MEDICAL NETWORK ONE

PRIMARY CARE PHYSICIAN

AND PRACTICE TEAM WEBINAR

JUNE 20, 2012

Welcome and Acknowledgements

Online Introductions

Current PCP membership

Welcome and Acknowledgements

Dedicated PCMH Implementation Team

BCBSM PCMH Designations

Behavior Health recruitment

Provider and Health Plan Outreach

Organized Systems of Care

Specialist Contracts

Congratulations: 2012 BCBSM PCMH Designations

• Everett Campbell • Douglas Hames, MD • Elzbieta Rozmiej, MD • Pam Cox, MD • Al Juocys, DO • Shalija Rastogi, MD • Elena Stephan, MD • Namir Stephan, MD • Rick Poston, DO • Michelle Pavlik, DO

• James Miller, DO • Tedd March, DO • Solon L. Alimario, MD • Anthony Clarke, MD • Alfred Newton, MD • Roy Elrod, MD • Katrice Herndon, MD • Nichole Massie, MD • Lennox Pike, MD • Ralph E. Williams II, MD

Congratulations: 2012 BCBSM PCMH Designations

• Richard Fici, DO • Polly Schmidt, DO • Kevin Klein, DO • Thomas Mianecki, DO • Karl Emerick, DO • David Ginnenbaugh, MD • Thomas Horrigan, MD • Ashraf Barry, MD • Anna Fraymovich, MD • Antoun Oska, MD

• James Miller, DO • Ia Y. Kue, MD • Bruce Johnson, DO • Susan Tam, DO • Abdul Kabir, MD • John Pradko, MD • Curtis LaJoie, DO • Taras Lisovsky, DO • John Floreno, DO • Robert Moretzky, DO

Congratulations: 2012 BCBSM PCMH Designations

• David Everingham, DO • Craig Everingham, DO • Gregory Henk, DO • Vesna Evkoska, DO • Ricardo Cabrera, MD • Fayes Shukairy, MD • Jeetender Matharu, MD • Ronald Williamson, MD • Stephen Bell, DO • Samar El-Achkar, MD

• Stephanie Lucas, MD • Logan Oney, MD • Maan Askar, MD • Steven Zalla, DO • James Kohlenberg, MD • WSU FP • WSU IM-5B • WSU IM-4C

Goals and Purpose of Webinars Restated

Provide information about ongoing company

endeavors both internal and external

Describe to your colleagues and practice teams

what we do and what we are striving for

Identify 3rd quarter goals

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Goals and Purpose of This Webinar

Present an overview of the following:

• CMS Demonstration Project (MiPCT)

• Diabetes Cell Phone Project

• Behavior Health Initiative

• Organized System of Care Activities

• Care Manager and Population Manager Training

Draw comments and input regarding:

• Communication efforts

• Collaborative efforts

• Initiatives

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Current Activities – Care Teams

Adult

Adolescent/Pediatric

R-Team (Pediatric Healthy Lifestyle)

Behavior Health

DSME

Worksite Wellness Programs

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Collaborative Activities

Mackinac Learning Collaborative III

Preparation for MLC IV

Practice Coaching

LEAN Coaching

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Enterprise Wide Activities

Dedicated PCMH Implementation “A” Team

Organized Systems of Care

Specialist Agreements

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Enterprise Wide Activities

IMPACT Model co-training with WSUPG Team

Monthly Specialist Focus Group Meetings

Quarterly Cluster Meetings

Complex Care Manager Training

Moderate Care Manager training

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Internal Activities

Medical Management

Physician Recruitment, Contracting and Retention

Quality Improvement

IT revamping

AADE audit

Staff training and education

HAP Contract

OMNICARE Contract

Blue Complete Contract

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Current Activities - Ongoing

MiPCT

CDSMP - PATH

Diabetes Crossover

Matter of Balance

Mindful Eating

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Clinical Activities

Patient Registry

ePrescribing

Generic Use Rate

QI Activities to Improve Quality Scores

MUSIC: WSUPG Committee Member

Cardiology: WSUPG Committee Member

Transitions of Care

Organized Systems of Care

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MiPCT: CMS Demonstration Project

PCMH designated practices for 2 years

Practice transformation payments

Participating health plans contribute $3.00 PMPM

to the incentive program pool

Performance incentive metrics in place

PO scores will be ranked from high to low and

placed into payment deciles, ranging from 82% to

118% of the mean payment

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MiPCT: MNO

Clinical leadership support

Care Manager Support

Implementation of tools and care processes that

enable the primary care practices to achieve

practice transformation

Analytical support with generation of reports to

measure transformation progress

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MiPCT: MNO and PCP

RN, MSW, PA-C and APRN care managers within

primary care practice settings

• Geisinger

• University of Massachusetts

• PTI

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MiPCT: MNO and PCP

Develop processes that enable primary care

practice teams to engage patients and their

caregivers and/or families, as appropriate, in their

own care through:

Care management

Self-management support

Navigation and coordination of care

Effective transitions of care

Linkage with community resources

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MiPCT: PCP

Develop processes that enable collaborative team

care

Enhance access to quality care through:

Same day appointments

After hours care

Electronic access to care: email, e-visits

Patient portal

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MiPCT: Deliverables

Year One: Develop primary care practice

infrastructure including enhanced access, all

patient registry system and embedding care

managers within the primary care practices

Year Two: Optimize care management, improve

quality metrics and avoid high cost care

Year Three: 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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MNO Engagement

Travel Team

• Behavior health

• RN

• Dietitians

• Exercise specialists

Medical Management

Care Management

Quality Improvement

IT

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Our Enterprise… It’s Up To You Now

What do we need to move forward effectively?

What evidence do we have to prove that our work

is making a difference?

What evidence do we have to prove that our work

made a difference?

Have we shared the results of our work beyond

our organization?

How can we share the results of our work beyond

our organization?

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Vision… Revision Required

To be recognized and respected as the premier

independent healthcare organization in Michigan

that offers community-based inter-professional

patient-centered/family-centered quality care.

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Ask Yourself This Question…

I know what action steps our organization is taking

next as a result of today’s meeting.

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