The Michigan Primary Care Transformation (MiPCT) Project The Business Case for Care Management Mary Ellen Benzik, MD Diane Marriott, DrPH 1

What Does Sustainability Mean? To the Practice: Maintaining and growing CM staffing, processes and roles To the PO (and Practice) : Payment reform for CM To the State and Patients: Servicing all patients, all payers with effective, efficient services 2

Sustainability Variables PRACTICE/POs: Success on key metrics; Funding to allow “margin to cover mission”; Change Management ENVIRONMENT: Demonstration Extension; Refinement of CMS G Code; Evolving health reform/landscape; “Accountable System” performance ROI/PAYER PARTICIPATION: Success on key metrics (by payer); Servicing members of all plans 3

The Evolution of Care Management Payment 4 Population- Based PMPM Acuity- Adjusted PMPM Activity-Based Care Management G/CPT Codes ????? Systems Level Payment PBPM (For Engaged Beneficiaries)

All-Payer Billing (Through August 2014) Most and Least Frequently Used Codes

MiPCT Resources to Support PO and Practice Business Cases All-Payer Billing Collaborative ▫ October 30 Morning Half Day In-Person Session  Focus on Care Managers, Billers, Coders, Office Staff  Special Webinar for Physicians ▫ Follow-up Team Webinars ▫ Three (3) Practice Learning Credits Granted ▫ To join, just with the subject line: MiPCT BILLING 2015 Revenue Projections to POs Across Payers All-Payer Resources on mipctdemo.org

MiPCT Resources to Support PO and Practice Business Cases, cont. Payer recruitment Policy support on federal and state initiatives MiPCT Demo mailbox queries

What Happens After 2016? Goal: Transition from demonstration to ongoing payment reform Sustaining and growing of the gains The Work Starts Now……..

One System’s Approach -Mary Ellen Benzik, MD

MiPCT vs. Chronic Care Codes Alone ? MIPCTChronic Care Codes Total revenue /month/ 1000 Medicare lives (PMPM,TOC, AWV) $ 16,888.73$ 7, Total expense /month / 1000 Medicare lives$ 12,678$ 4, REVENUE - EXPENSE = CONTRIBUTION MARGIN per year$ 50,524$ 29,850.95

Calculating Revenue Opportunity Interactive excel spread sheet System/practice specific characteristics are entered into calculator tool Applicable to Transition of Care (TOC), Annual Wellness Visit (AWV), and Chronic Care Codes (CCC) Factors in anticipated investment /expense to capture revenue Allows modeling of necessary practice activity to budget targets

Demonstration of Excel Sheet