Michigan Primary Care Transformation

Demonstration Project

April 3, 2013 Webinar

Agenda

Year One metrics

What’s being measured in Year Two

Training

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Committee Composition

David Livingston, UnitedHealthcare Community Plan of Michigan

Dr. Paul Ponstein, POM ACO and MCCSI

Carol Callaghan, Michigan Department of Community Health

Ruth Clark, Integrated Health Partners

Dr. Jim Forshee, Molina Healthcare of Michigan

Margaret Mason BCBSM

Betsy Wasilevich, BCBSM alternate

Ewa Matuszewski, Medical Network One

Dr. Kimberlee Coleman, United Physicians (N)

Christina Hildreth, Metro Health PHO (N)

Susan Dolby, MSU Health Team (N)

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Goals

Year One (2012): Develop primary care practice

infrastructure including enhanced access, all patient

registry system and embedding care managers within the

primary care practices.

Year Two (2013): Optimize care management, improve

quality metrics and avoid high cost care.

Year Three (2014): Achieve the “Triple Aim” of improved

quality of care, improved patient and primary healthcare

team experience of care and reduced /stabilized costs of

care.

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Data Sources

Claims Data: All participating health plans will

submit claims data to the Michigan Data

Collaborative which can be used to calculate

utilization and cost metrics. Claims data will be

calculated for each Health Plan and aggregated

across all contracted plans. Confidence intervals at

95% will be provided.

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Data Sources

MiPCT Quarterly Reports: The report will

document updates to the MiPCT Implementation

Plan and progress to date in developing PCMH

infrastructure capabilities and carrying out MiPCT

clinical initiatives.

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Data Sources

Self-Reported Data (SRD): PGIP POs currently

report to BCBSM twice a year on their practice’s

PCMH capabilities. BCBSM applies accuracy,

validity and inter-rater reliability checks and

balances to the reports. Financial penalties are

imposed on POs for inaccurate reporting of

capabilities and are reflected proportionally on the

distribution of funds to the PO.

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Data Sources

Registry/EHR data: PO’s/practices will submit

requested clinical data from EHR or registry

systems in a specified format to the Michigan Data

Collaborative for calculation of clinical quality

metrics.

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6 Month Ranking

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PO ID

# MiPCT Practices

30% SD appoint

After hours

appoint. 8 hr/wk

Registry Function

MCM hired

MCM trained

CCM hired

CCM trained

Total Rank

A 7 10 10 10 5 5 5 5 50.00 1 B >25 10 10 10 5 5 5 5 50.00 1 C <5 10 10 10 5 5 5 5 50.00 1 D <5 10 10 10 5 5 5 5 50.00 1 E 6 10 10 9.3 5 5 5 5 49.30 5 F 15 9.3 10 9.7 5 5 5 5 48.70 6 G 5 10 10 8.8 5 5 5 5 47.80 7 H 6 10 10 8.7 5 5 5 5 47.50 8 I 18 10 9.4 9.2 5 5 5 5 46.50 9 J 11 9.1 9.1 9.8 5 5 5 5 46.73 10

Care Managers Six Month

Moderate care managers (MCM) trained and working

MiPCT Quarterly report

1. Number of MCM hired/ contracted by practices and/or PO

2. Number of MCM within PO that have completed the required training

1. Number of required MCM per PO

2. Number of MCM hired/ contracted

10 points

Complex care managers (CCM) trained and working

MiPCT Quarterly report

1. Number of CCM hired/ contracted by practices and/or PO

2. Number of CCM in PO that have completed the required training

1. Number of required CCM per PO

2. Number of CCM hired/ contracted

10 points

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Complex Care Manager 12 Months

Complex care managers (CCM) trained and working*

MiPCT Quarterly report and Care Manager Resource Center Verification

IM/FP: Number of CMC trained and providing services to practices in PO

Plus

Peds: Number of CMC trained and providing services within PO

Number of attributed MiPCT members in PO as of June 30, 2012 divided by 5000

(may be a lower ratio for pediatric practices compared to internal and family medicine practices)

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Moderate Care Manager 12 Months

Moderate care managers (MCM) trained and working

MiPCT Quarterly report

Internal Medicine & Family Practice (IM/FP): Number of MCM trained and providing services to practices in PO

Pediatrics (Peds.): Number of MCM trained and providing services within PO

(Trained means completed MiPCT approved Moderate Care Manager course and will be self-reported by the PO.)

Number of attributed MiPCT members as of June 30, 2012 in PO divided by 5000 (may be a higher ratio for pediatric practices compared to internal and family medicine practices)

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12 Month Transitions and ED

Notification of admissions and discharges for at least 50% of MiPCT beneficiaries

MiPCT Quarterly report

Number of practices reporting capability

Number of Practices in PO

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Primary care sensitive ED visits

(NYU algorithm)

Claims Data

Change in PO PCS ED visits/1000 (Baseline Rate – 2012 rate

PO Baseline Rate (Mean of 2010 & 2011 ED visits/1000)

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Patient Registry

Electronic patient registry functionality: Tracking chronic illness care and preventive services

a. MDC attestation b. Electronic report of the clinical metrics

Number of practices with ability to transmit clinical data to the MDC

PLUS

Sum of the points practices received for summary report of clinical measures

Total number of practices in PO Total number of practices in PO

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Access

30% same day appointments

SRD report (5.7)

Number of practices in PO with capability

Number of practices in PO

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Access outside regular hours: 12 hr/week

SRD report (5.5)

Number of practices in PO with capability

Number of practices in PO

10

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Outcome Measures

Utilization (Improvement over baseline) 55

Primary care sensitive ED visits (NYU algorithm) 30

Ambulatory Care Sensitive Hospitalizations 15

Readmissions 10

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Outcome Measures

Clinical Quality Metrics - Claims Based ( Improvement over baseline) 15

Diabetes: AIC tests completed

Diabetes: Annual retinal eye exams

Breast Cancer Screening

Cervical Cancer Screening

Well Child Visits - 15 months

Well Child Visits - 3-6 years

Adolescent immunizations

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Process Measures

Clinical Quality Metrics – EHR or registry (Pay for Reporting) 15

Diabetes Control (adults): a. AIC < 8

1. Diabetes Poor Control (adults): AIC > 9

1. Diabetes (adults): Blood Pressure < 140/90

1. Cardiovascular Disease (adults): Blood Pressure < 140/90

1. Hypertension (adults): Blood Pressure < 140/90

1. Asthma (ages 5-64): Asthma Action Plan or self-management plan for a. all asthma and b. persistent asthma

1. Tobacco Use ( 13 years and older): Percent smokers

1. Obesity - children: BMI Percentile

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Process Measures

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Notification of hospital admissions & discharges 3

Tracking referrals of high-risk patients to community resources. (10.7)

3

Follow-up of high-risk with community referrals for next steps. (10.8)

3

At least one member of PO or practice unit has completed formal training in a nationally or internationally-accredited self-management support program and works with/educates practice unit staff members to actively use self-management support concepts and techniques. (11.8)

3

Self-management support is offered to all patients with the chronic condition selected for initial focus (based on need, suitability, and patient interest. (11.2)

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2014 Measures

ADD/ADHD

Depression Screening

Pediatric/Adult Obesity

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One Year Refresher Workshop

Each PU team participates 5 hour training

• Three Sessions: Saturday and weekdays

Each Care Manager participates in training

• Ten Sessions: Saturday and weekdays

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Open Discussion

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