The Michigan Primary Care Transformation (MiPCT) Project

1. The Michigan Primary Care Transformation (MiPCT) Project All-Partner Launch Event MiPCT 101

2. Agenda • U.S. Health Care Trends (the burning platform) • The Michigan Primary Care Transformation Project • MiPCT Vision • Financial Model • Clinical Model • Resources Available • How Will We Define Success? • Summary • Questions and Discussion

3. U.S. Health Care Trends

4. Average Health Spending Per Capita ($US): The ubiquitous and non-sustainable cost curve 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 Page 4

5. Where is the silver lining? • Accountable Care Organizations? • Patient Centered Medical Homes? • Health Care Reform? • All/None of the above?

6. 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

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

8. Michigan: Some fun facts • 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

9. And, last but not least… • Although Michigan is called the "Wolverine State" there are no longer any wolverines in Michigan

10. Michigan: Selected health statistics • 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

11. The Michigan Primary Care Transformation (MiPCT) Model

12. 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

13. Guiding Principle: The “Triple Aim”

14. MiPCT Participants

15. 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: • Care Management • Self-Management Support • Care Coordination • Linkage to Community Services

16. Participating Provider and Payer PartnersAs of April 2012 *Choice of a January 1 or April 1 start date; no additional practice or PO starting date opportunities post 4/1/12

18. MiPCT Financial Model

19. MiPCT Funding Model $0.26 pmpm Administrative Expenses $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*** * 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

20. MiPCT Clinical Model:Optimizing Patient Engagement, Improving Population Health

21. 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

22. Managing Populations: Stratified approach to patient care and care management IV. Most complex(e.g., Homeless,Schizophrenia) <1% of population Caseload 15-40 III. ComplexComplex illnessMultiple Chronic DiseaseOther issues (cognitive, frail elderly, social, financial) 3-5% of population Caseload 50-200 50% of populationCaseload~1000 II. Mild-moderate illnessWell-compensated multiple diseases Single disease I. Healthy Population

24. 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

25. 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

26. Resources Available

27. 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

28. www.mipctdemo.org

29. Care Management Resource Center • UMHS/BCBSM collaboration • Goal is to help disseminate effective, evidence-based care management models throughout Michigan • Initial focus is MiPCT practices - available to all Michigan PO/PHOs /practices • Web-based resource for templates, tools, evidence-based information • Webinars, workshops and mentoring in care management

30. 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

31. 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

32. How Will We Define Success?

33. Success = Improvements in Population Health + Cost + Patient Experience

34. Reduction in Unnecessary and Non-Value-Added Costs The tie to budget neutrality and ROI 34

35. 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

36. 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

37. 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)

38. Evaluation Details • Statistical analysis of the effect of your work (care management, care transitions, community linkages, IT, patient access) on quantifiable outcomes, using: • 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

39. Summary

40. 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) Key Dates

41. 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!!

42. Hope on the Horizon James D. Reschovsky, Ph.D., ArkadiptaGhosh, 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

43. MiPCT Contacts • MiPCT Demo Mailbox: mipctdemo@michigan.gov • Carol Callaghan (Co-Chair) callaghanc@michigan.gov • Jean Malouin, MD MPH (Co-Chair, Medical Director) jskratek@med.umich.edu • Sue Moran (Co-Chair) MoranS@michigan.gov • Diane Bechel Marriott, DrPH (Project Manager) dbechel@umich.edu

44. Questions and Discussion