The Michigan Primary Care Transformation (MiPCT) Project

PO Quarterly WebinarJuly 28, 2015Noon to 1:30

Agenda•Tiger Team Update - Mary Ellen Benzik

(30 minutes)

•Briefing on the 2016 CMS Physician Fee Schedule:  MiPCT-Relevant Proposed Changes – Diane Marriott (20 minutes)

•Best Practices for Clinical Data Submission MDC – Chris Reid (20 minutes)

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Tiger Team Update

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Tiger Team AIM Statement:The clinical subcommittee will be subdivided into tiger teams related to the 2015-2017 MiPCT Clinical focus areas: • Impacting social determinants of health (SDH) and•Integration of behavioral and mental health (IBMH ) into primary care teams The teams will be charged to: •Create a framework for the POs to assess their current state in addressing these areas •Synthesize existing evidence based tools and measurement strategies related to the two clinical areas •Creation of a tool kit from findings in #2 for the use of the Physician Organizations in impacting MiPCT clinical focus areas of SDH and IBMH •Creating foundational documents and partnership with the evolving state of Michigan SIM

Social Determinants of Health

Healthy People 2020 https

://www.youtube.com/watch?v=5Lul6KNIw_8&feature=player_embedded

Creating the Michigan Model – distilling the evidence, making it actionable

Gray Year 1- 3 Blue Year 3- 5

Defining Component of “Michigan Model”

*General literacy and health literacy are two separate capabilities that are inter-related but not interchangeable.

Polling Question #1 Which of the following is the most important for your PO to address ? A. Addressing the social factors that impact health

B. Addressing the integration of mental health into practice workflow

C. We haven’t decided which we would be most likely to address

D. We have decided that we will not be able to address these issues

Polling question #2 – Of the social factors which would be the one you would like the most help with addressing?

A. Literacy / health literacyB. Abuse of ETOH , drugs, tobacco C. Financial ConstraintsD. Transportation E. History of adverse childhood eventsF. Suitable housing G. Safe Housing ( ie mold exposure, fall risk) H. Other (please fill in the blank)

Polling Question #3 – Which of these is the most important deliverable for the POs related to impacting social determinants of health? A.Screening tool B.Grid of resources related to area identified C.Training related to that area for practice teamsD.Information / best practices on community partnerships and best practices E.Other – please fill in the blank

Polling Question #4 –Related to the integration of mental health in the primary care practice–which area do you consider the most important for your PO ?

A. Depression B. Anxiety C. Substance useD. Adverse Events of Childhood ( and the

impact on adult functioning) E. Other

Polling question #5 – What is the most important deliverable related to mental health integration for the POs?

A. Screening tools B. Resource grid for applicable available

services C. Training for the practices on

interventions D. Evidence based practices and best

practices examples E. Other

2016 Proposed Physician Fee Schedule (PFS) Release and

Comment Preparation

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•MiPCT-Relevant Proposals:

▫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: One code would cover the first 30 minutes and the

other would cover any additional 30-minute blocks that are needed.

Consideration of making it “an optional element” of a beneficiary's annual wellness visit

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PFS Highlights Overview (Issued 7/8/15)

▫2) Comprehensive Primary Care Initiative Potential Expansion

Our “sister program” that parallels the Multipayer Advanced Primary Care Demonstration (MAPCP) approach. MAPCP: CMS joins existing State efforts CPCI: CMS leads with multipayer partner participation

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” 

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PFS Highlights Overview

▫2) Comprehensive Primary Care Initiative Potential Expansion, cont.

7 CPCI areas currently (AK, CO, NJ, OR, Captial District-Hudson Valley; Cincinnati/Dayton; Greater Tulsa)

Payment approx $15 PMPM with shared savings option (distributed by relative quality performance)

Practices must report at least 9 of 31 electronic clinical quality measures (aligned with PQRS; Meaningful Use)

Expansion potential in 2017 (as CPCI expires 12/31/16)

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PFS Highlights Overview

CMS Comment Invitation Areas

• What support is needed by practices?

• How ready are payers and self-insured employers to join?

• Would Medicaid participate (FFS, managed care)?

• Are practices ready to report clinical quality measures?; Are payers interested in using results (vs payer population) for incentive distributions?

• How can actionable data for performance improvement be provided to practices with an emphasis on cost of care?

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▫3) Other Proposals of Interest

Improved Care Management payment for TCM and CCM Codes that considers the resources required for a particular beneficiary

Reduced TCM and CCM reporting burden

Collaborative Care Model (for chronic conditions and/or behavioral health)

Beneficiary financial responsibility waiver for coordination services invisible to patient

TCM and CCM eligibility for FQHCs and RHCs

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PFS Highlights Overview

Proposed Process for 2015 Comment Submission

• Comments due by 5pm September 8th.

• Leverage our standard process from prior years• Draft comment preparation • Operations Group review • Steering Committee review and refinement via email

• Also coordinating with our State partners from other demonstration sites (MAPCP and CPCI) and Milbank

Best Practices for Clinical Data Submission

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