The Michigan Primary Care Transformation (MiPCT) Project The Demonstration Extension: What It Means for MiPCT POs and Practices 1

Two Year Extension Granted for MAPCP/MiPCT! Here’s what we know… 2

MAPCP Demo: Participating States in 2014 Maine 70 practices 122,420 patients Michigan 358 practices 1,109,926 patients Minnesota **282 practices 1,013,545 patients New York 41 practices 99,019 patients North Carolina 47 practices 83,553 patients Pennsylvania ** 51 practices 163,670 patients Rhode Island 16 practices 57,676 patients Vermont123 practices 272,324 patients ____________________________________________ TOTAL 988 practices 2,922,151 patients ** no extension granted

Michigan: Post-Demonstration MiPCT 4 1/1/12 12/31/14 Post-Demo MiPCT Original Demonstration Period Two Year CMS Extension 12/31/16 GOAL: To sustain our gains (effective, efficient team- based care with embedded Care Managers) post- demonstration period

Outcomes of Discussion with CMS Project Officer on Demonstration Extension (9/29/14) Q: Will the Medicare payments continue at $9.76 PMPM and be paid as they are currently (practice transformation directly to practices; care management and incentives to UMHS centrally for distribution to POs as appropriate)? A: Yes. Medicare will extend payment as is ($9.50 PMPM to POs/practices and.26 for admin). Sequestration will apply if so directed by Congress. Q: Will the national evaluation period remain at 1/1/12-12/31/14 for Michigan, or will it now be extended until 12/31/16? A: The full national RTI evaluation will cover the time period. (Note though that the MPHI evaluation would however be for the entire five year period). 5

Outcomes of Discussion with CMS Project Officer on Demonstration Extension (9/29/14), cont. Q: Will Medicare permit increasing the number of Medicare beneficiaries? Practices? POs? A: Yes – up to the maximum permitted in the original demonstration agreement. (Note that addition of practices and/or POs would require discussion and consent of the other participating payers, however). Q: Will CMS have the same expectations for state oversight of the project in years 4-5? A: Yes. (MDCH/PO/Practice/Commercial Payer agreements should continue, etc.). 6

MiPCT 2015 Project Funding and potentially $41.92 PBPM for engaged chronic non-MiPCT patients (but no “double-dipping” permitted) Medicare FFS payment will continue as $9.50 PMPM (with demo period extension) for MiPCT attributed members; and potentially $41.92 PBPM for engaged chronic non-MiPCT patients (but no “double-dipping” permitted) Medicaid: $7.50 PMPM continues through December 2016 Medicaid: $7.50 PMPM continues through December 2016 BCBSM: 5% E&M Uplift and G/CPT Codes, Existing incentives Priority Health: $3.25 PMPM Care Management Incentive and G/CPT Codes (including Medicare Advantage), Existing incentives BCBSM Medicare Advantage: G/CPT Codes (not part of MiPCT) BCN: Evaluation in process 7

MiPCT 2015 Operational Issues To Be Addressed PO/Practice and Payer Agreements with MDCH Participation Requirements Infrastructure Requirements Care Manager Staffing Ratios On-going Training (Care Managers, Practice teams) Documentation requirements for Care Management Documentation requirements for Care Management Possibility of adding new practices Possibility of adding new practices Implications for existing payers Implications for existing payers Recruitment of new Recruitment of new payers Coordination with the State Innovation Model (SIM) 8

Expanding the Reach of MiPCT: Adding New Payers Efforts underway to recruit additional payers PO Survey to identify most important additional payers ▫ PO partners will participate in outreach to plans ▫ Medicare Advantage plans 9

PO 2015 Visioning Meeting Stakeholder participation in shaping the future ▫ Clinical focus areas ▫ Partnering with community resources One two-hour in-person session in Lansing Timing: Late October/November

MiPCT Key Messages Sustainability and Continuity THREE (3) MONTHS left in the demonstration’s national evaluation period (ending DEC 31, 2014!) to produce continued and improved results for each payer on: We cannot lose focus on using the THREE (3) MONTHS left in the demonstration’s national evaluation period (ending DEC 31, 2014!) to produce continued and improved results for each payer on: ▫ Increased volume of MiPCT eligible patients receiving Care Management ▫ Reduced Avoidable ED and Inpatient Visits ▫ Improved Clinical Metrics (especially diabetes) Your continued and focused efforts now on the key metrics above can pave the path to support the case for ongoing funding from participating payers Your continued and focused efforts now on the key metrics above can pave the path to support the case for ongoing funding from participating payers ▫ Patient-Centered Medical Home model ▫ Care Management 11

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Questions/Discussion