The Michigan Primary Care Transformation (MiPCT) Project

The Demonstration Extension:What It Means for MiPCT POsand Practices

1

Two Year Extension Granted for MAPCP/MiPCT!

Here’s what we know…

2

MAPCP Demo: Participating States in 2014

•Maine 70 practices 122,420 patients•Michigan 358 practices 1,109,926 patients•Minnesota ** 282 practices 1,013,545 patients•New York 41 practices 99,019 patients•North Carolina 47 practices 83,553 patients•Pennsylvania ** 51 practices 163,670 patients•Rhode Island 16 practices 57,676 patients•Vermont 123 practices 272,324 patients

____________________________________________•TOTAL 988 practices 2,922,151 patients ** no 2015-

16 extension granted

Michigan: Post-Demonstration MiPCT

4

1/1/12 12/31/14

Post-Demo MiPCT

Original Demonstration Period

Two Year CMS Extension

12/31/16

GOAL: To sustain our gains (effective, efficient team-based care with embedded Care Managers) post-demonstration period

Outcomes of Discussion with CMS Project Officer on Demonstration Extension (9/29/14)

Q: Will the Medicare payments continue at $9.76 PMPM and be paid as they are currently (practice transformation directly to practices; care management and incentives to UMHS centrally for distribution to POs as appropriate)? A: Yes. Medicare will extend payment as is ($9.50 PMPM to POs/practices and .26 for admin). Sequestration will apply if so directed by Congress.

Q: Will the national evaluation period remain at 1/1/12-12/31/14 for Michigan, or will it now be extended until 12/31/16? A: The full national RTI evaluation will cover the 2012-14 time period. (Note though that the MPHI evaluation would however be for the entire five year period).

5

Outcomes of Discussion with CMS Project Officer on Demonstration Extension (9/29/14), cont.

Q: Will Medicare permit increasing the number of Medicare beneficiaries? Practices? POs? A: Yes – up to the maximum permitted in the original demonstration agreement. (Note that addition of practices and/or POs would require discussion and consent of the other participating payers, however).

Q: Will CMS have the same expectations for state oversight of the project in years 4-5?A: Yes. (MDCH/PO/Practice/Commercial Payer agreements should continue, etc.).

6

MiPCT 2015 Project Funding

• Medicare FFS payment will continue as $9.50 PMPM (with demo period extension) for MiPCT attributed members; and potentially $41.92 PBPM for engaged chronic non-MiPCT patients (but no “double-dipping” permitted)

• Medicaid: $7.50 PMPM continues through December 2016

• BCBSM: 5% E&M Uplift and G/CPT Codes, Existing incentives

• Priority Health: $3.25 PMPM Care Management Incentive and G/CPT Codes (including Medicare Advantage), Existing incentives

• BCBSM Medicare Advantage: G/CPT Codes (not part of MiPCT)

• BCN: Evaluation in process

7

MiPCT 2015 Operational Issues To Be Addressed

• PO/Practice and Payer Agreements with MDCH

• Participation Requirements• Infrastructure Requirements • Care Manager Staffing Ratios• On-going Training (Care Managers, Practice teams)

• Documentation requirements for Care Management

• Possibility of adding new practices

• Implications for existing payers

• Recruitment of new payers

• Coordination with the State Innovation Model (SIM)

8

Expanding the Reach of MiPCT: Adding New Payers

• Efforts underway to recruit additional payers

• PO Survey to identify most important additional payers

▫ PO partners will participate in outreach to plans

▫ Medicare Advantage plans

9

PO 2015 Visioning Meeting

• Stakeholder participation in shaping the future▫ Clinical focus areas▫ Partnering with community resources

• One two-hour in-person session in Lansing

• Timing: Late October/November 2014

10

MiPCT Key Messages Sustainability and Continuity

• We cannot lose focus on using the THREE (3) MONTHS left in the demonstration’s national evaluation period (ending DEC 31, 2014!) to produce continued and improved results for each payer on:

▫ Increased volume of MiPCT eligible patients receiving Care Management ▫ Reduced Avoidable ED and Inpatient Visits▫ Improved Clinical Metrics (especially diabetes)

• Your continued and focused efforts now on the key metrics above can pave the path to support the case for ongoing funding from participating payers

▫ Patient-Centered Medical Home model▫ Care Management

11

12

www.mipctdemo.org

Questions/Discussion