the michigan primary care transformation (mipct) project update mipct overview

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The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

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Page 1: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

The Michigan Primary Care Transformation (MiPCT) ProjectUpdate

MiPCT Overview

Page 2: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

MiPCT Origin and Partners

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Page 3: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

CMS Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration

• Centers for Medicare & Medicaid Services interested in PCMH improving US health care and value▫ Participating in state-based PCMH demonstrations

• CMS Demo Stipulations▫ Must include Commercial, Medicaid, Medicare patients▫ Must be budget neutral over 3 year (2012-14) period▫ Must improve cost, quality, and patient experience

• 8 states selected to participate, including Michigan• Michigan and five other states granted a two year extension

(through 12/31/16) by CMS• Michigan’s other participating payer partners also extend their

participation until 12/31/16

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Page 4: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

MAPCP Demo: Participating States•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

Page 5: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

The Vision for a Multi-Payer Model•Use the CMS Multi-Payer Advanced Primary Care

Practice demo as a catalyst to redesign MI primary care▫Multiple payers will fund a common clinical model▫Allows global primary care transformation efforts▫Support development of evidence-based care models

•Create a model that can be broadly disseminated▫Facilitate measurable, significant improvements in

population health for our Michigan residents▫Bend the current (non-sustainable) cost curve▫Contribute to national models for primary care redesign

•Form a strong foundation for successful ACO models

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Page 6: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Practice Participation Criteria

•Criteria: Continuous PGIP or NCQA designation•Part of a participating PO/PHO/IPA•Maintain key PCMH capabilities (e.g., extended

access; 30% same-day scheduling; registry, etc.)•Agree to work on the four selected focus initiatives:oCare Managemento Self-Management SupportoCare Coordinationo Linkage to Community Services

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Page 7: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

MiPCT Participants

• 355 practices• 35 POs• 1,815 physicians• 1.1 million patients

– Medicare– Medicaid managed

care plans– BCBSM– BCN– Priority Health (7/13)

Page 8: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Two Primary Interventions

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•Clinical (care managers embedded in primary care office)

•Financial (payment for care management services)

Page 9: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

MiPCT Financial Model

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Page 10: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

MiPCT Funding Model

$0.26 pmpm Administrative Component$3.00 pmpm* Care Management Support$1.50 pmpm ** Practice Transformation Reward$3.00 pmpm ** Performance Improvement$7.76 pmpm Total Payment by non-Medicare

Payers***

* Commercial payers fund via care management G and CPT billing and amounts paid are based on services provided (may exceed or be less than $3 pmpm)

** Plans with existing payments toward MiPCT components may apply for and receive credits through review process

*** Medicare will pay additional $2.00 PMPM to cover additional services for the aging population

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Page 11: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

MiPCT Clinical Model:Optimizing Patient Engagement, Improving Population Health

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Page 12: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

PCMH as the Foundation for ACO Population Management

12Source: Premier Healthcare Alliance

The goal of Accountable Care Organizations should be to reduce, or at least control the growth of, healthcare costs while maintaining or improving the quality of care patients receive (in terms of both clinical quality, patient experience and satisfaction). - Harold Miller

Page 13: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

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

Page 14: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

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Page 15: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

MiPCT Care Management Principles•Care managers work in close proximity to PCP team

▫In PCP office as much as possible▫Work with PCP team to meet their needs▫Evidence supports this model as superior to vendor-

based•Focus on Chronic Disease and Complex Care

▫Manage high-complexity, high-cost patients and those who are likely to benefit from care management

▫Patients selected based on risk score plus PCP input•Focus on evidence-based interventions

▫Medication reconciliation▫Care transitions▫In-person contact with patients whenever possible▫Comprehensive and coordinated care plan

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Page 16: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

MiPCT PO/Practice Expectations•Care management

▫Performed for appropriate high and moderate risk individuals ▫Transitions of care promptly coordinated

•Population management▫Registry functionality▫Proactive patient outreach ▫Point of care alerts for services due

•Access improvement▫24/7 access to clinician▫30% same-day access▫Extended hours

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Page 17: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Resources To POs, Practices

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Page 18: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Care Management Resources •For launch, partnered with Geisinger for Care

Management training▫How to identify patients for care management▫Tools for care management deliver that draw from best

practices▫How to integrate within your practice

•Over 400 care managers trained!▫National and local evidence-based models▫Also allow credit for existing PO/PHO training models

Page 19: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Multipayer Data Warehouse

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• Summary level and PO-specific

• Delivered to PO (and practices for whom PO approves access)

PO

Multi-Payer Claims Database

datasets

reports

Practice Practice

Practice

Practice

Practice

Practice

Practice

datasets

reports

datasets

reports

PO PO

Retrospective Reports Quality and Utilization performance

metrics chosen for the project (recent incorporation of registry data)

• Requires 2-3 month run-out to ensure availability of complete data

Prospective Reports Timely feedback about attributed

population for use in care management

Incentive Payments Reports Incentive scores and payments

Member List Reports

Page 20: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

MDC: MiPCT Dashboards

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PopulationMembership

• Attributed members by PayerRisk Information

• # of members by Risk LevelPopulation Information

• # patients by Chronic Condition (Asthma, CKD, CHF, etc)

Quality MeasuresScreening and Test Rates

• Diabetes tests, Cancer Screens, etcPrevention

• Immunization Rates, Wellness Visits, etc.Comparison to Benchmarks

Utilization MeasuresRates

• ED Use, Admissions, Re-admissions, etcComparison to Benchmarks

Page 21: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

MiPCT/MiHIN/CareBridge Admission, Discharge, Transfer (ADT) Electronic Alerting

• Provided via project (at no cost to PO) • Allows Care Managers near-real-time web-based ADT alerting for timely initiation of

transition care (Trinity, HFHS, UM, Beaumont, Oakwood, McLaren, etc.

Page 22: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Incorporating the Voice of Patients•Statewide Patient Advisory Council with

representatives from across the state▫Real patients and families served by the program▫Advise on program design and operation

•Launch of patient and family advisors within primary care practices (in partnership with the Institute for Patient and Family-Centered Care and the Greater Detroit Area Health Council)

Page 23: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Team Development Resources•Goal: Build on PCMH team-based capabilities

▫Using team members to the maximum capability of their roles and licenses

▫Clearly define roles for physicians, nurses, medical assistants, front office staff, and all other team members (social workers, pharmacists, dieticians, etc.)

•Updates and Dialogue with Physician Organizations as key partners and supporters of practice teams

•Facilitated learning opportunities for practice teams▫ Examples: Practice Collaboratives (e.g., team-based care, billing

and coding, etc.) , Practice Coaching, webinars, etc.

Page 24: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

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www.mipctdemo.org

Page 25: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Cost, Quality and UtilizationNational and State Metrics

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Page 26: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

How Will We Define Success?

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Page 27: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Utilization and Cost Metrics: MI and National Evaluations are Consistent

•Total PMPM Costs▫Medicare Payments (National)▫Utilization based standardized cost

calculations across all participating payers (Michigan)

▫Additional analysis of cost categories•Utilization

▫All-cause hospitalizations▫Ambulatory care sensitive hospitalizations▫All-cause ED visits▫‘Potentially preventable’ ED visits

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Page 28: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

2012-14 Quality and Experience of Care Metrics: MI and National Evaluations are

Different, But Share Common Elements (Discussion in process re:

2015/16)

NationalDiabetes care:•LDL-C screening •HbA1c testing •Retinal eye examination •Medical attention for nephropathy•All 4 diabetes tests•None of the 4 diabetes tests

Ischemic Vascular Disease: •Total lipid panel test

Patient experience (CAHPS)

Michigan•Diabetes•Asthma•Hypertension•Cardiovascular•Obesity•Adult preventive care•Child preventive care•Childhood lead screening (Medicaid)

•Patient experience (CAHPS)•Provider/staff experience

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Page 29: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Success = Improvements in Population Health + Cost + Patient Experience

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Page 30: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Reduction in Unnecessary and Non-Value-Added Costs

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The tie to budget neutrality and ROI

Page 31: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Cost, Quality and UtilizationResults to Date

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Page 32: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

MiPCT Statewide Progress to Date

•Over 400 Care Managers hired and trained▫Building caseloads of targeted high-risk patients

•Building infrastructure in partnership with participating Physician Organizations and practices▫Ongoing Care Manager training, coaching, mentoring▫Learning collaboratives (team-based care, billing) ▫2014 - developing Palliative Care expertise▫Best-practice sharing

•Multi-payer claims database▫Dashboards, member lists, activity reports▫Now incorporating clinical (registry) data

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Page 33: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

State Evaluation

Conducted by: Michigan Public Health Association (MPHI)

Page 34: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

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Care Manager Survey Results

Page 35: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Physicians Support MiPCT

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Page 36: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Staff Support MiPCT

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Page 37: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

“I would like to see care management in my practice

continue”

Page 38: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Good News!The report found that the

in its first year, the demonstration produced an estimated $4.2 million in savings for Medicare. Importantly, the rate of growth in Medicare FFS

health care expenditures was reduced in Vermont

and Michigan, driven largely by reduced growth in inpatient expenditures. For Michigan, this was

estimated at about $148 per full-year eligible

Medicare beneficiary.

Page 39: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

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

▫ $148 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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Page 40: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Sustainability and Funding For the Long Term (post 2016)

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Page 41: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

What Does Sustainability Mean?• To the Health Plan: Added value for their

customers

• To the Practice: Maintaining and growing CM staffing, processes and roles

• To the PO: Payment reform for CM

• To the State and Patients: Servicing all patients, all payers; Improved value, quality and experience of care

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Page 42: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Our Own Governor’s Advocacy for MiPCT Continuity

Page 43: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Pre-Extension Payer Sustainability Statement "As participating Michigan Primary Care Transformation Project (MiPCT) payers, we recognize the value of care management embedded in primary care practices.  We applaud CMS' recent payment proposal to continue funding for complex care coordination after the December 31, 2014 ending period of the demonstration project.   We support continuation of this model of care to produce improvements in patient experience, quality and the value of care. We look forward to working together with the partnership of the MiPCT, the plans and the health care providers in improving Michigan's primary care system."

Page 44: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

• 2015 Physician Fee Schedule includes revised Medicare monthly 99490 code for non-face-to-face chronic care management language

▫ Effective January 1, 2015 at rate of ~$41/month (expectation of at least 20 min of clinical services per month) for: Medicare Beneficiaries with 2+ chronic conditions that place the patient at significant

risk of death, acute exacerbation/decompensation, or functional decline; and For whom care coordination services would be expected to last at least 12 months or

until the death of the patient

▫ MiPCT submitted comments on potential improvements and enhancements in future years Discouraging CMS from imposing patient financial responsibility for care management

services Enhance payment rate; Existing rate is not sufficient level of contact with patient and to

provide for care management

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Medicare 2015 Care Management Code

Page 45: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Relationship to Other Key Initiatives

The Michigan Primary Care Transformation Project (MiPCT) is an underpinning and foundation of the State Innovation Model (SIM) recently awarded to the State.

The MiPCT is also a basis for primary care transformation in the Michigan Blueprint and Healthy Michigan programs.

The MiPCT has enabled a state-wide voluntary data base, standardized care management training model that is evidence-based, and served to assist providers in the movement to reimbursement based on value.

Page 46: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Michigan: Post-Demonstration MiPCT

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1/1/12 12/31/14Post-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

Page 47: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

What We’ve Learned• Care manager integration is not plug-and-play, and requires all of the

following for optimal success:▫ Fully functioning team, including physician buy-in▫ IT that allows information sharing among team▫ Effective population risk stratification▫ Notification of transitions in care, ideally electronic

• “Sticking to the knitting” with effective interventions pays off (execute, execute, execute)

• POs, practice teams, patients, purchasers and payers really do have common goals

• Multi-payer support for a common model and a platform for effective scaling are key

• This window of opportunity will not come again. We must fully leverage it to maximize returns on investment for all stakeholders

Page 48: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

MiPCT Contacts•Diane Bechel Marriott, DrPH (Project Manager)

[email protected]

•Sue Moran (CoDirector) [email protected]

• Jean Malouin, MD MPH (CoDirector, Medical Director) [email protected]

•Theresa Landfair (CoDirector)[email protected]

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Page 49: The Michigan Primary Care Transformation (MiPCT) Project Update MiPCT Overview

Questions and Discussion