the michigan primary care transformation (mipct) project november 2015 po quarterly webinar
DESCRIPTION
1. Final 2016 CMS Physician Fee Schedule and the MiPCT 3TRANSCRIPT
The Michigan Primary Care Transformation (MiPCT) Project
November 2015PO Quarterly Webinar
Agenda
1. Final 2016 CMS Physician Fee Schedule and the MiPCT (10 min)-Diane Marriott
2. PO/Practice/MDHHS 2016 Agreement Overview/Status (20 min)-Theresa Landfair
3. Tiger Team Update (15 min)- Mary Ellen Benzik
4. MPHI Evaluation Update (10 min)-Jason Forney, Clare Tanner
5. MDC Update (15 min) – Cindy Adams, Susan Stephans
6. Summit 2016 Dates (5 min) – Jean Malouin
7. Announcements and Open Q&A – Amanda First and Jean Malouin
2
1. Final 2016 CMS Physician Fee Schedule and the MiPCT
3
•1) New Advance Care Planning Codes▫Purpose: To pay for a provider's time
discussing patient choices for advance directives and completing necessary forms.
▫Code Detail: Coverage of first 30 minutes Additional 30-minute blocks
▫ Beginning 1/1/16, CMS will reimburse CPT codes 99497 and 99498.
4
The Final PFS (Issued 10/30/15)- Implications for the MiPCT
1) New Advance Care Planning Codes, cont.
▫Does NOT waive beneficiary copay for discussions (except for discussions at annual wellness visits)
▫ Also billable for FQHCs and RHCs
▫ Payment estimated at $86 for 99497 (initial 30-minutes) and $75 for 99498 (subsequent 30 minutes).
5
The Final PFS (Issued 10/30/15)- Implications for the MiPCT
2) Transitional Care Management (99495 and 99496)
▫Now allows submission of claim when the face-to-face visit is completed
3) Still Waiting……..New Collaborative Care Model Code for Beneficiaries with Common Behavioral Conditions…Potentially in 2017
6
The Final PFS (Issued 10/30/15)- Implications for the MiPCT
4) The Bigger Issue for Us – Potential Comprehensive Primary Care Expansion
• Our “sister program” that parallels the Multipayer Advanced Primary Care Demonstration (MAPCP) approach.
▫ CPCI focus areas (milestones) largely similar to MiPCT programming Enhanced patient access and continuity of care, Planned chronic and preventive care, Risk-stratified care management, Patient and caregiver engagement, and Coordination of care across a “medical neighborhood”
• CMS staff acknowledge that (if expanded), an announcement early in 2016 is key to continuity of staffing and servicing
7
The Final PFS (Issued 10/30/15)- Implications for the MiPCT, cont.
2. PO/Practice/MDHHS 2016 Agreement Overview/Status
8
See MS Word document labeled: “Substantive Changes in the MiPCT
2016 Paricipation Agreement” and Draft 2016 Agreement Redline
9
3. Tiger Team Update
10
IV. Most complex(e.g., Homeless,Schizophrenia)
III. ComplexComplex illness
Multiple Chronic DiseaseOther issues (cognitive,
frail elderly, social, financial)
II. Mild-moderate illnessWell-compensated multiple
diseases Single disease
I. Healthy Population
<1% of population Caseload 15-40
3-5% of population Caseload 50-200
50% of populationCaseload~1000
Managing Populations: Stratified approach to patient care and
care management
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
PCMH Services PCMH InfrastructureComplex CareManagementFunctional Tier 4
All Tier 1-2-3 services plus: Home care team Comprehensive care plan Palliative and end-of life care
Care Management
Functional Tier 3
All Tier 1-2 services plus: Planned visits to optimize
chronic conditions Self-management support Patient education Advance directives
Transition Care
Functional Tier 2
All Tier 1 services plus: Notification of admit/discharge PCP and/or specialist follow-up Medication reconciliation
Navigating the Medical Neighborhood
Functional Tier 1
Optimize relationships withspecialists and hospitals
Coordinate referrals and tests Link to community resources
Prepared Proactive Healthcare TeamEngaging, Informing and Activating Patients
Michigan Primary Care Transformation Project Advancing Population Management
P O P U L A T I O N M A N A G E M E N T
Where do we go from Demonstration?• Key areas to be addressed
▫ Social determinants of health ▫ Integration of Behavioral health
Creating the Model – Engaging with the POs •Created Tiger Teams to address each
area•Representatives from PO, practices,
payers , and state wideExpertise on these topics•Met monthly – every other in person•Created model and tool kits for the
addressing social determinants and integrating behavioral health
MiPCT INTEGRATION and INTER RELATEDNESS OF MENTAL HEALTH AND SOCIAL DETERMINANTS OF HEALTH
PCMH Neighborhood – partnering on social
Determinants of health
Advanced Medical Home: collaborative
Care model with behavioral health partnerships
PCMH functionality: registry utilization,
Process redesign for screening tool utilization
Panel management, treat to target, integrati on of
Brief cognitive therapy
Creating necessary infrastructure
Registry development, partnerships with
Mental health and community agencies
Planning steps for integration of at the PO level
Mental Health integration Addressing Social Determinants
Financial analysis and business plan
1. Business case for behavioral integration monograph PDF
2. Business case proforma 3. AIMS Center U of W ,
implementation guide step 2 4. http://www.integration.sam
hsa.gov/financing/Sustainability_Checklist_revised_2.pdf
5. http://www.integration.samhsa.gov/financing/billing-tools\
6. http://www.integration.samhsa.gov/financing/Michigan.pdf
Addressing Patient’s Social Needs: Business Case ADDRESSING PATIENTS’ SOCIAL NEEDS: An Emerging Business Case for Provider Investment. Reasons to invest in social determinants, examples and strategies of various projects/programs payment models. http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/may/1749_bachrach_addressing_patients_social_needs_v2.pdf
Assessment of current state of integration
Integrated tool #1 Compass self-assessment OATI #4 Collaborative care principles and components - AIMS center
Assessment of resources at practice, PO and community
CMS funding brief DBM reference Identification of the relationships with psychiatric partners for developing care collaborative model
Practical Playbook; Primary Care and Public Health Together Community Commons Interactive Maps: Poverty levels, education and more by census tract.(Log in is required). See Maps and Data Tab http://assessment.communitycommons.org/Footprint/
Current state assessment of community partnerships and joint planning of intervention
Partnership checklist OATI tool 1
Frieden: Health Impact Pyramid Linking with your community health team works
Current state assessment for readiness for change
OATI tool 3 administrative readiness tool or AIMS Center Organizational readiness worksheet
GROW Pathway Planning Worksheet
BUILDING INTEGRATION ON A FRAMEWORK OF ADVANCED MEDICAL HOME CAPABILITY PRESENT IN MIPCT PHYSICIAN ORGANIZATIONS AND PRACTICES
Planning steps for integration of at the practice level
Behavioral Health integration Addressing Social Determinants
Financial analysis and business plan
SBIRT basics utilization and financial aspects
Assessment of current state of integration
MeHAF Integrated practice assessment tool (IPAT) CHIS framework American Academy of Pediatrics integration tool Bright Future
Assessing Chronic Illness Care (ACIC) particularly sections 2, 7
Assessment of resources at practice, PO and community
CHIS quick start decision tree section workforce and clinical practice
Current state assessment of community partnerships and joint planning of intervention
Same as PO *assessment of health literacy , cultural competency – see SD tool kit
Current state assessment for readiness for change
AIMS center organizational readiness
GROW Pathway Planning Worksheet AAP MH Practice Readiness Inventory http://pediatrics.aappublications.org//125/Supplement_3/S129.full.pdf
BUILDING INTEGRATION ON A FRAMEWORK OF ADVANCED MEDICAL HOME CAPABILITY PRESENT IN MIPCT PHYSICIAN ORGANIZATIONS AND PRACTICES
Doing the work at the Practice Level – Defining new Workflow
Measurements strategy
Implementation plan
Pilot, test of scale, spread
Registry development
Implementation of screening tool
Registry utilization for positive screen
Addressing social determinants
Referral / partnerships for collaborative model
Treatment intensification
Panel management and follow up
Optimization of behavioral health care
Toolkit for the Practices to Change Workflow
Social determinants of health
Practice level steps – operationalizing the change
Tools to support (more in website – these starting documents )
Poverty Behavioral factors (smoking, at risk substance use )
Adverse childhood events
Integration of behavioral health
Overview document
Community Commons Interactive Maps
The Childhood Adversity Narratives CAN.
http://www.improvingprimarycare.org/work/behavioral-health-integration
Measurement strategy
GROW tool Capturing Social and Behavioral Domains and Measures in EHRs: Phase 2. Measuring Vital Signs
http://integrationacademy.ahrq.gov/atlas/overviewofmeasures#reviewmeasures
Implementation plan
Strengthening Families- A Protective Factors Framework
https://aims.uw.edu/collaborative-care/implementation-guide
Guidebook for professional practices for implementation Suicide prevention tool kit
Screening tools HealthBeginsSocial screening tool V6
Resiliency and ACES Assessment Tool.(pdf)
Depression tool kit Community care North Carolina SAMSA screening tools
Toolkit for the Practices to Change Workflow
Social determinants of health
Practice level steps – operationalizing the change
Tools to support (more in website – these starting documents )
Poverty Behavioral factors (smoking, at risk substance use )
Adverse childhood events
Integration of behavioral health
Registry utilization
http://aims.uw.edu/sites/default/files/ClinicalWorkflowPlan.pdf http://aims.uw.edu/collaborative-care/implementation-guide/plan-clinical-practice-change/identify-population-based
Treatment intensification
AIMS Center – commonly prescribed psychotropic meds Primary Care Psychiatry –Pocket Guide V. 1.5 Feb 2014
Panel management and follow up
http://aims.uw.edu/collaborative-care/implementation-guide/plan-clinical-practice-change/create-clinical-workflow
Referral partnerships for advanced services
MiICCSI Community Resources Directory Click on Community Resources link at http://www.miccsi.org/CareManagement.html
Addressing Team Factors: Health Literacy and Cultural Competency
Team based factors impacting integration
Framework / toolkits
Assessment of PO/ practice capabilities
PO/practice care team process/ tools and training
Patient Tools / educational materials
Health literacy AHRQ Health Literacy Universal Precautions Toolkit The Health Literacy Environment of Hospitals & Health Centers: Making Your Healthcare Facility Literacy-Friendly
Ten Attributes of Health Literate Health Care Organizations The Health Literacy Environment Activity Packet: First Impressions and A Walking Interview Measures to Assess a Health-literate Organization
In Plain Words - TrEffective Communication Tools for Healthcare Professionals (Tr video)National Network of Libraries of Medicine: Health literacy (Tr – info to include in training)
Ask Me 3- Partnership for Clear Health Communication—Ask Me 3 -http://www.npsf.org/?page=askme3
Ethnicity/Cultural Competency
Effective Communication Tools for Healthcare Professionals (tr video)Guide to Providing Effective Communication and Language Assistance Services?National Standards for Culturally and Linguistically Appropriate Services http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53https://www.thinkculturalhealth.hhs.gov/Content/clas.asp
Thank You •Mary Ellen [email protected]
Mipctdemo.orgResources tab
Clinical areasSocial Determinants
4. MPHI Evaluation Update
23
24
5. MDC Update
25
MDC Agenda•Where do I get information?•What’s New?
▫Coming soon – new MDC web page▫All Payer Patient Lists▫Report Writer▫Standard Cost Enhancement
26
Dashboard
27
•Accessing Dashboard and Support Documentation▫Michigan Data Collaborative Website
www.MichiganDataCollaborative.org
•Support page includes the following materials:▫Dashboard general reference and user guides▫Dashboard release notes▫Information about the data included in the Dashboard▫All Payer Patient List reference document
28
New MDC Web Page
Page 29
Support Page
29
Page 30
Dashboard Reference Materials
General info, user guides
Provides more detail about each report
30
Page 31
Release Notes
31
Page 32
Data Reference Material
32
Page 33
Data Timeline33
All-Payer Patient List Changes - 2015
34
•Addition of High Risk Flag (April)•Healthy MI Flag (coming soon)
▫Identifies members who have signed up for coverage in the Affordable Care Act
▫Only set in the Medicaid population (not traditional Medicaid recipients)
Page 35
All-Payer Patient List - Helpful Documentation
35
Page 36
All-Payer Patient List Information Document
36
Page 37
All-Payer Patient List - Details
37
Dashboard – What’s New?
38
•Report Writer Enhancements (August 2015)▫Added Totals▫Added Overall measures
Quality Adult Preventive Diabetes Pediatric Preventive
▫Trends – Diabetes OverallNote: The enhancements are documented in the Report Writer August 2015 Enhancement Release Notes
39
Dashboard – Accessing Report Writer
40
Report Writer – Totals & Overall checkboxes
41
Report Writer – Selecting What You Want
42
Report Writer – Viewing Results
43
Standard Cost Background• Truven Health provides standard cost valuation utilizing their MarketScan
database that includes large state and national Employer/Commercial data for over 180 million patients
• MarketScan provides the mean unit price based on:▫ DRG for inpatient claims▫ ICD, CPT, and HCPCS Procedure and Revenue Codes for facility claims ▫ CPT and HCPCS Procedure Codes for professional claims▫ NDC for pharmacy claims
• As new codes are implemented, they flow into the Truven system; however, unit prices are not published until all data has been submitted and analyzed
• MarketScan data is currently based on 2012 data• When claims are processed on the dashboard, some procedures and revenue
codes do not have standard costs associated with them
44
Standard Cost Enhancement•Released with Enhancement 14.01 on 11/10/15•When MarketScan standard costs are updated with
new codes, MDC re-evaluates previously received claims with no standard cost and applies the new rate(s)
• Increased claims and members are included in standard cost rates adding over 50,000 members in the current measurement period
45
Standard Cost Enhancement•High and Very High Risk groups show the largest rate
increases since they are higher utilizers•Medicare populations show a larger rate increase
because they contain more patients in the High and Very High risk groups
•Because the updates from Truven are based on claims through 2012, earlier trend periods are enhanced the most by updating standard costs for previously-blank codes
6. 2016 Summit Dates
46
2016 Summits – Save the Date!•October 13, 2016 – Thompsonville
Summit (North)
•October 18, 2016 – Grand Rapids Summit (West)
•October 26, 2016 – Ann Arbor Summit (Southeast)
47
Announcements and Open Q and A
48