MiPCT Demonstration Project

Medical Network OneJanuary 22, 2014

Agenda

Introduction of practice unit new team members Comparative G code billing results Care Managers Metrics for 2014 Learning requirements

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Comparative G Code Use

Slipped in ranking Who is on your practice team? How is your team working together? How can your team be invigorated? What are your practice’s current challenges? Tell us how many referrals you’ve received from

your PCPs?

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PCMH Accreditation

Two national accreditation bodies• URAC• NCQA

One local payer designation• BCBSM

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What Are We Measuring?

Utilization (assessed at PO level)Exceed benchmark or % improvement over previous year Primary care sensitive ED visits (NYU algorithm) Asthma ED Visits for Previously Diagnosed Asthma* Ambulatory Care Sensitive Hospitalizations Hospital Readmissions

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Claims

What Are We Measuring?

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Clinical Quality Metrics (assessed at PO level) Exceed benchmark or % improvement over previous year

Diabetes: Annual retinal eye exams Breast Cancer Screening Cervical Cancer Screening Well Child Visits - 15 months Well Child Visits - 3-6 years Adolescent immunizations

Claims

What Are We Measuring?

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Clinical Quality Metrics (assessed at PO level)

Exceed benchmark or % improvement over baseline Diabetes Control A1C < 8 Diabetes: Blood Pressure < 140/90 CVD: Blood Pressure < 140/90 Hypertension: Blood Pressure < 140/90 Tobacco Use Assessment Weight Assessment for Children and Adolescents

Registry and Claims

What Are We Measuring?

Process Measures (assessed at practice level)

Depression Screening for Patients with Chronic Health Conditions

Notification of hospital admissions and discharges Follow-Up Referrals to a Community-Based

Program or Agency Self-Management Support Offered for Chronic

Condition of Focus

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Registry, Claims and Quarterly MiPCT Report

Learning Requirements: 2014

Specific Care Manager learning requirements Specific Practice Team learning requirements

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Learning Event: Care Managers

12 hours Learning events for Care Managers

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Learning Requirement: Practice Unit

Care Team Members: It is not “care manager” and the team”

Eight hours of group learning

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MiPCT Learning Activities

Thanks to Priority Health for their engagement Recommended for physicians, mid level providers,

other healthcare professionals and staff ICD-10 goes live on October 1, 2014 ICD-10 Workshop (6 CEUs toward 2014 CMC)• January 30, 2014• 9am-4pm• Training Center in Madison Heights

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MiPCT Learning Activities

MiPCT Learning Collaborative Expectation was for 100% of the MNO MiPCT

practices to participate Fluctuation of care team activity and competencies• Three Saturday Sessions at Blue Care Network• January 25 from 8am-4pm

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MiPCT Collaborative Team Participants

Anchor Bay Clinic Country Creek Family Physicians Country Creek Pediatrics Hampton Medical Center Lifetime Family Care Michigan Healthcare Professionals (Angela’s Team)

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MiPCT Learning Collaborative Teams

Center for Preventive Medicine Everingham Clinic Macomb Pediatrics Monroe Medical Woodhaven Pediatrics Ricardo Cabrera, MD Jeetender Matharu, MD Douglas Hames, MD Meadowbrook Internists

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CMS Ruling

Appeal of the criteria for care managers Review of hiring requirements

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Open Discussion

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