The Michigan Primary Care Transformation (MiPCT) Project

1. The Michigan Primary Care Transformation (MiPCT) Project All-Partner Launch Event March 13, 2012

2. Agenda • U.S. Health Care Trends (the burning platform) • The Michigan Primary Care Transformation Project • CMS MAPCP Background Information • MiPCT Vision • Participants • 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. CMS Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration • Centers for Medicare & Medicaid Services is exploring the role of the PCMH in improving US health care • Participating in state-based PCMH demonstrations • CMS Demo Stipulations • Must include Commercial, Medicaid, Medicare patients • Must be budget neutral over 3 years of project • Must improve cost, quality, and patient experience • 8 states selected for participation, including Michigan • Michigan start date: January 1, 2012

9. MAPCP Demo: Participating States • Maine 22 practices  42 (year 3) • Michigan 410 practices • Minnesota 159 practices  340 (year 3) • New York 35 practices • North Carolina 54 practices • Pennsylvania 78 practices • Rhode Island 13 practices • Vermont 110 practices  220 (year 3) _____________________________________________ • TOTAL 881 practices  1,192 (year 3)

10. 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

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

12. 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

13. The Michigan Primary Care Transformation (MiPCT) Model

14. 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 • Support development of evidence-based care models • Create a model that can be broadly disseminated • Facilitate measurable, significant improvements in population health for our Michigan residents • Bend the current (non-sustainable) cost curve • Contribute to national models for primary care redesign • Form a strong foundation for successful ACO models

15. Guiding Principle: The “Triple Aim”

16. MiPCT Participants

17. 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

18. 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

19. MiPCT Financial Model

20. 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

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

22. 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

23. 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

25. 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

26. 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

27. What can MiPCT practices expect? • Additional resources available to help support team-based approach to care • Develop a model that suits the unique circumstances of each practice while maintaining consistency across state • Preserve local autonomy • Information for population management • Multi-payer claims based database • Provide risk stratification, utilization reports • Goal: To support Michigan primary care

28. Resources Available

29. www.mipctdemo.org

30. Care Management Resources • Care Management Resource Center • UMHS/BCBSM collaboration • Web-based resource for templates, tools, evidence-based information, care manager job descriptions, etc. • Free care management consultation service • Care management implementation guide • Care Manager Training and Support • National and local evidence-based models • Also allow credit for existing PO/PHO training models

31. Team Development Resources • Goal: Build on PCMH team-based capabilities • Using team members to the maximum capability of their roles and licenses • Clearly define roles for physicians, nurses, medical assistants, front office staff, and all other team members (social workers, pharmacists, dieticians, etc.) • Facilitated learning opportunities for practice teams • Examples: Learning Collaboratives, Lean workshops, Practice Coaching, webinars and seminars • Training contracts awarded to state resources

32. MDC – the Michigan Data Collaborative • The Michigan Data Collaborative (MDC) is a data collection and provisioning group at the University of Michigan. • Collect claims data from Medicare, Medicaid, BCBSM, and BCN • Collect other data such as registry, immunization, self-reported data, and others • Build “multi-payer claims database” • Create reports • Provide reports and data to POs

33. Multi-Payer Claims Database • Collect data from multiple Payers (insurance carriers) and aggregate it together in one database • Creates a more complete picture of a patient’s information when they: • Receive benefits from multiple insurance carriers • Visit physicians from different Practices or Physician Organizations • Collects more complete information on a patient’s: • Procedures • Diagnosis • Visits • Tests • Test Results (if results are collected) • Prescriptions (if Rx data are collected) MiPCT BCN Medicaid BCBSM Medicare Multi-Payer Claims Database

34. Reporting • Summary level and PO-specific • Delivered to POs • POs will distribute to Practices Multi-Payer Claims Database • Retrospective Reports • Quality and Utilization performance metrics chosen for the project • Only claims-based metrics for Year 1 • Requires 2-3 month run-out to ensure availability of complete data • Prospective Reports • Timely feedback about attributed population for use in care management • Providers are not being measured/scored • Incentive Payments Reports • Incentive scores and payments datasets datasets datasets reports reports reports PO PO PO Practice Practice Practice Practice Practice Practice Practice

35. How Will We Define Success?

36. Patients are surveyed to assess their experience • Performance on operational metrics is assessed regularly via a performance dashboard to ensure program integrity and inform improvement opportunities and budget neutrality • Specialist care is coordinated, and systems are in place to prevent errors that occur when multiple physicians are involved. • Follow-up and support is provided. • Integrated and coordinated team care depends on a free flow of communication among physicians, nurses, care managers, and other health professionals (including behavioral health professionals) • Duplication of tests and procedures is avoided Patient Feedback and Reporting Metrics Care Coordination Team Care MiPCT Builds Patient-Centered Medical Home Capacity in Michigan Source: Health2 Resources 9.30.08 8

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

38. Reduction in Unnecessary and Non-Value-Added Costs The tie to budget neutrality and ROI 38

39. 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

40. 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

41. MiPCT Evaluation - Overview • Unprecedented opportunity to measure the outcomes of investing in primary care across a diverse state • Quality, cost, efficiency • Experience of care • Population health It’s about the relationship between the changes you make in the clinic and patient outcomes

42. What does this involve? • 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

43. Summary

44. Key Dates • Webinar Schedule (Select Thursdays, 3-5pm) • March 22 – Financial Reporting and Templates • Recommend your topics! We want to be helpful! • 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)

45. No magic bullet - the key to better health care delivery at lower cost will involve multiple solutions • The Patient Centered Medical Home, as a foundation for the ACO/OSC model, offers one promising solution • 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!!

46. 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

47. Questions and Discussion