Transcript Multi-Payer Advanced Primary Care Practice Demonstration

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The Michigan Primary Care
Transformation (MiPCT) Project
All-Partner Launch Event
March 13, 2012
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Agenda
• U.S. Health Care Trends (the burning platform)
• The Michigan Primary Care Transformation Project
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CMS MAPCP Background Information
MiPCT Vision
Participants
Financial Model
Clinical Model
Resources Available
How Will We Define Success?
• Summary
• Questions and Discussion
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U.S. Health Care Trends
Average Health Spending Per Capita ($US):
The ubiquitous and non-sustainable cost curve
7000
6000
United States
Germany
Canada
France
Australia
United Kingdom
5000
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2000
1000
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K. Davis et al. Slowing the Growth of U.S. Health Care Expenditures: What Are the Options?, The
Commonwealth Fund, January 2007, updated with 2007 OECD data
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Where is the silver lining?
• Accountable Care Organizations?
• Patient Centered Medical Homes?
• Health Care Reform?
• All/None of the above?
PCMH as the Foundation for ACO
Population Management
The goal of Accountable
Care Organizations should
be to reduce, or at least
control the growth of,
healthcare costs while
maintaining or improving
the quality of care patients
receive (in terms of both
clinical quality, patient
experience and
satisfaction).
- Harold Miller
Source: Premier Healthcare Alliance
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CMS Multi-Payer
Advanced Primary Care Practice
(MAPCP) Demonstration Project
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CMS Multi-Payer Advanced Primary
Care Practice (MAPCP) Demonstration
• Centers for Medicare & Medicaid Services is exploring
the role of the PCMH in improving US health care
▫ Participating in state-based PCMH demonstrations
• 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
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MAPCP Demo: Participating States
• Maine
22 practices  42 (year 3)
• Michigan
410 practices
• Minnesota
159 practices  340 (year 3)
• New York
35 practices
• North Carolina
54 practices
• Pennsylvania
78 practices
• Rhode Island
13 practices
• Vermont
110 practices  220 (year 3)
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• TOTAL
881 practices  1,192 (year 3)
Michigan: Some fun facts
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Total population (2010 census): 9,883,640
11th largest state in the United States
Home to more than 11,000 lakes
The longest freshwater shoreline in the world
The largest State Forest system in the nation
Favorite vacation spot of Ernest Hemingway
Birthplace of Charles Lindbergh, Henry Ford, Stevie
Wonder, Gilda Radner, Madonna, “Magic” Johnson and
(who can forget...) Alice Cooper
And, last but not least…
• Although Michigan is called the "Wolverine State"
there are no longer any wolverines in Michigan
Michigan: Selected health statistics
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45th (of 50 states) in coronary heart disease deaths
41rd in percent of obese adults
34th in infant mortality rate
34th in percent of adults who smoke
34th in overall cancer death rate
20th in percent of adults who exercise regularly
12th in adults receiving colon cancer screening
5th in childhood immunization rate
Source: Comparison of Michigan Critical Health Indicators and Healthy People 2010
Targets, Michigan Department of Community Health, May 2011
The Michigan Primary Care
Transformation (MiPCT) Model
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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
▫ Support development of evidence-based care models
• Create a model that can be broadly disseminated
▫ Facilitate measurable, significant improvements in
population health for our Michigan residents
▫ Bend the current (non-sustainable) cost curve
▫ 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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MiPCT Participants
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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
• Agree to work on the four selected focus initiatives:
o Care Management
o Self-Management Support
o Care Coordination
o Linkage to Community Services
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Participating Provider and Payer Partners
As of April 2012
# Practices*
# POs # Physicians
# Payers
410 Practices 36 POs Over 1700
4 (Medicaid,
Physicians Medicare, BCBSM,
BCN)
*Choice of a January 1 or April 1 start date; no additional
practice or PO starting date opportunities post 4/1/12
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MiPCT Financial Model
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MiPCT Funding Model
$0.26 pmpm
$3.00 pmpm*, **
$1.50 pmpm*, **
$3.00 pmpm*, **
$7.76 pmpm
Administrative Expenses
Care Management Support
Practice Transformation Reward
Performance Improvement
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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MiPCT Clinical Model:
Optimizing Patient Engagement,
Improving Population Health
Developing a Framework to assist
POs/PHOs/Practices with
MiPCT Population Management
• Build on the great work you’ve 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/practice needs
Managing Populations:
Stratified approach to patient care and
care management
IV. Most
complex
(e.g., Homeless,
Schizophrenia)
<1% of population
Caseload 15-40
III. Complex
Complex illness
Multiple Chronic Disease
Other issues (cognitive, frail
elderly, social, financial)
II. Mild-moderate illness
Well-compensated multiple diseases
Single disease
I. Healthy Population
3-5% of population
Caseload 50-200
50% of population
Caseload~1000
Michigan Primary Care Transformation Project
Advancing Population Management
PCMH Services
Complex Care
Management
Functional
Tier 4
Care Management
Functional Tier 3
Transition Care
Functional Tier 2
Navigating the Medical
Neighborhood
Functional Tier 1
PCMH Infrastructure
All Tier 1-2-3 services plus:
 Home care team
 Comprehensive care plan
 Palliative and end-of life care
All Tier 1-2 services plus:
 Planned visits to optimize
chronic conditions
 Self-management support
 Patient education
 Advance directives
All Tier 1 services plus:
 Notification of admit/discharge
 PCP and/or specialist follow-up
 Medication reconciliation
 Optimize relationships with
specialists and hospitals
 Coordinate referrals and tests
 Link to community resources
Prepared Proactive Healthcare Team
Engaging, Informing and Activating Patients
P O P U L A T I O N
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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
M A N A G E M E N T
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MiPCT PO/Practice Expectations
• Care management
▫ Performed for appropriate high and moderate
risk individuals
• Population management
▫ 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
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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?
• Additional resources available to help
support team-based approach to care
▫ Develop a model that suits the unique
circumstances of each practice while
maintaining consistency across state
▫ Preserve local autonomy
• Information for population management
▫ Multi-payer claims based database
▫ Provide risk stratification, utilization reports
• Goal: To support Michigan primary care
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Resources Available
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www.mipctdemo.org
Care Management Resources
• Care Management Resource Center
▫ UMHS/BCBSM collaboration
▫ Web-based resource for templates, tools, evidence-based
information, care manager job descriptions, etc.
▫ Free care management consultation service
▫ Care management implementation guide
• Care Manager Training and Support
▫ National and local evidence-based models
▫ Also allow credit for existing PO/PHO training models
Team Development Resources
• Goal: Build on PCMH team-based capabilities
▫ Using team members to the maximum capability of
their roles and licenses
▫ Clearly define roles for physicians, nurses, medical
assistants, front office staff, and all other team
members (social workers, pharmacists, dieticians, etc.)
• Facilitated learning opportunities for practice teams
▫ Examples: Learning Collaboratives, Lean workshops,
Practice Coaching, webinars and seminars
▫ Training contracts awarded to state resources
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MDC – the Michigan Data Collaborative
The Michigan Data Collaborative (MDC) is a data
collection and provisioning group at the University of
Michigan.
• Collect claims data from Medicare, Medicaid, BCBSM, and BCN
• Collect other data such as registry, immunization, self-reported data,
and others
• Build “multi-payer claims database”
• Create reports
• Provide reports and data to POs
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Multi-Payer Claims Database
• Collect data from multiple Payers
(insurance carriers) and aggregate it
together in one database
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Creates a more complete picture of a patient’s
information when they:
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Receive benefits from multiple insurance carriers
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Visit physicians from different Practices or
Physician Organizations
MiPCT
Medicaid
Medicare
BCN
BCBSM
Collects more complete information on a
patient’s:
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Procedures
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Diagnosis
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Visits
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Tests
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Test Results (if results are collected)
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Prescriptions (if Rx data are collected)
Multi-Payer Claims
Database
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Reporting
Multi-Payer Claims
Database
• Summary level and PO-specific
• Delivered to POs
 POs will distribute to Practices
Retrospective Reports
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Quality and Utilization performance
metrics chosen for the project
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Only claims-based metrics for Year 1
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datasets
datasets
datasets
reports
reports
reports
Requires 2-3 month run-out to ensure
availability of complete data
Prospective Reports
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Timely feedback about attributed
population for use in care management
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PO
PO
Providers are not being measured/scored
Incentive Payments Reports
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PO
Practice
Practice
Practice
Practice
Incentive scores and payments
Practice
Practice
Practice
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How Will We Define Success?
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MiPCT Builds Patient-Centered
Medical Home Capacity in Michigan
Superb Access
to Care
Patient
Engagement
in Care
Clinical
Information
Systems
•Patients can easily make appointments and select
the day and time.
•24/7 access to a clinical decision maker
•Waiting times are shorter.
•eMail and telephone consultations are offered.
•Off-hour service is available.
•Patients have the option of being informed and
engaged partners in their care.
•Practices provide information on treatment plans,
preventative and follow-up care reminders, access
to medical records, assistance with self-care, and
counseling.
•These systems support high-quality care, practicebased learning, and quality improvement.
•Practices maintain patient registries; monitor
adherence to treatment; have easy access to lab
and test results; and receive reminders, decision
support, and information on recommended
treatments.
Care
Coordination
Team Care
Patient
Feedback and
Reporting
Metrics
• Specialist care is coordinated, and
systems are in place to prevent errors
that occur when multiple physicians
are involved.
• Follow-up and support is provided.
• Integrated and coordinated team care
depends on a free flow of
communication among physicians,
nurses, care managers, and other
health professionals (including
behavioral health professionals)
• Duplication of tests and procedures is
avoided
• Patients are surveyed to assess their
experience
• Performance on operational metrics is
assessed regularly via a performance
dashboard to ensure program integrity
and inform improvement
opportunities and budget neutrality
Source: Health2 Resources 9.30.08
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Success = Improvements in
Population Health + Cost + Patient
Experience
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Reduction in Unnecessary and NonValue-Added Costs
The tie to budget
neutrality and ROI
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Budget Neutrality and ROI
• Budget Neutrality
▫ The minimum required
▫ Amount expended in additional payments to providers
(practices and POs) plus administrative costs must be equal
to or less than the amount saved by avoiding unnecessary
services (e.g., ambulatory care-sensitive ED visits and
inpatient stays, redundant testing, etc.)
▫ Must trend toward budget neutrality at the end of Year Two
(2013)
• ROI
▫ The GOAL
▫ “Return on Investment”
▫ Saving more in avoidable costs than is spent on additional
payments to providers and administrative costs
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Strategies for achieving…
SHORT TERM SAVINGS
• High-risk patient intensive
care management
• 24/7 clinical decision maker
access 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 “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
MiPCT Evaluation - Overview
• Unprecedented opportunity to measure the
outcomes of investing in primary care across a
diverse state
1. Quality, cost, efficiency
2. Experience of care
3. Population health
It’s about the relationship between the
changes you make in the clinic and patient
outcomes
What does this involve?
• Statistical analysis of the effect of your work
(care management, care transitions, community
linkages, IT, patient access) on quantifiable
outcomes, using:
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Claims data
Clinical quality indicators
Patient survey on experience of care
Provider/clinic staff survey on work life satisfaction
• Key interviews and feedback gathering from
practice and PO representatives
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Summary
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Key Dates
• Webinar Schedule (Select Thursdays, 3-5pm)
• March 22 – Financial Reporting and Templates
• Recommend your topics! We want to be helpful!
• CCM Rollout Training – 2 Q 2012
• Quarterly Report and Financial Templates
• Quarter 1 (Due May 1, 2012): Brief interim reports
• Quarter 2 (Due August 1, 2012): Documentation for the 6 month
performance incentive metrics
• Quarter 3 (Due November 1, 2012): Brief interim reports
• Quarter 4 (Due February 1, 2013): Updated Implementation Plans
• Incentive Metrics
• Six month metrics (Jan-June 2012)
• Twelve month metrics (August – December 2012)
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• No magic bullet - the key to better health care delivery
at lower cost will involve multiple solutions
• The Patient Centered Medical Home, as a foundation
for the ACO/OSC model, offers one promising solution
• The Michigan Primary Care Transformation Project will
help shape the future of primary care in our state
• TOGETHER, WE CAN MAKE A DIFFERENCE FOR
MICHIGAN!!
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MiPCT Contacts
• MiPCT Demo Mailbox:
• Carol Callaghan (Co-Chair)
[email protected]
[email protected]
• Jean Malouin, MD MPH (Co-Chair, Medical Director)
[email protected]
• Sue Moran (Co-Chair)
[email protected]
• Diane Bechel Marriott, DrPH (Project Manager)
[email protected]
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Questions and Discussion