Transcript Multi-Payer Advanced Primary Care Practice Demonstration

1
The Michigan Primary Care
Transformation (MiPCT) Project
PGIP Meeting Update
September 12, 2014
2
Agenda
1. Welcome and Overview
2. Evaluation Update
3. Diabetes Performance and Practice Coaching
Update
4. Billing Collaborative, Payer Updates and CMS
Response Letter
5. Best Practice Workgroup Update
3
Evaluation Update
4
Topics
• National Evaluation Update
▫ Most recent cost and utilization analysis
▫ Patient experience
• Michigan Evaluation Update
▫ Cost and utilization analysis
▫ Key survey findings to date: multiple perspectives
on Care Management
5
National Evaluation
Results from Research Triangle Institute
6
Quarterly Trend Comparison:
Medicare PMPM Payments
7
Quarterly Trend Comparison:
Payments to PC and Specialty Physicians
8
Quarterly Trend Comparison:
Hospital Admissions
Patient Survey – PCMH CAHPS
• Medicare Beneficiaries
State
Response Rate (%)
# Completed
ME
46.2
643
MI
42.6
599
MN
43.3
602
NC
45.3
634
NY
44.6
630
PA
41.6
584
RI
46.1
544
VT
44.3
627
• Analysis adjusted for demographic and other factors for purposes of
comparison
Access to Care Composite
Communication with Providers
Composite
Shared Decision-Making Composite
Self-Management Support Composite
Comprehensive Orientation Composite
15
Michigan Evaluation
Michigan Public Health Institute
16
Status
Activity
Status
Cost, quality and
utilization analysis
• MiPCT practice level analysis underway
• Comparison data supplied by all payers
through December 2013
• Being processed – expected Delivery to MPHI:
October
PO Survey
Complete
Care Manager Survey
Three time points available, additional survey
planned
Practice/Staff Survey
Still open for response
Patient Survey
• Mail/phone follow-up
• Using claims data to randomly select
respondents
• We could use your help to encourage response
17
Survey Data
Multiple Perspectives on Care Management
18
Care Manager Survey
Data Collected via Survey
Monkey ®
Survey 1:
Survey 2:
Survey 3:
May 2013
Dec. 2013 June 2014
May 20th Dec. 16th, 2013
June 9th June 12th, 2013 - Jan. 5th, 2014 June 26th, 2014
Number of Care Managers
emailed invitations to
participate
434
424
421
Care Managers who
completed the survey #(%)
228 (53%)
213 (50%)
209 (50%)
New respondents # (%)
228 (100%)
83 (39%)
58 (28%)
N/A
130 (61%)
151 (72%)
Repeat respondents
Data cleaning and analysis performed using SPSS v19
19
Average Percent of Time Spent at the
Following Locations:
Min: 0%
Max: 100%
Min: 0%
Max: 100%
Min: 0%
Max: 25%
Min: 0%
Max: 90%
20
Physicians’ Availability
21
Physicians Support for Care Management
22
Staff Support for Care Management
Provider/Staff Survey
Preliminary Results, n=1,032
Other
20%
Physician
21%
RN
5%
Practice
Manager
11%
Receptionist/
Secretary/
Front Desk
13%
MiPCT
Care
Manager
14%
Medical
Assistant
16%
24
Provider/Staff Survey
Preliminary Results
(questions not asked of Care Managers)
Percent Agree/Strongly Disagree
(5 point scale, remaining responses largely neutral)
The MiPCT care manager has become an
important member of our team
There is good communication between
care managers & providers/staff
The PO provides the support needed to
implement MiPCT
Having a MiPCT care manager has
improved our ability to meet patient needs
Information about MiPCT is sufficiently
communicated throughout our practice
0%
20%
40%
60%
80%
100%
25
Please help us encourage
response to the Provider/Staff
Survey
Deadline extended to end of next week
PO Feedback:
MiPCT should do differently next time
• Clear and consistent expectations (n=13)
▫
▫
▫
▫
▫
In general
Related to performance incentives
Consistency across payers
Consistency over time, fewer program changes
Better and more timely communication
▫
▫
▫
▫
Better data sooner
More access to data
Assistance with physician engagement
Assistance with care management implementation
• More help (n=10)
• More responsiveness to local variation and capacity(n=2)
• Different model (n=2)
▫ Over-reliance on Geisinger and/or nursing model
PO Lessons Learned:
PO should do differently next time
• Care Management Embedment (almost everyone!)
▫ Better define practice roles from the beginning, better
planning
▫ Physician engagement, incentives, requirements
▫ Pair practice coaches with Care Managers
▫ More oversight of Care Managers by POs, more meetings with
practices, PO hire CMs not practices
▫ Software investment
▫ Develop alternatives to the MiPCT patient list
• Be more selective, include fewer practices, assess practice
readiness earlier (n=6)
• Collaborate with other POs, contract for CM services (n=3)
• We did it right! (n=1)
28
Diabetes Performance and
Practice Coaching Update
80%
40%
Jackson Health Network
Northern Physician Organization Inc
University of Michigan Health System
United Physicians, PC
Physician Organization of Michigan
Sparrow Medical Group
Professional Medical Corporation, PC
Primary Care Partners, Inc (Covenant)
Oakland Southfield Physicians
St. Mary's of Michigan PHO
Metro Health PHO
Genesys
HVPA
Integrated Health Associates
Spectrum Health Medical Group
Michigan State University Health Team
Sparrow Physician's Health Network
Lakeshore Health Network
Upper Peninsula Health Plan
Holland PHO
Advantage Health Physicians
Integrated Health Partners
ProMed Healthcare
West Michigan Physician's Network
Oakwood ACO
St. John Providence Partners in Care,…
Medical Network One
UOP, LLC
Physician Healthcare Network, PC
Mercy Physician Community PHO
Great Lakes OSC
Bronson Medical Group
Oakland Physician Network Services
McLaren Physician Partners
Henry Ford Medical Group
CIPA
29
Retinal Eye Examination Rate
Based on Medicare FFS Beneficiaries Assigned
January, 2012 - December, 2013
100%
90%
National benchmark: 82%
70%
60%
50%
100%
90%
40%
Holland PHO
Advantage Health Physicians
Metro Health PHO
Integrated Health Associates
Professional Medical Corporation, PC
Physician Healthcare Network, PC
Sparrow Medical Group
Jackson Health Network
Northern Physician Organization Inc
Primary Care Partners, Inc (Covenant)
Upper Peninsula Health Plan
UOP, LLC
United Physicians, PC
Spectrum Health Medical Group
Physician Organization of Michigan
Oakland Southfield Physicians
Integrated Health Partners
Lakeshore Health Network
Bronson Medical Group
Michigan State University Health…
Medical Network One
Oakwood ACO
Henry Ford Medical Group
Oakland Physician Network Services
ProMed Healthcare
Genesys
HVPA
McLaren Physician Partners
Great Lakes OSC
Sparrow Physician's Health Network
St. John Providence Partners in…
West Michigan Physician's Network
St. Mary's of Michigan PHO
Mercy Physician Community PHO
University of Michigan Health System
CIPA
30
Nephropathy Rate
Based on Medicare FFS Beneficiaries Assigned
January, 2012 - December, 2013
National benchmark: 94%
80%
70%
60%
50%
100%
40%
Physician Healthcare Network, PC
Mercy Physician Community PHO
Holland PHO
Upper Peninsula Health Plan
Sparrow Medical Group
Metro Health PHO
Advantage Health Physicians
Northern Physician Organization Inc
Professional Medical Corporation, PC
Jackson Health Network
Oakwood ACO
Oakland Physician Network Services
Sparrow Physician's Health Network
Oakland Southfield Physicians
Integrated Health Partners
St. Mary's of Michigan PHO
United Physicians, PC
Integrated Health Associates
UOP, LLC
Genesys
Primary Care Partners, Inc…
ProMed Healthcare
Bronson Medical Group
Lakeshore Health Network
Physician Organization of Michigan
Great Lakes OSC
Medical Network One
Michigan State University Health…
McLaren Physician Partners
St. John Providence Partners in…
Spectrum Health Medical Group
HVPA
CIPA
University of Michigan Health System
Henry Ford Medical Group
West Michigan Physician's Network
31
LDL-C Screening Rate
Based on Medicare FFS Beneficiaries Assigned
January, 2012 - December, 2013
National benchmark: 94%
90%
80%
70%
60%
50%
50%
40%
20%
Metro Health PHO
Holland PHO
Northern Physician Organization…
Advantage Health Physicians
Professional Medical…
Sparrow Medical Group
Jackson Health Network
Integrated Health Associates
Physician Organization of Michigan
Oakland Southfield Physicians
United Physicians, PC
Primary Care Partners, Inc…
Upper Peninsula Health Plan
Spectrum Health Medical Group
Lakeshore Health Network
Michigan State University Health…
Physician Healthcare Network, PC
Oakwood ACO
Integrated Health Partners
Genesys
HVPA
St. Mary's of Michigan PHO
University of Michigan Health…
ProMed Healthcare
Sparrow Physician's Health…
Bronson Medical Group
Medical Network One
UOP, LLC
Oakland Physician Network…
St. John Providence Partners in…
West Michigan Physician's Network
Mercy Physician Community PHO
McLaren Physician Partners
Great Lakes OSC
Henry Ford Medical Group
CIPA
32
All 4 Diabetes Process Measures
Based on Medicare FFS Beneficiaries Assigned
January, 2012 - December, 2013
100%
90%
80%
70%
60%
Average: 44%
30%
100%
80%
20%
Mercy Physician Community PHO
McLaren Physician Partners
Professional Medical Corporation, PC
UOP, LLC
Oakland Physician Network Services
Jackson Health Network
Genesys
Advantage Health Physicians
United Physicians, PC
Upper Peninsula Health Plan
Sparrow Medical Group
St. Mary's of Michigan PHO
Bronson Medical Group
Oakwood ACO
Michigan State University Health Team
Physician Organization of Michigan
Integrated Health Associates
Integrated Health Partners
Sparrow Physician's Health Network
Primary Care Partners, Inc (Covenant)
Oakland Southfield Physicians
Medical Network One
St. John Providence Partners in Care,…
Great Lakes OSC
Spectrum Health Medical Group
Lakeshore Health Network
ProMed Healthcare
CIPA
Northern Physician Organization Inc
University of Michigan Health System
Metro Health PHO
Holland PHO
West Michigan Physician's Network
HVPA
Henry Ford Medical Group
Physician Healthcare Network, PC
33
Total Lipid Panel Screening Rate Among
Beneficiaries with Ischemic Vascular Disease
(IVD) Based on Medicare FFS Beneficiaries Assigned
January, 2012 - December, 2013
90%
Average: 77%
70%
60%
50%
40%
30%
34
MiPCT 2014 Annual Summits
35
2014 Summit Overview
Morning Session – Open to All
The morning session is an all-stakeholder meeting that is open to all. The
theme for the morning is: “The Future of Primary Care: MiPCT in 2015 and
Beyond”.
Practice teams attending with a physician are eligible to earn 4 Practice Learning Credits
Afternoon Session – Care Manager Training
• Designed for MiPCT Care Managers though other interested team partners
are welcome to attend as well
• Topics include a Palliative Care RN Expert Presentation and Update on the
MiPCT Care Management Best Practice Work Group Update.
The MiPCT 2014 Summit Care Manager Session has been submitted to the Michigan Nurses
Association for approval to award contact hours. The Michigan Nurses Association is an approver of
continuing nursing education is the State of Michigan Board of Nursing.
36
2014 Summit Logistics
Morning Summits – Two in-person locations:


Ann Arbor – University of Michigan North Campus Research Center (NCRC),
October 7, 2014 – 8:00 AM to Noon; and
Grand Rapids – Frederik Meijer Gardens, October 9, 2014 – 8:00 AM to Noon
(this location will also have a live webinar link allowing those who cannot
travel to participate).
Afternoon Care Manager Education – Three in-person locations:



Ann Arbor – University of Michigan North Campus Research Center (NCRC),
October 7, 2014 – 1:00 pm-4:30pm
Grand Rapids – Frederik Meijer Gardens, October 9, 2014 – 1:00 pm-4:30pm
Gaylord –Ostego Conference Center October 1, 2014 – 11:30am – 4:30 pm
Note: The Gaylord morning Summit session will not take place this year. Instead, Gaylord afternoon Care manager
training will begin with a special hour-long briefing session with MiPCT Leadership on MiPCT evaluation and 2015
sustainability/continuity. The Grand Rapids morning summit on October 9th will also be available via webinar link and
will be recorded and available on the mipctdemo.org site soon afterward.
37
2014 Summit Registration
•
Register by visiting the mipctdemo.org website and clicking on the “2014
MiPCT Annual Summits” tab.
• Registration is key to practices receiving Practice Learning Credits
• Tab contains detailed information on locations, hotel block codes for
travelers, parking information
• Meeting material will also be posted here in advance of the summits
• To allow for processing time for materials registration will close on
September 30th so register now!
• Registration is at no cost to attendees; lunch is provided
38
Billing Collaborative, Payer
Updates and CMS Response Letter
39
MiPCT Multipayer Billing and Coding
Collaborative
• Led by Mary Ellen Benzik
• Practice Learning Credits Awarded: Four credits
• Focus: Accelerated support to POs and practices for robust billing
and coding infrastructures and processes
• Structure – Each PO is invited to join with one to three practices for:
▫ A half day in-person session
▫ Monthly Webinars
• Sign up by emailing [email protected] by 9/17 with: PO
name, practice participants and roles (practice manager; billers and
coders; Care Managers, etc.)
40
MiPCT Multipayer Billing and Coding
Collaborative
• Payer-led briefings
• The business case for care management
• Learning from the leaders: Best processes and practices
2015 PO Projections - MiPCT Care Management Revenue Modeling with and w/o CMS Demo Period Extension
Estimates Based on June 2014 MiPCT Member Counts
PO: Sample PO
Scenario One: With Demonstration Period Extension
Scenario Two: Transition from Demonstration to Ongoing Program
This describes revenue estimation with Medicare continuing to pay on a PMPM basis should they
extend the period of the demonstration
This describes revenue estimation with Medicare's G code for engaged patients with two or more
chronic conditions
Indicates that estimate is in process
Indicates that estimate is in process
CARE MANAGEMENT REVENUE
Payer
Medicare
Medicare
Medicaid
Managed Care
MiPCT
Priority
Commercial
MiPCT
Priority
Commercial
MiPCT
BCBSM
Commercial MiPCT***
BCBSM
Commercial MiPCT***
Payment
Approach
PMPM for
Attributed
Patients
Monthly G
Code for
nonattributed
engaged
patients
(PEPM)*
PMPM
CARE MANAGEMENT REVENUE
PMPM
$9.50
$42.00
$7.50
G/CPT Codes
Incentive for
PCMH and
Embedded
Care Manager
% Patients
with Two
or More
2013 G/CPT
Chronic
Code
Member
Cond.
Revenue** Count
56%
Revenue
15000 $
1,710,000
424 $
213,457
20000 $
1,800,000
10000
$3.25
10000
G/CPT Codes
10000
E&M Uplift
10000 $
BCBSM Medicare
Advantage**
G/CPT Codes
TOTAL
360,000
5000
$
Stage Two Additional Modeling Components:
PHYSICIAN TRANSITION OF CARE REVENUE from 99495 and 99496 (to be added)
4,083,457
Payer
Medicare
Medicare*
Medicaid
Managed Care
MiPCT
Priority
Commercial
MiPCT**
Priority
Commercial
MiPCT
BCBSM
Commercial MiPCT**
BCBSM
Commercial MiPCT***
BCBSM
Medicare
Advantage**
TOTAL
Payment
Approach
PMPM for
Attributed
Patients
Monthly G
Code for
engaged
patients w/
2+ chronic
conditions
(PEPM)
PMPM
G/CPT
Codes
Incentive for
PCMH and
Embedded
Care
Manager
% Patients
with Two
or More
2013 G/CPT
Chronic
Code
Member
Cond.
Revenue** Count
PMPM
N/A
$
15000 N/A
41.92
7.5
56%
3388
$1,704,400
20,000
$1,800,000
10000
3.25
70000
G/CPT
Codes
10000
E&M Uplift
10000
G/CPT
Codes
Revenue
$360,000
5000
$
3,864,400
Stage Two Additional Modeling Components:
PHYSICIAN TRANSITION OF CARE REVENUE from 99495 and 99496 (to be added)
ADDITIONAL PRACTICE VISIT REVENUE FROM CLOSING GAPS IN CARE (to be added) including increase
ADDITIONAL
in officePRACTICE
visits due to
VISIT
decreased
REVENUE
ED use;
FROM
etc.
CLOSING GAPS IN CARE (to be added) including increase in office visits due to decreased ED use; etc.
41
MiPCT 2015 Plan Care Management Funding Recap
(regardless of CMS demonstration period extension decision)
• Medicaid: $7.50 PMPM continues
• BCBSM: E&M Uplift and G/CPT Codes
• Priority Health: $3.25 PMPM Care Management Incentive and
G/CPT Codes
• BCBSM Medicare Advantage: G/CPT Codes
• BCN evaluation in process
Medicare FFS payment will continue as $9.50 PMPM (with demo period
extension) or at the $41.92 PBPM for engaged chronic patients)
42
CMS Chronic Care Management Monthly G Code:
The MiPCT Response
• Submitted on September 2, 2014
• Main themes:
▫ Insufficiency of payment rate proposed to fund effective care
management
▫ Non-Face-to-Face Care Management not included
▫ Patient financial liability may pose barrier to patient engagement
▫ EHR certification level
▫ Clarification needed regarding definition of clinical staff
43
Best Practice Workgroup Update
MiPCT Care Management Best Practice
Work Group – Background
• Care management activity across the state is
varied.
• Statewide the volume of care management
encounters are lower than expected.
• Care management best practices do exist and it
will be beneficial to gather and analyze these
best practice activities via a MiPCT work group
to identify models and improvement processes.
MiPCT Care Management Best Practice
Work Group – SOW Deliverables
High Level Deliverable: Create a Generic Framework
which can be individualized to meet the needs of the
practice /PO
• Identify best practice for Care Manager time
management, caseload, patient encounters, positive
patient outcomes
• Care Management delivery best practice model for
complex and moderate risk patients
• Preliminary findings, best practice infrastructure to
support care management
A Unique Opportunity
• To recognize and highlight collective workgroup
expertise
• To create an evidence based toolkit for MiPCT Care
Management delivery based on best practice
• To share this work with
▫
▫
▫
▫
MiPCT Leadership
MiPCT POs/practices/care managers
Participating MiPCT payers
Potentially other health care leaders
MiPCT Care Management (CM) Best
Practice Work Group Participants
• MiPCT Statewide Representation
• Invitation based on performance criteria of CM
encounter data, MiPCT quality and utilization
metrics for Adult population
 PO Leaders
 Care Managers
 Clinical Leads
 Physician(s)
CM Best Practice Participants
MiPCT PO Leaders and MiPCT Clinical Leads
• Anne Levandoski- UPHP
• Susan Viviano- Advantage Health
• Margaret Jacobs- UMHS
• Maureen Braun- IHA
• Karen Bennett- Sparrow Health Medical Group
• Chris Rusin- United Physicians
• Ruth Clark- Integrated Health Partners
• Lynn King- Lakeshore Health Network, MiPCT
Clinical Lead
CM Best Practice Participants
cont.
MiPCT PO Leaders, Care Managers, and MiPCT
Clinical Leads
•
•
•
•
•
•
•
•
•
•
•
Belinda Fish- UMHS
Mary Kramer- UPHP
Victoria Lee- Advantage Health Physicians
Diane McLeod- Sparrow Medical Group
Lindsay Schohl- Lakeshore Health Network
Robin Schreur- Spectrum Health Medical Group, MiPCT Clinical Lead
Della Slavsky- UPHP, MiPCT Clinical Lead
Tammy Starks- IHP
Heidi Steinhebel- IHA
Juliann Testy- Henry Ford Medical Group, MiPCT Clinical Lead
Loretta Warda- CIPA/MAG, MiPCT Clinical Lead
MiPCT Clinical Leadership:
Dr. Kevin Taylor, Dr. Jean Malouin, Marie Beisel, Paula Amormino
Individual Care Manager
(CM): How does the care
manager complete daily
work?
Individual
Care Manager
Daily work:
CM Role, CM
Skill, Patient
Acuity
System Factors:
Leadership, Infrastructure
& Practice embedment
System
Factors,
Practice
Embedment
Four Focus Areas
• Care Management Fundamentals
▫ 5 Step CM process for moderate and complex patients
• Sharing Innovative Best Practices
▫ Identify what is working
• “New work” development
▫ Focus on topics with high level of impact to contribute to efficient
and effective care management delivery
▫ CM best practice participants form a sub group – develop
guidelines
• CM activity – what does effective and efficient care
management look like?
▫ Non direct patient care such as care coordination
Potential Outcomes of this Work Group
• Shared learning of CM Best practice innovative
work
▫ Document “what works” to achieve increased
Care Management encounters / benchmark goals
and quality outcomes
• Document “what has been tried and does not
work”
Potential Outcomes of this Work Group cont.
• Evidence based best practice model utilizing patient
acuity as the driver for care interventions.
▫ Address Complex and moderate risk patients and improved
patient outcomes
• Toolkit
▫ Resources, tools, workflows developed by MiPCT
participants
▫ Crosswalk key elements required by MiPCT participating
health plans, CMS Chronic Care codes which will be
effective Jan 2015
• Reference list
▫ Evidence based resources, articles and websites
Timeline
•
•
•
•
•
•
•
7/17/14
Kick off webinar
8/5/14
In person meeting
8/12/14
Webinar
8/26/14
In person meeting
9/18/14
Webinar
9/26/14
In person meeting
Plan one additional in person meeting
• Nov/Dec 2014 Share statewide
▫ Toolkit and Best Practice materials
Progress to date
cont.
• Care Management Fundamentals – group work,
report out, documentation
▫ 5 Step Care Management process – patient
identification, screening, assessment,
intervention/management, case closure
 Moderate care management
 Complex care management
• Identification of 7 Innovative topics:
▫ Chart audit, coaching and mentoring CMs, social
determinants of health, care giver action plan, case
closure criteria, advance directives and inpatient/out
patient Care Manager Care Coordination.
Progress to date
cont.
CM Best Practice Participants- survey distributed
9.8.14
▫ 7 Innovative topics current state
 assess each participants level of implementation
 goal – report out Best Practice sharing, gather
documentation
▫ Prioritize potential “New topics”
• Gathering: resources, work flow, tools
Questions?