The Michigan Primary Care Transformation (MiPCT) Project

MiPCT UpdatePGIP Quarterly MeetingMarch 13th, 2015

Agenda

•Evaluation Update/RTI Reports•Clinical Focus Areas•2015 Incentive Program•PO/Practice Level Success Story Program•Physician Champion Program•Announcements/MiPCT Summit Dates

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Update

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RTI Methodology• What would have happened in Michigan without

the MiPCT demonstration?• Initial answer: how different are our outcomes

from the single payer model?• Two comparison groups: PCMH and non-PCMH

• “Difference-in-difference” model: compares change in trend from baseline

• Cost savings: sum all quarter by quarter differences and compare to total fees paid

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Basis of cost savings

First Annual MAPCP Report• MiPCT’s year 1 estimated savings = $27.8 million

▫ $147 per full-year eligible Medicare FFS beneficiary

• Results are preliminary ▫ Future years of evaluation are required to confirm

whether results persist over time• Future reports will address quality

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RTI Quarterly Reports(Medicare)• Draft received March 2014• PRELIMINARY, not public!!“During the first 10 quarters of the demonstration, there is

strong evidence of cost savings when comparing beneficiaries assigned to MiPCT Demonstration practices to those assigned to comparison PCMH practices.”

• Compared to non-PCMH – cost trends inconclusive

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MiPCT Compared to Other PCMH(Quarterly Report 11, Medicare FFS)Acute-care expenditures

Post-acute care expenditures

Outpatient expenditures

Primary care/specialty physician expendituresAll-cause admissions

Chronic PQI admissions

ER visits

Unplanned readmissions

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Update

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Data Collection Status Comparison Group Claims Data

2010-2013 Payers have delivered, in process at MDC & MPHI 2014 Coming in

Patient Experience Survey• Phone follow-up begins March 20• Additionalresponse needed:

▫Children▫Non-Medicare

Adults

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2015 Clinical Focus Areas (approved by MiPCT Steering Committee)

•Addressing social determinants of health and overcoming barriers

•Patient registry and data support for population health

•Integrating behavioral health•Integrating palliative and end-of-life care•Addressing appropriateness of care (e.g.,

Choosing Wisely program, etc.)

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Clinical Subcommittee “Retooling”•Will have a work group dedicated to each

Clinical Focus Area

•This work group will in next 90 days:▫Define the key intervention they would like

to champion to support the PO/practices in those improve in those areas

▫Define metrics for success of that intervention

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Clinical Subcommittee “Retooling”•Clinical Subcommittee will oversee the

deliverables of the interventions

•Seeking additional members interested in shaping these interventions

•Monthly 2 hour meetings for 6 months , then every other month

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Proposed 2015 Incentive Metrics•Very similar to 2014 Incentive Metrics,

with a few tweaks:▫PCS ED visit rate will be replaced with risk-

adjusted Overall ED Visit Rate per 1000 attributed patients (due to move to ICD-10)

▫Childhood Immunization/Combo 3 metric on MDC dashboard to be added

▫Three process metrics to be deleted▫Points to shift slightly

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2015 MiPCT Success Stories – Adding Team Based Practice, Physician Organization•New for 2015:

▫Team Based Practice Success Stories▫Physician Organization Success Stories

•Purpose: ▫Highlight MiPCT Success Stories▫Share and learn from each other▫Spread “what works”

•Potential for MiPCT Practice Learning Credits

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MiPCT Team Based Practice and Physician Organization Success Stories

• Suggestion - to align topic of Success Stories with the 2015 MiPCT Clinical focus areas ▫ Addressing social determinants of health and

overcoming barriers▫ Patient registry and data support for population health▫ Integrating behavioral health▫ Integrating palliative and end-of-life care▫ Addressing appropriateness of care (e.g., Choosing

Wisely program, etc.)

• However, not limited to MiPCT 2015 Clinical focus areas

• Submission of stories may be completed by MiPCT Practice team members, MiPCT PO Leaders

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Team Based Practice Success Story – Web Based Submission Template

• Identify the practice staff involved in the team based practice success

• What problem is the team trying to address?

• What changes were made to address the challenge or problem?

• What barriers did your team recognize and address during this practice change?

• What improvements have been recognized as a result of the team-based change?

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Physician Organization Success Story – Web Based Submission Template

• What are you trying to accomplish? • Please describe the project aim. What will be

improved, by how much, for whom, by when?

• Why are you doing this project?• Describe assessment

• Key leadership involved

• Describe the metrics collected

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Physician Organization Success Story - Web Based Submission Template cont.

•What changes have you made that resulted in the improvement?

•How did you know your change was an improvement?

Please submit data

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MiPCT Success Story Process Steps

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Step 1 – Submit the Team Based Practice and PO Success Stories

•Website link for submission will be available on MIPCTdemo.org

▫Separate Web link template for each type of MiPCT success story Team Based Practice Success Stories PO Success Stories CM Success Stories

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Step 2: Gather the Details

•Once the story is submitted, the practice team member or PO Leader who submitted the story will be contacted for a discussion about the story

•This discussion allows the MIPCT Master Trainer and/or Clinical Lead to write up the story

questions which will help to “build the story”

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Step 3: Write the Success Story, Review and Approve

•Draft version: Write the narrative Team Based Practice or Physician Organization Success Story▫Draft version: Master Trainer and/or

Clinical Lead write the story ▫Review and edits by the individual who

submitted the story

•Final version: Review and Approval by Practice Leader and PO Leader

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Step 4: Share the Team Based Practice and PO Success Stories

How will the MiPCT Team Based Practice and PO success stories be shared?

•MiPCT Practice Flash Newsletter

•MiPCT Implementation Guide

•Presentations - regional and statewide ▫ In person meetings

PGIP Quarterly meetings, MiPCT Summit▫Webinars

MiPCT Care Management Webinars, MiPCT PO Webinars

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Getting Started

•MiPCT Practices and PO Leaders▫Please share your Team Based Practice and

PO Success Stories Via mipctdemo.org - new Team Based

Practice and PO Success Story Web templates available end of March 2015

Announcement and details will be in the MiPCT FLASH newsletter

•Plan:▫Practice FLASH – publish the Team Based

Practice Success and/or Physician Organization success story every two months

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Sample Success Story: Add your MiPCT Practice Team PHOTO!

Questions

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PO Physician Champion Role (one per PO)

•2015 Contract Expectations:▫The intent of the PO Physician Champion as

per the contract, is to communicate with the physicians in the PO and practice about team care and the PO/practices’ deployment of the MiPCT clinical model.

▫This includes the PO and practices’ work on clinical focus areas, practice learning activities, care management oversight and support, etc.

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Physician Champion Leadership Training (Open to All Interested MiPCT Physicians)•2015 MIP CT learning activity requirements:

▫Physician champion leadership training (4 hours). This option consists of physicians to physician training and best practice sharing that supports team based care and embedded care management.

▫Plan to provide Webinars What are you currently doing with physician

leadership training? What would be helpful for physician leadership

training?

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Save the Dates! 2015 MiPCT Summits

• Western: September 16, 2015▫ Frederik Meijer Gardens & Sculpture Park – Grand Rapids▫ 8am to noon general session open to all; Afternoon care management training

• Northern: October 20, 2015▫ Crystal Mountain Resort – Thompsonville (new location)▫ 11 to noon Project Leadership briefing followed by afternoon care management training

• Southeastern: October 29, 2015▫ U of M NCRC, Building 18 Dining Hall – Ann Arbor▫ 8am to noon general session open to all; Afternoon care management training

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