10% Increase over baseline in DY4 4 and 15% over baseline in DYS. 10% increase over baseline in DY4 and 15% over baseline In DYS. In DY4, the City of Lubbock hopes to 1 to decrease the number of elderly adults with urgent care needs by 10% under baseline and to decrease 15% under baseline in 5 Greatest DYS.When considering the impact upon each person's care experience, his/her health and the reduced cost upon the community's healthcare delivery system, the scope and size of this project will be fairly great. This project will be managed by highly trained staff who specialize in linkage to the right core In the right setting, Project The City of Lubbock's Investment in this project will be fairly significant. Staffing will Include a Program Director, Dentist(s), Licensed Investment Hygienists, Dentals Technicians, office personnel, etc. (Some administrative staff will be shared with StarCare and Combest In order to 4 Scale: obtain economies of scale.) Other investments include physical space, furnishings and equipment, computer hardware/software, etc. City of Lubbock Health Department - RHP 12 Plan Page 25 of 26 I to 5I As one might Imagine, dental equipment can be very expensive. 5 Greatest 135103304.3.2 3.IT-7.7 Urgent dental care needs In older adults City of Lubbock, Health Department 135303304 Related Category Project: 135103304.1.2 Starting Point/Baseline: To be determined In OY3 Process Milestone 1: P-1 Process Milestone 2: P-2 Outcome Improvement Target 1: Outcome Improvement Target 2: Project planning —engage Establish baseline rates 177.7: Urgent dental care needs in IT7.7: Urgent dental care needs In stakeholders, identify current alder adults older adults capacity and needed resources, determine timeliness and document Improvement Target: Decrease the Improvement Target: implementation plans. number of older adults 65 years or Decrease the number of older adults older with urgent dental care needs by 65 years or older with urgent dental 10% from baseline care needs by 15% from baseline Data Source: Implementation Plan Data Source: PP Utilization Data, Data Source: PP Utilization Data, Data Source: PP Utilization Data, Clinic Utilization Data Clinic Utilization Data Process Milestone 1 Estimated Clinic Utilization Data Incentive Payment: $15,639.47 Estimated Outcome Improvement Estimated Outcome Improvement Milestone 2 Estimated 1 Incentive Target 1 Incentive Payment: Target 2 Incentive Payment: Payment: $35,333.49 $73,848.93 $34,707.85 DY 2 Estimated Outcome Amount. DY 3 Estimated Outcome Amount: DY 4 Estimated Outcome Amount: DY S Estimated Outcome Amount. $15,639 $34,708 $35,333 $73,849 TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4 -YEAR PERIOD: $159,530 City of Lubbock Health Department - RHP 12 Plan Page 26 of 26