Michigan Primary Care Transformation
Demonstration Project
April 4, 2012Webinar #4
Agenda
Definition of MiPCT and brief explanation Statewide Rollout Update Participation Update Funding Update including Metric Update Care Management Training Update Next Steps…
2
Clarification of MiPCT
Michigan Primary Care Transformation Demonstration Project (MiPCT)
Eight states selected other states, besides Michigan are Maine, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island and Vermont
Practices eligible to participate in MiPCT were either NCQA PCMH Level 2 or 3 before July 1, 2010 and/or BCBSM PCMH designation 2010 and 2011
No PCMH is obligated to participate
3
MiPCT Rollout
Day-long, all-partner MiPCT Launch Meeting occurred on March 28, 2012
MNO Care Manager Team attended MNO PCMH teams participated
4
MiPCT Funding
Practice transformation payment - $1.50 per member per month ($2.00 for Medicare)
Performance incentives - $3.00 per member per month
Care coordination payment - $3.00 per member per month ($4.50 for Medicare)
Additionally, a $.26 per member per month administrative fee is contributed by payers
5
MiPCT Expectations
In return for receiving these payments, practices and providers are being held accountable for achieving gains in • efficiency• appropriateness • quality of care that in turn should improve the
patient’s experience of care and the health status of the patient population
6
MNO Expectations
Attendance at webinars• Share current information• Brief training moments• 100% practice representation• eMail addresses of physicians• Hold each other accountable and create buddy
relationships• Create inter-professional collaborative care teams
7
Moderate Care Manager Training
Required by all including Master Trainers and Leaders Formal training curriculum with competency
assessment Certificate of Completion Must be well versed in “self management strategy”“self management strategy”
8
Definition of Self Management Support
Self-management support is the systematic provision of education and supportive interventions by health care team members to increase patients’ skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support.
9
Definition of Self Management
Self-management is the tasks that individuals must undertake to live well with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management, and emotional management of their conditions.
10
Self Management Training
Certain existing training programs are not acceptable• Stanford Chronic Disease Self- Management
Training: Peer led by 2 lay leaders
Clinician guided plans• Flinders• Teamlet: Dr. Bodenheimer• Generic
11
Moderate Care Manager Training
Moderate Care Manager (PA-C, CNP, RN, APRN, or MSW)• Focus on Self Management Support and Skills• Completed by June 30, 2012• Calendar, offerings and curriculum emailed to all and
MNO online • Physicians do not qualify for Care Manager designation• Moderate Care Manager Job Description
12
Care Team Composition
Lead Care Manager• RN, MSW, CNP, PA-C, APRN• Must complete Care Manager Training
Other Qualified Healthcare Professionals• LPN, CDE, RD, nutritionist, clinical pharmacist,
respiratory therapist, certified asthma educator, certified health educator specialist (bachelor’s degree or higher), licensed professional counselor, licensed mental health counselor, certified health educator specialist (bachelor’s degree or higher), licensed
13
PCMH Care Planner
Works in concert with Care Manager “What should they be called” population coach, care
designer
Focus on Self Management • Completed by June 30, 2012• Calendar, offerings and curriculum emailed • It is recommended that each PCMH identify a team
member to complete the training
14
Complex Care Manager Training
Geisinger: PROVENHEALTH® NAVIGATOR program Selected by MiPCT Steering Committee• Steering committee comprised of mix: primary care
physicians, researchers• Sub committees: Primary care physicians,
researchers and operations
First cohort will be trained on April 19, 2012 8 MNO “complex” care managers attending first
training event
15
Pay for Performance: 6 Months(August 2012)
Moderate Care Manager in place Complex/Hybrid Care Manager in place Patient e-Registry orEMR/EHR with registry
capabilities HEDIS Quality Scores for the population Extended Access
16
Pay for Performance: 12 Months(February 2013)
Moderate Care Manager in place Complex Care Manager in place Patient Registry or EMR/EHR with registry
capabilities: Generate Trend Reports HEDIS Extended Access Additional items: Depression Screening PHQ-2,
PHQ-9
17
12 Month Metrics: Challenge
Metrics for care managers• Difficult to reach agreement • What should be measured• How does a patient’s experience fall into the mix
18
Next Steps
By April 20, 2012 schedule a one hour all practice meeting to begin planning with your care manager
By May 1, 2012 with the assistance of your care manager your practice should complete “community mapping”
Locate a spot in your practice that a care manager can call “home”
With the assistance of your care manager plan a process to complete “population profiling”
19
Next Steps
With the assistance of your care manager review specialty linkages such as • Home health care• Community resources• Payer connection
20
21
Issues in 3 x
5
CommentsComments
Top Related