Michigan’s Multi-Payer Advanced Primary Care Practice Demonstration – Application to CMS Carol Callaghan Michigan Department of Community Health and Michigan Primary Care Consortium

Priorities of the Michigan Primary Care Consortium Transform Primary Care Practices to routinely provide evidence-based, coordinated, whole-person care Reform Payment System for primary care Engage Consumers in their own health management Rebuild the Primary Care Workforce Most Promising Solution to ALL of the above: Patient-Centered Medical Home (PCMH)

CMS Requirements for Multi-Payer PCMH Demo Up to 6 states to be selected Number of Medicare beneficiaries < 150,000 (More might be allowed if case is compelling) Total Medicare funding < $10 PMPM Common payment methodology Budget neutral over 3 years of project Multi-payers, including Medicaid, commercial plans, self-insured employer-sponsored group health plans CMS GOAL: Determine the impact of PCMH on cost and quality of health care

Stakeholders in MI Application for PCMH Demo Payers, public and private 16 PO/PHO/IPA’s 32 PGIP-PCMH/NCQA Practices 477 Beneficiaries Medicare 358,000 Medicaid (non-dual) 248,000 Privately insured 1,153,000 Total Beneficiaries 1,749,000

Proposed Governance Steering Committee MDCH – 3 PO/PHO/IPA – 6 (elected) Payers – 5 (elected) Advisory Committee Professional medical associations Other participating payers Other participating POs/PHOs/IPAs Others

Clinical Model Support for deeper practice transformation will take place through networks of PO’s plus learning collaboratives, with special focus on: Care Management Self-Management Support Care Coordination Linkage to Community Services

Proposed Funding Model $ .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 Payers* * Medicare will pay additional $2.00 PMPM to cover additional services for the aging population

Participating Payers Commercial Medicare Medicaid Fee For Service Blue Care Network Blue Cross Blue Shield of Michigan Health Alliance Plan HealthPlus of Michigan McLaren Health Plan Physicians Health Plan of Mid-Michigan Priority Health Medicare Medicaid Fee For Service

Participating Payers (continued) Medicaid Managed Care Plans CareSource Great Lakes Health Plan Health Plan of Michigan HealthPlus Partners McLaren Health Plan Midwest Health Plan Molina Healthcare Physicians Health Plan of Mid-Michigan Priority Health, Gov’t Programs, Inc. Total Health Care Upper Peninsula Health Plan

If Michigan is NOT selected by CMS . . . Could we do this anyway, without Medicare? Would Michigan payers agree? Would support from employers be useful? Would legislative authority be useful? or necessary?