The Michigan Primary Care Consortium MPCC Member Orientation. March 5, 2010.

The Michigan Primary Care Consortium

MPCC Member Orientation.

March 5, 2010

The Primary Care Crisis

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National MD Experience

Number of Residents 2000 to 2005

*Combined Primary Care/Specialty Residents, e.g. FM/ER, are Counted as a .5 FTE, all FM & IM Emphasis and Track Interns are Included in these Numbers as well as MDs who participate in SCS programs. Traditional interns are not included.

2000 2001 2002 2003 2004 20050

200

400

600

800

Primary Care

Non-Primary Care

Primary Care 367.5 318.5 281.5 289.5 261.5 276

Non-Primary Care 499.5 493.5 530.5 593.5 629.5 703

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Michigan DO Experience

Ideal: 50% Primary Care Physicians (Pew Commission Report on Health Care Workforce)

Michigan: 35% Primary Care Physicians, of which 43% plan to retire or stop practicing

within ten years (MDCH Survey of Physicians 2008)

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Michigan’s Primary Care Status

• $150,000 - $200,000 Debt• Three Years GME @ $40-45,000/Year

Take Your Choice!Starting Salaries:Family Practice $120,000 - $150, 000Internal Medicine $120,000 - $175,000Pediatrics $110,000 - $125,000Orthopedic Surgery $250,000 - $400,000Cardiology $250,000 - $400,000 (Medical Opportunities in Michigan 2006 Data)

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Medical School Perspective

Year Inflation Medicaid Medicare

BCBSM

2005 3.39 -2% (-4% for 6 months)

1.5% 2%

2004 2.68 0 1.5% 2%2003 2.27 0 1.4% 2%2002 1.59 11%* -4.8% 2%2001 2.83 0 5.0% 2%2000 3.38 0 5.5% 1.5%1999 2.19 0 2.3% 1.6% (2% for 8

months)

1998 1.55 0 2.3% .8%1997 2.34 0 .6% 2.4%1996 2.93 0 .8% 2%Totals 25.1% 9% 16.1% 18.3%*Medicaid HMOs received an 11% increase for physician services.

The amount that flowed to physicians is unknown. 7

How does Michigan’s reimbursement compare to inflation?

FIN

Per Capita Health Care Expenditures

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Primary Care Score vs. Health Care Expenditures,

1997

More Primary Care Physicians / 100,000

• Lower Cost

• Higher Quality

(2003 Medicare Data on “General Practitioners”)

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Primary Care is the Foundation of the Health

Care System

Community safety

Education

Family & social support

Employment

Built environment

Environmental quality

Income

Unsafe sex

Alcohol use

Diet & exercise

Tobacco use

Access to care

Quality of care

Physical environment(10%)

Social & economic factors(40%)

Health behaviors(30%)

Clinical care(20%)

Health Factors

Programs and Policies

Health OutcomesMortality (length of life): 50%

Morbidity (quality of life): 50%

County Health Rankings model © 2010 UWPHI

The Michigan Primary Care Consortium: A Brief History

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World Health Org: Acute vs. Chronic Care

“Health care systems [throughout the world] evolved around the concept of infectious disease, and they perform best when addressing patients’ episodic and urgent concerns. However, the acute care paradigm is no longer adequate for the changing health problems in today’s world.

Both high- and low-income countries spend billions of dollars on unnecessary hospital admissions, expensive technologies, and the collection of useless clinical information.

As long as the acute care model dominates health care systems, health care expenditures will continue to escalate, but improvements in the population’s health status will not.”

World Health Organization. Innovative care for chronic conditions: building blocks for action: global report. (Geneva: WHO; 2002.)

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Changing Needs

1900 – 1950 Infectious disease 1950 – 2000 Acute, episodic care 2000 – 2050 Chronic care

Gerald Anderson, PhD – Johns Hopkins UniversityGerald Anderson, PhD – Johns Hopkins University

How do we create new systems to meet today's healthcare needs?

Health Care Spending Fact: In 2007, the U.S. spent $2.2 trillion

— or more than 16% of its Gross Domestic Product — on health care. We spend more than any other country, yet our health system continually underperforms and lags behind less advanced countries.

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Broken Health Care System

Rising costs of health care Rising rates of uninsured, underinsured Flat or worsening health status

indicators Significant health disparities Unimpressive quality indicators Rising dissatisfaction by all Aging population greater demands

on health care system

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Primary Care System in Crisis

Fragmented, uncoordinated patient care Inconsistent delivery of evidence-based care,

especially preventive and chronic care Misaligned reimbursement system Increasing expectations by payers and

purchasers impacting providers’ quality of life

Shrinking primary care workforce (i.e., physicians, NP’s, PA’s, others)

Will primary care survive?


BACKGROUNDIn 2005-06, 134 Michigan professionals developed strategic recommendations to resolve key primary care system barriersFive barriers to effective primary care: Under-use of community resources Under-use of patient registries, other HIT Under-use of evidence-based guidelines Inappropriate reimbursement system Practices not designed to deliver effective chronic care

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Informed,ActivatedPatient

ProductiveInteractions

Prepared,ProactivePractice Team

Improved Outcomes

DeliverySystemDesign

DecisionSupport

ClinicalInformation

Systems

Self-Management

Support

Health SystemResources and Policies

Community Health Care Organization

Chronic Care Model

Outcomes

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The Mission of the MPCC The MPCC is a collaborative

partnership of organizations concerned about the survival of primary care

The MPCC was created to improve preventive and chronic care

The MPCC is committed to aligning existing QI initiatives, addressing gaps, and engaging in problem-solving

Michigan Primary Care Consortium

The MPCC spent its early years: Convening organizations concerned about the

rising incidence of preventable health conditions, spiraling health care costs, and the survival of primary care

Gathering information on huge challenges like inadequate reimbursement for primary care services and looming workforce shortages

Building consensus on the actions needed

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Strategies to Solve Michigan’s Primary Care Crisis (2008)

Transform practices to Patient-Centered Medical Homes (PCMH)

Increase reimbursement for Primary Care Professionals in PCMH practices

Rebuild the supply of MDs/DO’s, NP’s, and PA’s working in Primary Care

Activate consumers regarding self-care 21

MI Primary Care Consortium MPCC: Current Status

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Professional & Trade Associations (15)

Insurers and Payers (11) Health Systems and Centers (7) Physician Organizations (26) Businesses (10) Regional QI Initiatives (4) Public Health Organizations (5) Academia (14) Consumer Organizations (4) Others (7) as of March 2010

MPCC Membership: >100

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MPCC Committees Steering/Board of Directors and Executive –

Chair, Janet Olszewski, MDCH Priorities – Chair, Kim Sibilsky, MPCA Communications – Chair, Rebecca Blake, MSMS Governance – Chair, Dennis Paradis, IHCS -

MSU Funding – Chair, Lody Zwarensteyn, AFH Strategic Planning – Chair, Larry Wagenknecht,

MPA


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Since 2008, MPCC activities have focused on• Redesign of primary care practices to be patient-

centered and efficient, and Patient-Centered Medical Homes

• Utilization of health information technology to improve safety and quality of care

• Processes to ensure that evidence-based preventive and chronic disease care are the norm

• Overhauling the way that primary care is reimbursed

• Making good use of community health resources• Helping consumers become actively engaged

members of their health care team• Rebuilding the primary care workforce

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Patient-Centered Medical Home

PCMH is an approach to providing comprehensive, team-based primary care for children, youth, adults and seniors based on the Chronic Care Model

PCMH is a health care setting that facilitates partnerships between patients and their personal physicians and health teams and, when appropriate, the patient’s family or caregivers

A PCMH makes effective use of community resources and supports to assist patients and families become activated and achieve their health goals

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Improving Performance in Practice” (IPIP) Program

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“Improving Performance in Practice” Program

The American Board of Medical Specialties created IPIP to support new physician recertification requirements

7 states were provided with program materials and support; Michigan was 3rd state selected

A grant, funded by Robert Wood Johnson Foundation provided 2 years of seed money to states, with states adding additional funds

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Michigan IPIP: A Unique Partnership with Industry

Michigan enrolled 35 practices in a year-long learning collaborative.

Practices are charged with implementing the change package and working toward PCMH

Each practice is coached by one or more volunteer quality improvement engineers from industry who had received an orientation to healthcare

The final Outcomes Congress will be March 24-25, 2010

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Key IPIP Interventions

1. Use a Patient Registry2. Initiate Team Care3. Implement Planned Visits4. Provide Self-Management Support5. Work toward Creation of a PCMH

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Michigan Primary Care ConsortiumMPCC Non-Profit Status Unanimous approval by MPCC

Leadership IRS Form 1023 process: awaiting

final internal approval Submission Planned before end of

March 2010 Why non-profit status?

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MPCC Funding Efforts No more fiscal support from the

State of Michigan for infrastructure No fiscal support for implementation

of priorities other than in-kind

Long term sustainability?

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Priorities


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2009 White Paper SeriesPrimary Care is in Crisis

Part 1: Primary Care is in CrisisPart 2: Transform Primary Care Practice and PaymentPart 3: Activate Consumers of Primary

Care Part 4: Rebuild the Primary Care

Workforce

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White Paper Recommendations

The white papers contained over 51 recommendations. Of these, 12 were identified as most important.

30 objectives for achieving the important recommendations were identified

Action Groups were formed to create implementation plans for the objectives

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MPCC Action Groups Created Implementation Plans for

30 Objectives Objectives and plans were further ranked and categorized:

9 were Top Priority Plans to be achieved by end of 2010

11 were Logical “Next Steps” to be implemented when top priority plans are implemented

10 were deemed beyond MPCC’s current capacity to implement, but could be implemented if a member organization agreed to sponsor and staff them

MPCC Action Planning Groups

1. Practice Transformation Leads: Ernie Yoder, MD, St John Health System and Larry Abramson, DO, POH

2. Consumer Engagement and Empowerment Lead: Stacey Hettiger, MSMS

3. Rebuilding the Primary Care Workforce Lead: TBD

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Top Priority Objectives

FOCUS AREA 1: PRIMARY CARE PRACTICE TRANSFORMATION Promote Health Information Technology (HIT) Create PCMH Toolkit Spread PCMH throughout Michigan Prepare Providers to Teach Self-Management Assessing Need/Demand for Community

Resources Determine the Cost of Creating a PCMH

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Practice Transformation Activities

A HIT Handbook will help practices prepare for, purchase and implement EHR systems

A PCMH Toolkit is available that includes web-accessible resources to assist practices meet BCBSM’s PGIP and NCQA’s PCMH requirements

PCMH Spread Group will be surveying physician organizations to: Determine their capacity to support their

practices working toward PCMH recognition Identify whether / how MPCC might assist 40

Practice Transformation Activities (cont.)

Self-management support resources for practices are being assembled. The workgroup is identifying strategies to make these accessible to practices

Consideration of what community resources are needed in communities to address medical and social determinants of health, and how to identify, use and align different resource databases, including 2-1-1

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FOCUS AREA 2: CONSUMER ENGAGEMENT AND

ACTIVATION

Teach Self-Management to Consumers Teach Health Literacy in the Michigan

Model for Comprehensive School Health Education

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FOCUS AREA 3: REBUILD PRIMARY CARE WORKFORCE

Create a Workforce State Plan Convene a Strategic Partnership

Conference with HRSA

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Top Priority Objective FOCUS AREA 4: PAYMENT REFORMAccomplishments - All-Payer Agreements on:

1. Michigan definition of PCMH2. Components of PCMH to incent in 2010 using common metrics: a) Expanded Accessb) Use of Registry c) Use of E-Prescribing

3. Discussion on measures for 2011 is underway

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In summary: MPCC is helping the primary care community

to:Redesign primary care practices to be patient-centered and efficient

Improve safety and quality of care by using health information technology

Make evidence-based care the norm

Overhaul the way that primary care is reimbursed

Help consumers become active engaged members of their health care team Ensure there are sufficient primary care providers


Message

Comprehensive, coordinated, whole-person care that is adequately reimbursed should be available in every primary care setting in Michigan.

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For more information about the MPCC: www.MIPCC.org

[email protected] (517) 241-7353

http://www.mipcc.org/

The Michigan Primary Care Consortium MPCC Member Orientation. March 5, 2010.

Documents

Transcript of The Michigan Primary Care Consortium MPCC Member Orientation. March 5, 2010.