Transcript Multi-Payer Advanced Primary Care Practice Demonstration

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The Michigan Primary Care
Transformation (MiPCT) Project
All-Partner Launch Event
MiPCT 101
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Agenda
• U.S. Health Care Trends (the burning platform)
• The Michigan Primary Care Transformation Project
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MiPCT Vision
Financial Model
Clinical Model
Resources Available
How Will We Define Success?
• Summary
• Questions and Discussion
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U.S. Health Care Trends
Average Health Spending Per Capita ($US):
The ubiquitous and non-sustainable cost curve
7000
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United States
Germany
Canada
France
Australia
United Kingdom
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K. Davis et al. Slowing the Growth of U.S. Health Care Expenditures: What Are the Options?, The
Commonwealth Fund, January 2007, updated with 2007 OECD data
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Where is the silver lining?
• Accountable Care Organizations?
• Patient Centered Medical Homes?
• Health Care Reform?
• All/None of the above?
PCMH as the Foundation for ACO
Population Management
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
Source: Premier Healthcare Alliance
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CMS Multi-Payer
Advanced Primary Care Practice
(MAPCP) Demonstration Project
Michigan: Some fun facts
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Total population (2010 census): 9,883,640
11th largest state in the United States
Home to more than 11,000 lakes
The longest freshwater shoreline in the world
The largest State Forest system in the nation
Favorite vacation spot of Ernest Hemingway
Birthplace of Charles Lindbergh, Henry Ford, Stevie
Wonder, Gilda Radner, Madonna, “Magic” Johnson and
(who can forget...) Alice Cooper
And, last but not least…
• Although Michigan is called the "Wolverine State"
there are no longer any wolverines in Michigan
Michigan: Selected health statistics
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45th (of 50 states) in coronary heart disease deaths
41rd in percent of obese adults
34th in infant mortality rate
34th in percent of adults who smoke
34th in overall cancer death rate
20th in percent of adults who exercise regularly
12th in adults receiving colon cancer screening
5th in childhood immunization rate
Source: Comparison of Michigan Critical Health Indicators and Healthy People 2010
Targets, Michigan Department of Community Health, May 2011
The Michigan Primary Care
Transformation (MiPCT) Model
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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
• Create a model that can be broadly disseminated
▫ Facilitate measurable improvements in population health for
our Michigan residents
▫ Contribute to national models for primary care redesign
• Form a strong foundation for successful ACO models
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Guiding Principle: The “Triple Aim”
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MiPCT Participants
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Practice Participation Criteria
• PCMH-designated in 2010, and maintain PGIP or
NCQA designation over the 3-year demonstration
• Part of a participating PO/PHO/IPA
• Agree to work on the four selected focus initiatives:
o Care Management
o Self-Management Support
o Care Coordination
o Linkage to Community Services
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Participating Provider and Payer Partners
As of April 2012
# Practices*
# POs # Physicians
# Payers
410 Practices 36 POs Over 1700
4 (Medicaid,
Physicians Medicare, BCBSM,
BCN)
*Choice of a January 1 or April 1 start date; no additional
practice or PO starting date opportunities post 4/1/12
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MiPCT Financial Model
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MiPCT Funding Model
$0.26 pmpm
$3.00 pmpm*, **
$1.50 pmpm*, **
$3.00 pmpm*, **
$7.76 pmpm
Administrative Expenses
Care Management Support
Practice Transformation Reward
Performance Improvement
Total Payment by non-Medicare
Payers***
* Or equivalent
** 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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MiPCT Clinical Model:
Optimizing Patient Engagement,
Improving Population Health
Developing a Framework to assist
POs/PHOs/Practices with
MiPCT Population Management
• Build on the great work you’ve already done!
• Develop working definitions for MiPCT focus areas
• Define evidence-based interventions and metrics for each
focus area, categorized by risk status and population tier
• Develop resources and training models to meet
PO/PHO/practice needs
Managing Populations:
Stratified approach to patient care and
care management
IV. Most
complex
(e.g., Homeless,
Schizophrenia)
<1% of population
Caseload 15-40
III. Complex
Complex illness
Multiple Chronic Disease
Other issues (cognitive, frail
elderly, social, financial)
II. Mild-moderate illness
Well-compensated multiple diseases
Single disease
I. Healthy Population
3-5% of population
Caseload 50-200
50% of population
Caseload~1000
Michigan Primary Care Transformation Project
Advancing Population Management
PCMH Services
Complex Care
Management
Functional
Tier 4
Care Management
Functional Tier 3
Transition Care
Functional Tier 2
Navigating the Medical
Neighborhood
Functional Tier 1
PCMH Infrastructure
All Tier 1-2-3 services plus:
 Home care team
 Comprehensive care plan
 Palliative and end-of life care
All Tier 1-2 services plus:
 Planned visits to optimize
chronic conditions
 Self-management support
 Patient education
 Advance directives
All Tier 1 services plus:
 Notification of admit/discharge
 PCP and/or specialist follow-up
 Medication reconciliation
 Optimize relationships with
specialists and hospitals
 Coordinate referrals and tests
 Link to community resources
Prepared Proactive Healthcare Team
Engaging, Informing and Activating Patients
P O P U L A T I O N
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Health IT
- Registry / EHR registry functionality *
- Care management documentation *
- E-prescribing (optional)
- Patient portal (advanced/optional)
- Community portal/HIE (adv/optional)
- Home monitoring (advanced/optional)
Patient Access
- 24/7 access to decision-maker *
- 30% open access slots *
- Extended hours *
- Group visits (advanced/optional)
- Electronic visits (advanced/optional)
Infrastructure Support
- PO/PHO and practice determine
optimal balance of shared support
- Patient risk assessment
- Population stratification
- Clinical metrics reporting
*denotes requirement by end of year 1
M A N A G E M E N T
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MiPCT PO/Practice Expectations
• Care management
▫ Performed for appropriate high and moderate
risk individuals
• Population management
▫ Registry functionality by end of year 1
▫ 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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MIPCT Joint PO/PHO and Practice
Implementation Plan
• Overview of PO/PHO Role in MiPCT
implementation
• High-level, jointly-developed Implementation
Plan (one per practice)
▫ Current and planned division of care management
responsibilities between Practice and PO
▫ Care Management Staffing Plans
▫ Practice Information (EHR, Registry, Key Contacts)
• Description of the planned distribution of care
coordination and incentive payments between
PO and practice
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Resources Available
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What can MiPCT practices expect?
• Additional resources available to help
support team-based approach to care
▫ Preserve local autonomy while maintaining
consistency across the state
• Information for population management
▫ Multi-payer claims based database
▫ Provide risk stratification, utilization reports
• Goal: To support Michigan primary care
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www.mipctdemo.org
Care Management Resource Center
• UMHS/BCBSM collaboration
• Goal is to help disseminate effective, evidencebased care management models throughout
Michigan
• Initial focus is MiPCT practices - available to all
Michigan PO/PHOs /practices
▫ Web-based resource for templates, tools, evidencebased information
▫ Webinars, workshops and mentoring in care
management
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Michigan Data Collaborative (MDC)
Data collection and provisioning group based at the
University of Michigan.
• Builds “multi-payer database”
• Creates and distributes reports that:
• Helps to identify high risk and at-risk patients
• Establishes baseline performance
• Identifies opportunities for improvement
• Supports report interpretation and practice use
QI and Team Development Resources
• Learning Sessions aimed at:
▫ Building on PCMH team-based capabilities
 Team members working at the top of their role and license
 Clearly defining roles for the entire practice team
▫ Nurturing a culture of support and respect
▫ Optimizing practice workflow and change management
Quarterly
Best
Practice
Sharing
Learning
Collaboratives
LEAN
Workshops
Practice
Coaching
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How Will We Define Success?
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Success = Improvements in
Population Health + Cost + Patient
Experience
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Reduction in Unnecessary and NonValue-Added Costs
The tie to
budget
neutrality and
ROI
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Budget Neutrality and ROI
• Budget Neutrality
▫ The minimum required
▫ Amount expended in additional payments to providers
(practices and POs) plus administrative costs must be equal
to or less than the amount saved by avoiding unnecessary
services (e.g., ambulatory care-sensitive ED visits and
inpatient stays, redundant testing, etc.)
▫ Must trend toward budget neutrality at the end of Year Two
(2013)
• ROI
▫ The GOAL
▫ “Return on Investment”
▫ Saving more in avoidable costs than is spent on additional
payments to providers and administrative costs
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Strategies for achieving…
SHORT TERM SAVINGS
• High-risk patient intensive
care management
• 24/7 clinical decision maker
access to prevent
unnecessary ED utilization
and inpatient admissions
• Baseline data analysis for
utilization outliers and focused
root cause analysis
• Educate on evidence-based
approaches to care (e.g., low
back pain management)
LONG TERM SAVINGS
• Focus on all “tiers” of patient
population
• Recognize and reward
performance on intermediate
markers of chronic conditions
to prevent long-term
complications (BP in diabetes,
etc.)
• Focus on primary
prevention/screening
• Work to build self-sustaining
healthy communities
MiPCT Evaluation - Overview
• Unprecedented opportunity to measure the
outcomes of investing in primary care across a
diverse state
• State and National Levels
▫ MPHI (State)
▫ RTI (National)
Evaluation Details
• Statistical analysis of the effect of your work
(care management, care transitions, community
linkages, IT, patient access) on quantifiable
outcomes, using:
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Claims data
Clinical quality indicators
Patient survey on experience of care
Provider/clinic staff survey on work life satisfaction
• Key interviews and feedback gathering from
practice and PO representatives
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Summary
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Key Dates
• Webinar and Q/A Calls --- (Alternate Thursdays, 3-5pm)
• CCM Rollout Training – 2 Q 2012
• Quarterly Report and Financial Templates
• Quarter 1 (Due May 1, 2012): Brief interim reports
• Quarter 2 (Due August 1, 2012): Documentation for the
6 month performance incentive metrics
• Quarter 3 (Due November 1, 2012): Brief interim reports
• Quarter 4 (Due February 1, 2013): Updated
Implementation Plans
• Incentive Metrics
• Six month metrics (Jan-June 2012)
• Twelve month metrics (August – December 2012)
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• Evidence-based, Goal-Oriented Care + Engaged Patient
+ Invested Care Team = MiPCT
• No magic bullet - the key to better health care delivery
at lower cost will involve multiple solutions
• The Michigan Primary Care Transformation Project will
help shape the future of primary care in our state
• TOGETHER, WE CAN MAKE A DIFFERENCE FOR
MICHIGAN!!
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Hope on the Horizon
James D. Reschovsky, Ph.D., Arkadipta Ghosh, Ph.D., Kate Stewart, Ph.D., and Deborah Chollet, Ph.D.; “Can Promoting Primary Care Help Bend
the Cost Curve?”; Commonwealth Fund, March 21, 2012
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MiPCT Contacts
• MiPCT Demo Mailbox:
• Carol Callaghan (Co-Chair)
[email protected]
[email protected]
• Jean Malouin, MD MPH (Co-Chair, Medical Director)
[email protected]
• Sue Moran (Co-Chair)
[email protected]
• Diane Bechel Marriott, DrPH (Project Manager)
[email protected]
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Questions and Discussion