Transcript Multi-Payer Advanced Primary Care Practice Demonstration

1
MiPCT
Evaluation Update
Clare Tanner
March 14, 2014
CMS Evaluation
Question: What would have happened in Michigan without the
MiPCT demonstration?
Conducted by: Research Triangle Institute (RTI)
RTI Measures
Cost
• Average PMPM
• Measured as Medicare
payments
Quality
Diabetes care:
• LDL-C screening
• HbA1c testing
• Retinal eye examination
• Medical attention for
nephropathy
• All 4 diabetes tests
Ischemic Vascular Disease:
• Total lipid panel test
Patient experience survey
Utilization
All-cause hospitalizations
ACSC hospitalizations (PQI)
All-cause ED visits
% ED visits that do not lead to
hospitalization
• Discharges from short-term
general, rehabilitation, and SNF
with (billed) clinical follow-up
within 14 days
• Rate of 30-day unplanned
readmissions (CMS definition
developed by the Yale New
Haven Health Services
Corporation)
•
•
•
•
4
To be considered a success:
Outcomes of MiPCT beneficiaries must
improve at a greater rate than comparison
beneficiaries
5
MiPCT Medicare Beneficiaries
Total PMPM cost
High risk average
Low risk average
$1,000
$900
$800
$700
$600
$500
3
4
5
6
7
8
9 10 11 12 13
Quarters (Jan 2010 - Jun 2013)
14
15
16
6
MiPCT Medicare Beneficiaries
All hospital admissions per 1000 beneficiaires
High risk
105
100
95
90
85
80
75
70
65
60
3
4
5
6
Low risk
Demo quarters
7
8
9 10 11 12 13
Quarters (Jan 2010 - Jun 2013)
14
15
16
7
MiPCT Medicare Beneficiaries
Percent of diabetes beneficiaries who had
all 4 diabetes exams
High risk
Low risk
44
Demo period
43
42
41
40
39
38
37
36
Jan 10 - Dec 10
Jan 11 - Dec 11
Jul 12 - Jun 13
100%
50%
St. Mary's of Michigan PHO
Integrated Health Partners
Upper Peninsula Health Plan
Professional Medical…
Physician Healthcare…
Mercy Physician Community…
Genesys
Oakland Physician Network…
Holland PHO
Advantage Health Physicians
Spectrum Health Medical…
Physician Organization of…
Northern Physician…
Sparrow Medical Group
Greater Macomb PHO
Michigan State University…
Metro Health PHO
Integrated Health Associates
Oakland Southfield Physicians
University of Michigan…
Lakeshore Health Network
United Physicians, PC
Sparrow Physician's Health…
McLaren PHO
CIPA
Oakwood ACO
UOP, LLC
Bronson Medical Group
West Michigan Physician's…
Medical Network One
Primary Care Partners, Inc…
Great Lakes OSC
ProMed Healthcare
Henry Ford Medical Group
St. John Providence Partners…
HVPA
Jackson Physician Alliance
8
HbA1c Testing Rate
Based on Medicare FFS Beneficiaries Assigned January, 2012-June, 2013
Quality of Care Measures: July 1, 2012 – June 30, 2013
National benchmark: 96%
90%
80%
70%
60%
90%
50%
Northern Physician…
Jackson Physician Alliance
Physician Organization of…
University of Michigan…
United Physicians, PC
Sparrow Medical Group
St. Mary's of Michigan PHO
Spectrum Health Medical…
Metro Health PHO
Oakland Southfield…
Upper Peninsula Health…
West Michigan Physician's…
Michigan State University…
Greater Macomb PHO
Sparrow Physician's…
Professional Medical…
Integrated Health…
HVPA
Genesys
Primary Care Partners, Inc…
Advantage Health…
Lakeshore Health Network
Holland PHO
Oakwood ACO
Oakland Physician…
Integrated Health Partners
Physician Healthcare…
Mercy Physician…
Medical Network One
St. John Providence…
ProMed Healthcare
UOP, LLC
McLaren PHO
Great Lakes OSC
Bronson Medical Group
CIPA
Henry Ford Medical Group
9
Retinal Eye Examination Rate
Based on Medicare FFS Beneficiaries Assigned January, 2012-June, 2013
Quality of Care Measures: July 1, 2012 – June 30, 2013
100%
National benchmark: 82%
80%
70%
60%
100%
50%
Advantage Health…
Professional Medical…
Physician Healthcare…
Greater Macomb PHO
Holland PHO
Jackson Physician Alliance
Integrated Health…
Metro Health PHO
Northern Physician…
Sparrow Medical Group
Oakland Southfield…
Upper Peninsula Health…
Spectrum Health Medical…
United Physicians, PC
Primary Care Partners,…
Lakeshore Health Network
Integrated Health Partners
Physician Organization of…
Bronson Medical Group
McLaren PHO
UOP, LLC
Michigan State University…
Oakwood ACO
Medical Network One
Henry Ford Medical Group
Oakland Physician…
St. Mary's of Michigan PHO
ProMed Healthcare
Great Lakes OSC
St. John Providence…
HVPA
Genesys
West Michigan…
Mercy Physician…
University of Michigan…
Sparrow Physician's…
CIPA
10
Nephropathy Rate
National benchmark: 94%
90%
80%
70%
60%
100%
50%
Greater Macomb PHO
Physician Healthcare…
Jackson Physician Alliance
Mercy Physician Community…
Sparrow Medical Group
Professional Medical…
Northern Physician…
Bronson Medical Group
McLaren PHO
Oakland Physician Network…
Upper Peninsula Health Plan
Oakland Southfield Physicians
Oakwood ACO
Integrated Health Partners
St. Mary's of Michigan PHO
Medical Network One
Metro Health PHO
Michigan State University…
Advantage Health Physicians
Integrated Health Associates
United Physicians, PC
UOP, LLC
Genesys
Physician Organization of…
Lakeshore Health Network
Holland PHO
Spectrum Health Medical…
Great Lakes OSC
Sparrow Physician's Health…
ProMed Healthcare
St. John Providence Partners…
Primary Care Partners, Inc…
West Michigan Physician's…
HVPA
CIPA
Henry Ford Medical Group
University of Michigan…
11
LDL-C Screening Rate
Based on Medicare FFS Beneficiaries Assigned January, 2012-June, 2013
Quality of Care Measures: July 1, 2012 – June 30, 2013
National benchmark: 94%
90%
80%
70%
60%
12
Cost Savings?
Demonstration effect:
The change in outcomes during the
demonstration period among beneficiaries
assigned to MAPCP Demonstration practices
compared to the change in outcomes for
beneficiaries assigned to comparison PCMH
practices.
13
MiPCT in Comparison (Medicare)
14
Quarterly Trend Comparison:
Medicare PMPM Payments
15
Quarterly Trend Comparison:
Payments to PC and Specialty Physicians
16
Quarterly Trend Comparison:
Hospital Admissions
17
Michigan Data
A Multi-payer Perspective
0
Greater Macomb PHO
Oakland Physician Network…
Mercy Physician Community PHO
Oakwood ACO
Henry Ford Medical Group
UOP, LLC
Jackson Physician Alliance
HVPA
Integrated Health Partners
Medical Network One
Professional Medical Corporation,…
Genesys
McLaren PHO
St. John Providence Partners in…
CIPA
Michigan State University Health…
Sparrow Physician's Health…
Bronson Medical Group
ProMed Healthcare
United Physicians, PC
Upper Peninsula Health Plan
Lakeshore Health Network
Primary Care Partners, Inc…
Physician Organization of Michigan
Integrated Health Associates
Sparrow Medical Group
Northern Physician Organization…
Oakland Southfield Physicians
University of Michigan Health…
Advantage Health Physicians
Spectrum Health Medical Group
Physician Healthcare Network, PC
Holland PHO
Metro Health PHO
West Michigan Physician's Network
18
Inpatient Admissions per 1000 Attributed Patients
300
250
200
150
100
50
180
160
140
120
100
80
60
40
20
0
Michigan State University…
Medical Network One
United Physicians, PC
Henry Ford Medical Group
Oakland Physician Network…
Greater Macomb PHO
St. John Providence…
Integrated Health Associates
University of Michigan…
UOP, LLC
Advantage Health Physicians
McLaren PHO
Genesys
Integrated Health Partners
Oakland Southfield Physicians
Mercy Physician…
Physician Organization of…
Oakwood ACO
HVPA
Northern Physician…
Professional Medical…
ProMed Healthcare
CIPA
Primary Care Partners, Inc…
Jackson Physician Alliance
West Michigan Physician's…
Spectrum Health Medical…
Holland PHO
Sparrow Physician's Health…
Bronson Medical Group
Metro Health PHO
Sparrow Medical Group
Upper Peninsula Health Plan
Lakeshore Health Network
Physician Healthcare…
19
30-Day All-Cause Readmission Rate
98
96
94
92
90
88
86
84
82
80
78
Physician Healthcare Network, PC
Sparrow Medical Group
Holland PHO
Upper Peninsula Health Plan
Oakland Physician Network…
Metro Health PHO
Physician Organization of…
Spectrum Health Medical Group
Integrated Health Partners
Professional Medical…
Greater Macomb PHO
Advantage Health Physicians
Northern Physician Organization…
HVPA
Integrated Health Associates
Lakeshore Health Network
United Physicians, PC
Mercy Physician Community PHO
Genesys
Bronson Medical Group
Primary Care Partners, Inc…
McLaren PHO
Sparrow Physician's Health…
Michigan State University Health…
University of Michigan Health…
CIPA
UOP, LLC
Oakland Southfield Physicians
West Michigan Physician's…
Jackson Physician Alliance
Medical Network One
ProMed Healthcare
St. John Providence Partners in…
Oakwood ACO
Henry Ford Medical Group
20
Diabetes HbA1c Testing Rate
21
Diabetes % with A1C: Change 2012-2013
Physician Healthcare Network
University of Michigan Health System
Oakland Physician Network Services
West Michigan Physician's Network
Holland PHO
Bronson Medical Group
Medical Network One
Oakwood ACO
Sparrow Physician's Health Network
Advantage Health Physicians
United Physicians
St. John Providence Partners in Care
McLaren PHO
Spectrum Health Medical Group
Michigan State University
Greater Macomb PHO
Integrated Health Partners
Professional Medical Corporation
HVPA
Integrated Health Associates
CIPA
Sparrow Medical Group
Oakland Southfield Physicians
Mercy Physician Community PHO
Lakeshore Health Network
Metro Health PHO
Physician Organization of Michigan
Genesys
Jackson Physician Alliance
UOP
ProMed Healthcare
Primary Care Partners (Covenant)
Upper Peninsula Health Plan
Henry Ford Medical Group
Northern Physician Organization
-10.00%
-5.00%
0.00%
5.00%
10.00%
22
Care Management Activity
Source: PO quarterly reporting, 2013
23
Care Manager Activity
2013 Q1 to Q3
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
Q1
Q2
Face-to-Face
Q3
Phone
* Data missing from one PO
Q4*
Patients
24
Typical Daily Care Manager Activity
Quarter 4
Care
Manager
Role
50th Percentile
Quarterly
Encounters/FTE
Translates to:
Encounters per day
Complex
134
2 encounters per day
Hybrid
162
3 encounters per day
Moderate
103
2 encounters per day
25
Care Manager Activity Benchmark
Performance
Quarter 4
Care
Manager
Role
90th Percentile
Quarterly
Encounters/FTE
Translates to:
Encounters per day
Complex
439
7 encounters per day
Hybrid
362
6 encounters per day
Moderate
352
6 encounters per day
26
Care Manager Survey
Source: Surveys conducted May 2013 and Dec 2013/January 2014
50% response rate
27
Average Self-reported Patient Caseload
100
95
90
80
70
60
50
40
74
67
60
63
39
Moderate Care
Manager
30
20
10
0
May
Complex Care
Manager
Hybrid Care Manager
December
28
Care Manager Survey Results
How Care Managers Build Caseloads
Physician referrals
91%
MiPCT list
79%
Electronic admit discharge notifications
63%
ED visit summaries
57%
Review in advance the practice visit…
54%
Registry
40%
Patient self-referrals
30%
Staff Meetings/Huddles
28%
Fax discharge summaries
21%
Other discharge list
Other
17%
5%
29
Care Manager Survey Results
Another staff member is designated to assist with:
Physician referrals
MiPCT list
Electronic admit discharge notifications
ED visit summaries
Review in advance the practice visit…
Registry
Patient self-referrals
Staff Meetings/Huddles
Fax discharge summaries
Other discharge list
Other
22% of all
respondents
specifically noted
that no other staff
member is
designated to
assist with any of
the tasks
30
Care Manager Survey Results
Physicians that Care Managers work with support the
concepts of the MiPCT care management team-based
care
May 2013
48
December 2013
69
0%
Strongly agree
107
Agree
20%
39
79
40%
60%
Neither agree nor disagree
9 12
32
80%
Disagree
53
100%
Strongly disagree
31
Care Manager Survey Results
Practice staff, other than physicians that Care
Managers work with support the concepts of the MiPCT
care management team-based care
December 2013
49
0%
Strongly agree
Agree
86
20%
40%
41
60%
Neither agree nor disagree
80%
Disagree
65
100%
Strongly disagree
32
Care Manager Survey Results
Proportion of Care Managers who have the
following amenities at ALL practice locations
100%
90%
Workstation
Private workspace
Desk
Computer
80%
70%
60%
50%
May 2013
December 2013
33
Next Steps
March - April
2014
April - May
2014
May-June
2014
October
2014
Ongoing Claims Analyses
Contact: [email protected]