The Michigan Primary Care Transformation (MiPCT) Project Annual Summit October 2013 MiPCT Overview...
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Transcript of The Michigan Primary Care Transformation (MiPCT) Project Annual Summit October 2013 MiPCT Overview...
The Michigan Primary Care Transformation (MiPCT) Project
Annual SummitOctober 2013
MiPCT Overview and Updates
1
Objectives
•Recap MiPCT Overview and 2013/14 Focus Areas
•Review MiPCT Project Evaluator Findings to Date
•Discuss Project Sustainability
MiPCT OverviewJean Malouin
CMS Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration
•Centers for Medicare & Medicaid Services is participating in state-based PCMH demonstrations▫ Assessing effect of different payment models
•CMS Demo Stipulations▫Must include Commercial, Medicaid, Medicare patients▫Must be budget neutral over 3 years of project▫Must improve cost, quality, and patient experience
•8 states selected for participation, including Michigan•Michigan start date: January 1, 2012
4
Participants
•380 practices•35 POs•1,500 physicians•1 million patients•5 Payers
▫Medicare▫Medicaid managed care
plans▫BCBSM▫BCN▫Priority Health (7/13)
MiPCT Funding Model
$0.26 pmpm Administrative Expenses$3.00 pmpm*, ** Care Management Support$1.50 pmpm*, ** Practice Transformation Reward$3.00 pmpm*, ** Performance Improvement$7.76 pmpm Total Payment by non-Medicare
Payers***
* Or equivalent** Plans with existing payments toward MiPCT components may
apply for and receive credits through review process*** Medicare will pay additional $2.00 PMPM to cover additional services for the aging population
6
4
MiPCT Mid-Point: Statewide Care Management Progress to Date
•Over 300 Care Managers hired and trained•Building infrastructure in partnership with POs
▫CM Documentation tools▫Ongoing Care Manager training, coaching, mentoring▫Patient education materials▫Communication- PCP, CM, staff members ▫Interface with community resources
•Building volume of G code and CPT codes submitted •Building caseloads of targeted high-risk patients
8
Multi-Payer Claims Database
9
• Collect data from multiple Payers and aggregate it together in one database
Creates a more complete picture of a patient’s information when they:• Receive benefits from multiple insurance
carriers
• Visit physicians from different Practices, Physician Organizations or Hospitals
Phase 1 – claims data
Phase 2 - claims and clinical data
Multi-Payer Claims Database
Medicare
Medicaid BCN
BCBSM
MiPCT
MDC: MiPCT Dashboards
10
PopulationMembership• Attributed members by PayerRisk Information• # of members by Risk LevelPopulation Information• # patients by Chronic Condition
(Asthma, CKD, CHF, etc)
Quality MeasuresScreening and Test Rates • Diabetes tests, Cancer Screens, etcPrevention• Immunization Rates, Wellness Visits, etc.Comparison to Benchmarks
Utilization MeasuresRates • ED Use, Admissions, Re-admissions, etcComparison to Benchmarks
Admission, Discharge, Transfer MiPCT Data Flow and Progress
• 17 POs participate in the “Spotlight” MiPCT offering (at no cost to PO) with opportunity for additional POs to join (by October 30, 2014)
• Allows care managers direct access to member lists via web interface• ADT notifications adding for Trinity, Henry Ford, and Beaumont!
2013-2014 Priorities
•Care managers fully integrated into practices•Target PCMH interventions to patients from all
participating payers▫Distribute multi-payer lists and dashboards▫Ensure care management for at risk members▫Use registry for proactive population management
•Focus on efficient and effective health care▫Avoid unnecessary services/hospitalizations▫Assess practice utilization patterns
•Ensure adequate clinic access to meet demands
12
How will CMS define success?
13
13
The tie to budget neutrality and ROI
Successes• Champions abound; We have
gained traction!
• Michigan is well-poised compared to other states despite its broad scale
• Hard-working, dedicated people
• Multi-payer Database
• Strong PCMH foundation
14
Challenges• Success on cost, quality and
utilization measures is key to sustainability
• Member lists vs. the population
• G and CPT code billing and “throughput”
• PO and practice infrastructure varies
• Many competing priorities
MiPCT Brief Review: Balancing Successes and Challenges
15
www.mipctdemo.org
MiPCT Evaluation UpdateClare Tanner
Objectives
•MiPCT Investment in PCMH•Care Management Implementation•Quality/Utilization
MiPCT Practices
Financial Investment, 2012“New” Money1 Total2
Care Coordination
$35,577,697 $35,577,697
Practice Transformation
$8,739,951 $28,287,509
1. New money includes: Medicaid, Medicare, BCN g-code payments, BCBSM g-code + make whole payments
2. Total adds in: BCBSM Practice transformation (E&M uplift) of $19 million, but does not include incentive payments
Hybrid59%
(248)
Mod-erate26%
(109)
Complex15% (63)
Care Manager RolesN=420
21
22
70% have 1 practice 23% have 2-4
practices 7% have 5 or more
practices
Care Manager Volume Quarter 2, 2013
EncountersUnique PatientsFace to
FacePhone
Total 15,250 32,709 22,237
Per CM FTE
63 112 82
23
Care Manager Survey
•Conducted in May 2013•434 care managers asked to complete
survey•53% completed the survey (n=228)
Care Manager Survey Results
•Care Managers reported working with an average of 8.4 physicians
•On average, 83% of these physicians referred patients
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Physician Interaction
Care Manager Survey Results
Other
Other discharge list
Other staff
Fax discharge summaries
Patient self-referrals
Registry
ED visit summaries
Electronic admit discharge notifications
Daily practice visit schedule
MiPCT list
Physician referrals
4%
1%
2%
24%
25%
39%
57%
61%
61%
79%
91%
How Care Managers Build Caseloads
26
Care Manager Survey Results
Number of maintenance drug prescriptions
BCBSM high deductable plan
Emergency department utilization
Risk score
Chronic condition diagnosis
11%
22%
36%
57%
57%
Utilization of MiPCT List In-formation
27
Care Manager Survey Results
Daily Weekly Every 2 weeks
> Every 2 weeks
Never0%
20%
40%
60%
42%35%
6% 8%3%
How Often Care Managers Converse with PCP Regarding MiPCT-Eligible
Patients
28
Care Manager Survey Results
Weekly Every 2 weeks
Monthly >Monthly Never0%
20%
40%
22%
8%
28%
7%
29%
How Often Care Team Meets to Discuss Delivery of Care Management and/or
Specific Patient Cases
29
Care Manager Survey Results
•The physician(s) I work with support the concepts of the MiPCT care management team.
30
Strongly
Disagree
Disagree
Neither Agree
nor Disagre
e
Agree Strongly Agree
Care Manager Survey Results
•Physicians are available on a daily basis to address questions related to management of MiPCT patients.
31
Never Rarely
Sometimes
Frequently
Always
Care Manager Survey Results
•Physicians understand and are actively involved in population management
32
Never Rarely
Sometimes
Frequently
Always
Care Manager Survey Results
33
•Top 3 broad areas of challenge▫Care Manager Challenges
Need for work flow processes Need for practice team support/understanding
of CM role Time management
▫Care Management Embedment Need for practice staff education on CM role
and process workflows CMs serving multiple practices or working as a
CM part time▫Physician Engagement
Care Manager Survey Results
34
•Top 3 broad areas of success▫Development of Process Improvement
Transition of Care Using the MiPCT List Reviewing the practice schedule regularly
▫Culture Change within the Practice Physician engagement Reviewing potential patients with the
provider/use of huddles Practice staff understanding of the CM role
▫Advanced/Improved IT Capabilities
Cost, Quality and Utilization
National and State Metrics
Utilization and Cost Metrics: MI and National Evaluations are Consistent
•Total PMPM Costs▫Medicare Payments (National)▫Utilization based standardized cost calculations
across all participating payers (Michigan)▫Additional analysis of cost categories
•Utilization▫All-cause hospitalizations▫Ambulatory care sensitive hospitalizations▫All-cause ED visits▫‘Potentially preventable’ ED visits
36
Quality and Experience of Care Metrics:MI and National Evaluations are Different,
But Share Common Elements
NationalDiabetes care:• LDL-C screening • HbA1c testing • Retinal eye examination • Medical attention for nephropathy• All 4 diabetes tests• None of the 4 diabetes tests
Ischemic Vascular Disease: • Total lipid panel test
Patient experience (CAHPS)
Michigan• Diabetes• Asthma• Hypertension• Cardiovascular• Obesity• Adult preventive care• Child preventive care• Childhood lead screening
(Medicaid)
• Patient experience (CAHPS)• Provider/staff experience
37
Cost, Quality and Utilization
Initial Results (Year One)
MiPCT Number of POs with Quality Rate Changes>= +10%
Positive<10%
Negative>-10% <= -10%
Number of POs with Positive Change in All
Group Measures
Breast Cancer Screening 1 22 12 0
Cervical Cancer Screening 30 5 0 0
Chlamydia Screening 8 8 7 12
Adult Preventive 7
Adolescent Well-Care 9 10 10 6
15-Month Well-Child 14 5 5 8
3-6 Year Well-Child 8 9 10 7
Well-Child Care 8
Diabetic Eye Exam 2 12 21 0
Diabetic HbA1c Testing 0 15 20 0
Diabetic LDL-C Testing 0 4 31 0
Diabetic Nephropathy Screening 3 10 19 3
Diabetes Care 2
MiPCT Number of POs with Quality Rate Changes
MiPCT Number of POs with Quality Rate ChangesStatistically Significant Increases (p<=.1)
Increases(Not
Statistically Significant)
Decreases (Not
Statistically Significant)
Statistically Significant Decreases
(p<=.1)
Overall MiPCT Change
Significant (p<=.1)
Breast Cancer Screening 5 18 11 1 Positive Yes
Cervical Cancer Screening
31 4 0 0 Positive Yes
Chlamydia Screening 1 15 10 9 Negative Yes
Adolescent Well-Care 8 11 8 8 Negative Yes
15-Month Well-Child 8 11 7 6 Positive No
3-6 Year Well-Child 5 12 6 11 Negative Yes
Diabetic Eye Exam 4 10 15 6 Negative Yes
Diabetic HbA1c Testing 3 13 16 3 None No
Diabetic LDL-C Testing 0 4 26 5 Negative Yes
Diabetic Nephropathy Screening
4 9 14 8 Negative Yes
MiPCT Number of POs with Quality Rate Changes
MiPCT 2012 PCS ED Rate per 1000 ED VisitsPercent Change from 2011 Baseline Rate by PO
-20.00%
-15.00%
-10.00%
-5.00%
0.00%
5.00%
POs/PHOs
MiPCT Overall
MiPCT Post-Demonstration Funding and SustainabilityDiane Marriott
What Does Sustainability Mean?•To the Health Plan: Added value for their customers
•To the Practice: Maintaining and growing CM staffing, processes and roles
•To the PO: Payment reform for CM
43
CMS Complex Care Management Post-Demo Payment Proposal
• Good News! CMS Physician Fee Schedule included proposed codes for Complex Care Management quarterly payment beginning 1/1/2015.
• MiPCT submitted comments on this constructive development, focusing on:▫ Discouraging CMS from imposing patient financial
responsibility for care management services▫ Recognizing alternative designations (e.g., PGIP PCMH) for
medical home definition▫ Removing the requirement that the practice employ an
advanced care nurse or PA (NP or PA) and streamlining requirements for electronic all-provider communication, annual patient consent, etc.
Payer Sustainability "As participating Michigan Primary Care Transformation Project (MiPCT) payers, we recognize the value of care management embedded in primary care practices. We applaud CMS' recent payment proposal to continue funding for complex care coordination after the December 31, 2014 ending period of the demonstration project. We support continuation of this model of care to produce improvements in patient experience, quality and the value of care. We look forward to working together with the partnership of the MiPCT, the plans and the health care providers in improving Michigan's primary care system."
Sustainability Progress
▫Addition of Priority Health
▫State Innovation Model (SIM)
▫Medicaid
▫Milbank Fund Advocacy
▫ROI PO Subgroup financial modeling
46
PO Primary Care Sensitive Emergency Department Use (Change from 1/1/12 to 12/31/12)
20
11
4
Improved (stat sig.)
For POs with Stat. Sig. Better Performance, Amt. of Change
Over 12%---2 POs8-12%-------4 POs5-8%---------3 POsUnder 5% --11 POs
Overall, from 2012 to 2013, the MiPCT decreased avoidable emergency visits decreased almost 4%.
No Improvement
Improved (not stat. sig.)
We ARE the MiPCT!
We can do this together!
We can make care better!
Questions?