The Michigan Primary Care Transformation (MiPCT) Project Presentation to MPCC April 13, 2012.

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The Michigan Primary Care Transformation (MiPCT) Project Presentation to MPCC April 13, 2012

Transcript of The Michigan Primary Care Transformation (MiPCT) Project Presentation to MPCC April 13, 2012.

The Michigan Primary Care Transformation (MiPCT) Project

Presentation to MPCCApril 13, 2012

CMS Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration Project

or MiPCT

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Agenda

•The Michigan Primary Care Transformation Project▫MiPCT Vision▫Financial Model▫Clinical Model▫Resources Available▫How Will We Define Success?

•Questions and Discussion

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The Vision for a Multi-Payer Model•Use the CMS Multi-Payer Advanced Primary Care

Practice demo as a catalyst to redesign MI primary care▫Multiple payers will fund a common clinical model▫Allows global primary care transformation efforts

•Create a model that can be broadly disseminated▫Facilitate measurable improvements in population health

for Michigan residents▫Contribute to national models for primary care redesign

•Form a strong foundation for successful ACO models

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Guiding Principle: The “Triple Aim”

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Practice Participation Criteria

•PCMH-designated in 2010, and maintain PGIP or NCQA designation over the 3-year demonstration

•Part of a participating PO/PHO/IPA•Agreement to work on four focused initiatives:oCare Managemento Self-Management SupportoCare Coordinationo Linkage to Community Services

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Participating Provider and Payer Partnersas of April 1, 2012

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Practices* PO/PHO Physicians Payers

410 36 1700+ 4 (Medicaid, Medicare, BCBSM,

BCN)

* Choice of a January 1 or April 1 start date; no additional practice or PO starting date opportunities after 4/1/12

MiPCT Funding Model

$0.26 pmpm Demo 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

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Developing a Clinical Framework to assist POs/PHOs/Practices with

MiPCT Population Management

• Build on the great work POs and Practices have already done!

• Develop working definitions for MiPCT focus areas

• Define evidence-based interventions and metrics for each focus area, categorized by risk status and population tier

• Develop resources and training models to meet PO/PHO and practice needs

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IV. Most complex

(e.g., Homeless,Schizophrenia)

III. ComplexComplex illness

Multiple Chronic DiseaseOther issues (cognitive, frail

elderly, social, financial)

II. Mild-moderate illnessWell-compensated multiple diseases

Single disease

I. Healthy Population

<1% of population Caseload 15-40

3-5% of population Caseload 50-200

50% of populationCaseload~1000

Managing Populations: Stratified approach to patient care and

care management

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Health IT- Registry / EHR registry functionality * - Care management documentation *- E-prescribing (optional)- Patient portal (advanced/optional)- Community portal/HIE (adv/optional)- Home monitoring (advanced/optional)

Patient Access- 24/7 access to decision-maker * - 30% open access slots *- Extended hours *- Group visits (advanced/optional)- Electronic visits (advanced/optional)

Infrastructure Support- PO/PHO and practice determine

optimal balance of shared support - Patient risk assessment - Population stratification - Clinical metrics reporting

*denotes requirement by end of year 1

PCMH Services PCMH Infrastructure

Complex CareManagementFunctional Tier 4

All Tier 1-2-3 services plus: Home care team Comprehensive care plan Palliative and end-of life care

Care Management

Functional Tier 3

All Tier 1-2 services plus: Planned visits to optimize

chronic conditions Self-management support Patient education Advance directives

Transition Care

Functional Tier 2

All Tier 1 services plus: Notification of admit/discharge PCP and/or specialist follow-up Medication reconciliation

Navigating the Medical Neighborhood

Functional Tier 1

Optimize relationships withspecialists and hospitals

Coordinate referrals and tests Link to community resources

Prepared Proactive Healthcare TeamEngaging, Informing and Activating Patients

Michigan Primary Care Transformation Project Advancing Population Management

P O P U L A T I O N M A N A G E M E N T

MiPCT PO/Practice Expectations•Care management▫Performed for appropriate high- and moderate-

risk individuals •Population management▫Electronic registry functionality by end of year 1▫Proactive patient outreach ▫Point-of-care alerts for services due

•Access improvement▫24/7 access to clinician▫30% same-day access▫Extended hours

MiPCT Joint PO/PHO and Practice Implementation Plan•Overview of PO/PHO Role in MiPCT implementation•High-level, jointly-developed Implementation Plan

(one per practice)▫ Current and planned division of care management responsibilities

between Practice and PO▫ Care Management Staffing Plans▫ Practice Information (EHR, Registry, Key Contacts)

•Description of the planned distribution of care coordination and incentive payments between PO and practice

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What can MiPCT practices expect?

• Information to support population management▫Multi-payer claims database▫Risk stratification and utilization reports▫Feedback reports

•Resources to help support team-based approach to care▫Preserve local autonomy while assuring basic

levels of consistency across the demonstration

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Michigan Data Collaborative (MDC)

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Data collection and analytic group based at the University of Michigan will

•Build “multi-payer database”

•Create and distribute reports that:

• Help to identify high-risk and at-risk patients

• Establish baseline performance levels

• Identify opportunities for improvement

•Support report interpretation and practice use

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www.mipctdemo.org

Care Management Resource Center •UMHS/BCBSM collaboration

•Goal: help disseminate effective, evidence-based care management models throughout Michigan

• Initial focus is MiPCT practices – will be available to all Michigan PO/PHOs /practices▫Web-based resource for templates, tools, evidence-

based information▫Webinars, workshops and mentoring in care

management

QI and Team Development Resources• Learning Sessions aimed at:▫Building on PCMH team-based capabilities

Team members working at the top of their role and license Clearly defining roles for the entire practice team

▫Nurturing a culture of support and respect▫Optimizing practice workflow and change management

Success = Improved Population Health + Improved Patient & Provider Experience of Care + Reduced Cost

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Strategies for achieving…SHORT TERM SAVINGS

• Intensive care management for complex patients, e.g., CHF, COPD

• Acess 24/7 to clinical decision maker to prevent unnecessary ED utilization and inpatient admissions

• Baseline data analysis for utilization outliers and focused root cause analysis

• Educate on evidence-based approaches to care (e.g., low back pain management)

LONG TERM SAVINGS• Focus on all four “tiers” of

patient population

• Recognize and reward performance on intermediate markers of chronic conditions to prevent long-term complications (BP in diabetes, etc.)

• Focus on primary prevention/screening

• Work to build self-sustaining healthy communities

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MiPCT Evaluation - Overview

•Unprecedented opportunity to measure the outcomes of investing in primary care across a large, diverse state

•State and National Levels▫MPHI (State)▫RTI (National)

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Evaluation Details•Statistical analysis of the effect of interventions

(care management, care transitions, community linkages, IT, patient access) on quantifiable outcomes, using: ▫Claims data▫Clinical quality indicators▫Patient survey on experience of care▫Provider/clinic staff survey on work/life satisfaction

•Key interviews and feedback from practice and PO representatives

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In Summary •Evidence-based, goal-oriented care + engaged patients

+ proactive care team = MiPCT

•No magic bullet. The key to better health care delivery at lower cost will involve multiple solutions

•The Michigan Primary Care Transformation Project will help shape the future of primary care in Michigan and – perhaps – for the nation

•TOGETHER, WE WILL MAKE A DIFFERENCE IN MICHIGAN !

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MiPCT Contacts• MiPCT Demo Mailbox: [email protected]

• Carol Callaghan, MPH (Co-Chair) [email protected]

• Jean Malouin, MD MPH (Co-Chair and Medical Director) [email protected]

• Sue Moran, MPH (Co-Chair) [email protected]

• Diane Bechel Marriott, DrPH (Project Manager) [email protected]

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