Pay-for-Performance Experience of DMC Primary Care Physicians, P.C.

Marilyn Bachelor, R.N., Healthcare Performance Consultant

Primary Care Physicians, P.C.

(PCPPC) The Group

 Incorporated in 1990 as an IPA  Comprised of approximately 150 primary care physicians share holders  From Family Practice, Internal Medicine, and Pediatrics  Located in 5 southeastern Michigan counties  Many have Detroit Medical Center affiliation  Board of Directors meet regularly to review financial, utilization, and other issues to assist with management of the group’s contracts

Primary Care Physicians, P.C.

Administrative Specialists, LLC

  A licensed TPA  All administration is delegated to Administrative Specialists for PCPPC’s managed care contracts:   Contracting Physician advocate with health plans     Performance (Financial & Quality) analysis and reporting Managed care education Computer & technical support Encounter processing Commercial & Medicaid contracted health plans:  BCBSM, BCN, Midwest Health Plan, OmniCare Health Plan, and ProCare Plus Health Plan  Participation with each health plan is optional

Pay-for Performance BCBSM POGS

   BCBSM Physician Group Incentive Program (PGIP) was established in 2004  Focused on chronic disease management and promoting generic drugs  A reward pool was created which BCBSM allocated 100 percent to PGIP participating physician organizations Physician Organization Gain Sharing Program, (POGS) began in 2006  Focused on reducing service category costs PCPPC participated only in POGS  PCPPC focused on :  Increasing the use of generic drugs     Implementing electronic prescribing Distributing Evidence Based Care (EBC) quality reports All members received at least minimal incentive payment for participation Established committee of the Board for program oversight

Pay-for Performance

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PGIP

PGIP combined both groups in 2007  35 physician organizations from across Michigan, including 6,415 primary care physicians and select specialists who are members of BCBSM's TRUST PPO network and provide care for about 1.7 million PPO members  Approximately 64 percent of active primary care TRUST physicians (internal medicine, family practice, pediatrics, and general practice)  Focuses on chronically ill populations  Introduced Patient Centered Medical Home concept

PCPPC PGIP Activities Year 1 - 2007

 Administrative Specialists increased capabilities:  Hired in-house IT support  Hired clinical performance consultant  Hired communications consultants  Purchased computers for members’ practices  Increased use of electronic communication tools  Began evaluating electronic registries & EMRs

PCPPC PGIP

 20,000+ BC Trust members  992 diabetics, 4.9% of panel *  162 asthmatics, 0.8% of panel  75 CHF, 0.4% of panel  337 CAD, 1.7% of panel * Opportunity for greatest initial impact

PCPPC PGIP Activities Year 2 - 2008

     Increased participation with BCBSM PGIP work groups Setting initiatives for the year Selecting disease registry   CDEMS with Data Entry & Reporting Training WellCentive – limited # licenses Membership in the Patient Centered Primary Care Collaborative POGS Committee to PGIP Committee   For goal setting Tracking progress

PCPPC PGIP Activities Year 2 - 2008

  PCPPC Initiatives: Increasing the use of generic drugs      Increasing electronic prescribing Decreasing unnecessary high tech radiology utilization Improving evidence based care (EBC) quality scores – focus on diabetics Implementing the basic requirements for the patient centered medical home Test tracking

PCPPC PGIP Activities Year 2 - 2008

   Focus for PCMH    Patient -provider agreements for at least 10% of BC patients (> 20% of all patients last qtr) All-payer electronic patient registry - CDEMS & WellCentive (selected practices)    Install registry and train staff in data entry at each selected practice site Patient demographics and key clinical measures for diabetes accessible at site of care Enter a minimum of 20 patients per physician per month ePrescribing Selected 7 practices (14 physicians) for PCMH pilot Added 5 practices (6 physicians) last qtr 08

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PCPPC PGIP Accomplishments Year 2 - 2008

Increased generic drug rates Increased ePrescribing    10 practices consistent 1 practice re-implementing 1 practice to begin 1 st qtr 09 Practices using AIMS high tech radiology precert program Improving EBC rates Patient-provider agreements    Developed and provided to the pilot practices Distributed to all patients Tracked in CDEMS Registry implemented    CDEMS loaded with diabetic BC patients for all 12 practices CDEMS at site of care for 10 practices Practices responsible for entering 20 diabetics/month - all payer   WellCentive licensed for 5 practices Identifying additional reporting needs

PCPPC - PGIP Plans for Year 3 - 2009

     2009 initiatives:      Continue 2008 initiatives Add reduced utilization of ED & inpatient Add asthma/COPD, CAD, CHF & well child measures to CDEMS Add more practices to PCMH pilot Get some of the pilot practices certified by BC as PCMHs Implement and evaluate WellCentive for 5 sites Increase IT capabilities Finalize reporting format Improve website for communication and 1-site software connectivity

PCPPC Barriers to PGIP Success

 Resistance to change  Most of the physicians are aged 50+  Physicians do not incent staff to participate  Reluctance to make major commitment to practice change:  Upgrading staff  Incorporating disease management  Facilitating self management  Cost of health IT (computers, ePrescribing, eHealth education, EMRs, electronic scheduling, electronic registries)