The Michigan Primary Care Transformation (MiPCT) Project Presentation to MPCC April 13, 2012

CMS Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration Project or MiPCT 2

Agenda The Michigan Primary Care Transformation Project ▫ MiPCT Vision ▫ Financial Model ▫ Clinical Model ▫ Resources Available ▫ How Will We Define Success? Questions and Discussion 3

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 Michigan residents ▫ Contribute to national models for primary care redesign Form a strong foundation for successful ACO models 4

Guiding Principle: The “Triple Aim” 5

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 Agreement to work on four focused initiatives: o Care Management o Self-Management Support o Care Coordination o Linkage to Community Services 6

Participating Provider and Payer Partners as of April 1, Practices*PO/PHOPhysiciansPayers (Medicaid, Medicare, BCBSM, BCN) * Choice of a January 1 or April 1 start date; no additional practice or PO starting date opportunities after 4/1/12

MiPCT Funding Model $0.26 pmpm Demo 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 9

Developing a Clinical Framework to assist POs/PHOs/Practices with MiPCT Population Management Build on the great work POs and Practices have 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 and practice needs 10

IV. Most complex (e.g., Homeless, Schizophrenia) 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 <1% of population Caseload % of population Caseload % of population Caseload~1000 Managing Populations: Stratified approach to patient care and care management 11

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MiPCT PO/Practice Expectations Care management ▫ Performed for appropriate high- and moderate- risk individuals Population management ▫ Electronic 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

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 14

What can MiPCT practices expect? Information to support population management ▫ Multi-payer claims database ▫ Risk stratification and utilization reports ▫ Feedback reports Resources to help support team-based approach to care ▫ Preserve local autonomy while assuring basic levels of consistency across the demonstration 15

Michigan Data Collaborative (MDC) 16 Data collection and analytic group based at the University of Michigan will Build “multi-payer database” Create and distribute reports that: Help to identify high-risk and at-risk patients Establish baseline performance levels Identify opportunities for improvement Support report interpretation and practice use

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

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 Collabor- atives LEAN Work- shops Practice Coaching

Success = Improved Population Health + Improved Patient & Provider Experience of Care + Reduced Cost 20

Strategies for achieving… SHORT TERM SAVINGS Intensive care management for complex patients, e.g., CHF, COPD Acess 24/7 to clinical decision maker 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 four “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 21

MiPCT Evaluation - Overview Unprecedented opportunity to measure the outcomes of investing in primary care across a large, diverse state State and National Levels ▫ MPHI (State) ▫ RTI (National) 22

Evaluation Details Statistical analysis of the effect of interventions (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 from practice and PO representatives 23

In Summary Evidence-based, goal-oriented care + engaged patients + proactive 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 Michigan and – perhaps – for the nation TOGETHER, WE WILL MAKE A DIFFERENCE IN MICHIGAN ! 24

MiPCT Contacts MiPCT Demo Mailbox: Carol Callaghan, MPH (Co-Chair) Jean Malouin, MD MPH (Co-Chair and Medical Director) Sue Moran, MPH (Co-Chair) Diane Bechel Marriott, DrPH (Project Manager) 25