Michigan Primary Care Transformation

Demonstration Project

September 25, 2013Webinar

Attendance

Anchor Bay Clinic Ricardo Cabrera, MD/Jeetender Matharu, MD Center for Preventive Medicine Country Creek Family Physicians Country Creek Pediatricians Everingham Clinic Douglas Hames, MD Hampton Medical

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Attendance

Lifetime Family Macomb Pediatrics Meadowbrook Internists Monroe Medical Oakland Medical Group – Family Medicine Partridge Family Physicians Woodhaven Pediatrics

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Learning Event: YOUR DECISION

Update for practice teams including physicians Saturday, September 28 from 8:30am-1:00pm Physicians Training Center: Madison Heights Topics:

• New billing codes• Advance Care Planning• Advance Directives• POLST• Durable Power of Medical Attorney• QI Process: PDSA

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Best Practice

Woodhaven Pediatrics: 9/25 Country Creek Pediatrics: 10/9 Douglas Hames, MD: 10/23 Partridge Family Physicians: 11/6 Country Creek Family Physicians: 11/20 Drs. Matharu and Cabrera: 12/4 Monroe Medical: 12/18

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Best Practice

Everingham Clinic: 1/15 Center for Preventive Medicine: 1/29 Oakland Medical Group – Family Medicine: 2/12 Lifetime Family: 2/26 Meadowbrook Internists: 3/12 Hampton Medical: 3/26 Anchor Bay Clinic: 4/9

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CMS Proposal

Proposal allows practices to submit a bill once every 90 days for delivery of complex care management services for patients with multiple complex chronic conditions that place the patient at a significant risk of death, acute exacerbation/decompensation, or functional decline

Must be nationally recognized PCMH, meet MU, access a care manager

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Number of Referrals from PCP

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Match the Numbers

1. $24,033.46

2. $31,803.11

3. 46%

4. 82%

5. 2749

6. 250

A. Adjustments Jan - Jun

B. Cancellation rate YTD

C. Number of encounters Jan – Jun

D. Payments Jan – Jun

E. Encounter to outreach rate YTD

F. Avg. encounters per CM Jan - Jun

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Matching Answers

1. $24,033.46

2. $31,803.11

3. 46%

4. 82%

5. 2749

6. 250

A. Payments Jan – Jun

B. Adjustments Jan - Jun

C. Cancellation rate YTD

D. Encounter to outreach rate YTD

E. Number of encounters Jan – Jun

F. Avg. encounters per CM Jan - Jun

10

11

113

84

124

10089

0

50

100

150

200

250

300

350

400

450

Apr May Jun Jul Aug

Encounters

98961 CM Group 2-4 pts 30 min 98962 CM Group 5-8 pts 30 min

98966 CM Coaching Call 5-10 min 98967 CM Coaching Call 11-20 min

98968 CM Coaching Call 21+ min 99487 COMPLX CHRON CARE COORD W/O PT VST 1ST HR PER M

G9001 CCM Initial Assessment G9002 CM Maintenance

New Encounters

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Objectives

Define Multi-payer Advanced Primary Care Practice Demonstration (MAPCP)

Define Advanced Primary Care Practice (APCP) Define purpose and goals of MAPCP Demo Define method of evaluation Define care management

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MAPCP Demonstration

What is it?

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MAPCP Demonstration

THIS IS MIPCT Largest demonstration of the Advanced Primary

Care Practice to date Eight states participating• Maine, Vermont, New York, Rhode Island,

Pennsylvania, North Carolina, Michigan, Minnesota

Each state has its own name for MAPCP Demo

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Advanced Primary Care Practice

What is it?

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Advanced Primary Care Practice

This is the CMS terminology for the Patient Centered Medical Home Model

The APCP/PCMH:• Uses the leading model for efficient management and

delivery of quality health care• Uses a team approach with the patient at the center• Emphasizes prevention, HIT, care coordination and

shared decision making (patient and provider)

Therefore: MAPCP/MIPCT is a DEMO OF THE PCMH MODEL

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MAPCP Demo

WHY? What is the purpose? GOALS? What are the expectations?

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MAPCP Demo Purpose

Determine if the APCP/PCMH:• Reduces unjustified variation in utilization and

expenditures• Improves the safety, effectives, timeliness and

efficiency of health care• Increases the ability of beneficiaries to participate

in decisions concerning their care• Increases the availability and delivery of care

consistent with evidence based guidelines

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MAPCP Expectations

Each of the demo projects will be “budget neutral” over the course of the three years• Budget neutrality: all payments under this demo

will be LESS THAN or EQUAL TO costs incurred for similar population in the absence of this demonstration (control group)• “significant savings” to Medicare while improving

quality of care provided to beneficiaries

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MAPCP Demo Evaluation

HOW will our work be appraised?

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MAPCP Demo Evaluation

Each state executes evaluation plan to monitor performance and provide feedback to payers, providers and communities

How have we affected:• Access• Quality• Patterns of utilization

This is the Michigan Data Collaborative

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MAPCP Demo Evaluation

CMS undertakes its own evaluation through an independent research organization• RTI International (Douglas Kamerow, MD)• Dr. Kamerow spent more than 20 years in the U.S.

Public Health Service, initiating and leading key federal research, health policy, public health, and clinical programs. • Dr. Kamerow has already interviewed MNO and will

be back• Findings will be compared to control population

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Care Management

What is it?

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Care Management

Care Management has been defined as a set of activities designed to assist patients and their support systems in managing medical conditions and related psychosocial problems more effectively, with the aim of improving patients’ health status and reducing the need for medical services.

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Care Management

Care management involves providing clinical and support services, including care coordination, provided by a nurse or other clinically trained provider. The intensity of follow-up and clinical interventions varies depending on the complexity of the individual patient’s health care needs. Care management is an essential function of a Patient-Centered Medical Home.

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Care Management

Goals of Care Management:• Improve patient’s functional health status• Enhance coordination of care• Eliminate duplication of services• Reduce the need for unnecessary, costly medical

services

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Care Management

Key Components of Care Management:• Identify patients most likely to benefit from care

management.• Assess the risks and needs of each patient.• Develop a care plan together with the patient/family.• Teach the patient/family about the diseases and their

management, including medication management.• Coach the patient/family how to respond to worsening

symptoms in order to avoid the need for hospital admissions.• Track how the patient is doing over time.• Revise the care plan as needed.

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Open Discussion

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