Medical Network OneMiPCT UPDATE

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WEBINAR #1

February 22, 20128:30am – 9:00am

Agenda•Status of MiPCT Project•Communication Plan•Self management training•Moderate and Complex Care manager training and

on-boarding•Patient registry•Patient portal•Transformation payments•Pay for Performance

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2012 Launch Preparedness3

Workstream Launch Readiness Activities AdvantageCommunication • PO Webinar/Call Series

• Website Expansion • Newsletter 2012• March Invitational Meeting in Troy, Gaylord, Grand Rapids• Practice Champions and Contacts Identified• Quarterly Best Practice Sessions• Webinars ever 2 weeks

• Establishes communication channels and peer network building

• Delivers consistent messaging in multiple platforms for user convenience

Michigan Data Collaborative

• Report Template Production• PO Interviews for Report Preferences• Population Analysis Readiness• Payer Intake Meetings

• User needs incorporated in report design

• Begins data loads

Provider Files • Payment Elements Verified with CMS • Intense Response File Investigation

• Minimizes payment delays experienced by other states

• Establishes platform for future filesStrategic

Partnerships• Discussions with Organizational Groups (MHA, MAHP,

MSMS, MOA, etc.)• Builds on common interests• Leverages strength of membership

groupsPO/PCMH Readiness

• Implementation Plan Reviews• PO Personalized Calls

• Allows insight on strengths and opportunities of partners

• Provides customized supportBudget Neutrality • Research on Promising Interventions

• Payer Recommendations• Incorporates experience of health

plans data insights

Participating Practices (and Affiliated POs)January and April 2012* Participants

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Start Date # PCMH # POs # Physicians # Patients

Jan 1, 2012 388 29 1631 1,111,290

April 1, 2012* 70 3 154 127,961

TOTAL 458 32 1785 1,239,251

*Dependent on submission of signed contracts, implementation plans, etc. by February 8, 2012

Medical Network One/PCMH Implementation Plan Reviews

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•Process for Responses to POs:▫Responses returned by January 20, 2012

▫3 Categories: Approved, Approved but requires clarification via a follow-up phone discussion, or Requires Resubmission.

▫Criteria Used for Categorization: 1) whether or not the PO (and its practices) plan to (or already) have 80% of their care managers on board by end of Year One; 2) whether or not the care managers are to be integrated w/in and serving at the practice site (or acceptable alternative); and 3) Adequacy of the four tier activities

MiPCT Performance Incentive Program •One component the additional funds provided

through the Demonstration to support PCMH transformation

•Designed by a multi-stakeholder MiPCT Committeeo Metrics for 2012 have been selectedo 2013 and 2014 metrics will be identified in 2012

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MiPCT Performance Incentive Program Objectives

Provide financial rewards to support transformation to enhance current PCMH activities

PCMH • Reward transformation efforts and achieving

desired outcomesPOs

• Reward transformation efforts and achieving desired outcomes

• Compensate for services to participating practices

MiPCT Performance Incentive Program Objectives

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Performance Incentive Payment Process

• Health plans contribute $3.00 PMPM to the incentive program pool

• Metrics are assessed every six months and points are calculated for each PO

• POs are ranked by total points and grouped into payment categories

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Performance Incentive Payment Process• Entire pool is paid out in variable amounts based on

ranking

• PO retains the agreed upon percentage 20%

• PO distributes 80% to the PCMH

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Division of Performance Incentive Funds Between POs and their PCMH

• 80% of funds flow to the providers of care: Primary Care Physicians and their staff

• PCMH may include POs that employ care managers or care team members

• Health systems should ensure incentive funds are passed to the practice unit level

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Incentive Fund Portion Retained by POs

May be used for one or more of the following:

• Implementation of tools and care processes that enable the practices to achieve practice transformation

• Clinical leadership support (Quality Improvement Specialist)

• Analytical and reporting support to measure and report transformation progress

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POs Will Account for Incentive Funds*

PO Level • Amount of incentive dollars retained• How retained funds were used

PCMH Level• Amount distributed to each practice• Distribution criteria• How were funds used: education, pay raise, hiring

new staff

* POs will submit regular MiPCT financial reports

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The Performance Metrics Reflect the MiPCT Focus for Each of the 3 Years

2012 Incentive Program Focus

• Develop primary care practice infrastructure Enhance access Create and use an all-patient registry system HEDIS measure imporovement

• Embed care managers within the PCMH

• Employ standardized processes for transitions of care

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Data Sources for Metrics

1. Claims Data: The Michigan Data Collaborative will receive claims data from participating Health Plans Utilization and cost metrics will be

calculated for each Payer and aggregated across all contracted plans.

Confidence intervals at 95% will be provided

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Data Sources for Metrics

2. MiPCT Quarterly Reports: Each PO will complete and submit a MiPCT Quarterly Report that includes Updates to their Implementation Plans PCMH/PO progress on development of

PCMH infrastructure capabilities and implementation of clinical initiatives.

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Data Sources for Metrics

3. Self-Reported Data (SRD): Reported by POs to PGIP twice yearly on practice PCMH capabilities Accuracy, validity and inter-rater

reliability checks and balances by BCBSM Financial penalties are imposed for

inaccurate reporting of capabilities

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6 Month Performance Metrics for 2012 Advanced Access• 30% Same Day Appointments - SRD Report 5.7 • Appointments Outside Regular hours: 8 hrs/week SRD

Report 5.3.

Electronic Patient Registry Functionality• Electronic Patient Registry

Practice has electronic registry (*Must meet)Registry has interface capabilityIncorporates evidence-based care guidelines Identifies individual attributed practitioner

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6 Month Performance Metrics for 2012 Electronic Patient Registry

• Information is available and used by the practice unit team at the point of care (2.4)

• Used to generate communications to patients regarding gaps in care (2.6)

• Used to flag gaps in care (2.7)• Information on patient demographics (2.8)• Registry identifies and tracks care for patients with at least 2

of the following (2 points maximum): Diabetes (2.1), Asthma (2.10), Cardiovascular disease (2.11), Pediatric obesity (2.17)

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6 Month Performance Metrics for 2012

Care Managers• Moderate care managers trained and

working (10 points)

• Complex care managers trained and working (10 points)

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Adult Clinical Quality Metrics y

Chronic Care Diabetes: (ages18-75 years & type 1 or 2 diabetes) HEDIS 1. A1C Test 2. Poor Control A1c>9 3. Control A1c< 8 4. LDL-C Test 5. LDL-C Controlled < 100 mg/dl 6. BP <140/90 7. Retinal Eye Exam 8. Nephropathy Screen or Evidence of Nephropathy* y

9. Asthma: Self-Management Plan or Asthma Action Plan (ages 5-50) Non HEDIS y

10. Hypertension: Controlled BP <140/90 (ages 18-85) HEDIS

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Adult Chronic Care (Cont)11. Cardiovascular Disease (CVD): BP management <140/90 mmHg (ages 18-75) HEDIS12. CVD: LDL-C Management <100 mg/dl (ages 18-85) HEDIS13. Obesity: Adult BMI (Meaningful Use)

Adult Preventive Care14. Tobacco: Percent Current Smokers (ages 13 and older) (non HEDIS) 15. Breast Cancer Screening: (ages 40-69) HEDIS16. Cervical Cancer Screening: (ages 21-64) HEDIS17. Colorectal Cancer Screening: (ages 50-75) HEDIS18. Chlamydia Screening: (sexually active women ages 16-24) HEDIS

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Pediatric Clinical Quality Measures 1. Asthma: Self-Management Plan or Asthma Action Plan

(ages 5-50) Non HEDIS 2. Obesity: Child BMI (ages 2-17yrs) Meaningful Use3. Lead Screening: (Medicaid only) (Age 2) HEDIS**4. Tobacco Use: (ages 13 and older)5. Chlamydia Screening: (sexually active women ages 16–24) HEDIS6. Childhood Immunizations: Age 2 HEDIS** 7. Childhood Immunizations: Adolescent Age 13 HEDIS** 8. Well Child Visits: 15 Months and 3-6 years HEDIS9. Well Child Visits: Adolescent (ages12-21) HEDIS

**MCIR reports may be counted if practice accesses MCIR for point of care use and can run reports for patient outreach

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Adult and Pediatric Clinical MetricsChronic Carey

1. DM*: A1C Test + Poor Control A1c>9 + Control A1c< 8 2. DM: LDL-C Test + LDL-C Controlled < 100 mg/dl 3. DM: BP <140/90 4. DM: Retinal Eye Exam 5. DM: Nephropathy Screen or Evidence of Nephropathy* 6. Asthma: Self-Management Plan or Asthma Action Plan

(ages 5-50) Non HEDIS 7. Hypertension: Controlled BP <140/90 (ages 18-85) HEDIS8. CVD**: BP<140/90 mmHG (ages 18-75) HEDIS9. CVD: LDL-C < 100 mg/dl (ages 18-85) HEDIS10. Obesity : BMI (ages 2-99) Meaningful Use w *DM = Diabetes Mellitus Type 1 or 2 (ages 18-75) HEDIS **CVD = Cardiovascular Disease

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Adult and Pediatric Clinical Metrics (cont)Preventive Carey

11. Tobacco: Percent Current Smokers (ages 13 and older) (non HEDIS)

12. Breast Cancer Screening: (ages 40- 69) HEDIS13. Cervical Cancer Screening: (ages 21-64) HEDIS14. Colorectal Cancer Screening: (ages 50-75) HEDIS 15. Chlamydia Screening: (sexually active women ages 16-24)

HEDIS16. Childhood Immunizations – Age 2: HEDIS**17. Childhood Immunizations – Adolescent: (Age 13) HEDIS**18. Well Child Visits: 15 months, 3-6 yrs and 12-21 yrs HEDISy

**MCIR reports may be counted if practice accesses MCIR for point of care use and can run reports for patient outreach

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