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Connecting Michigan 2017 The Evolving Role of Physician Organizations
June 8, 2017
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What is a PO? Network of Physicians Contract with health plans
HMO BCBS (PGIP) Quality Incentives Utilization Moving into Population Health Care management Performance management Risk focus Education Activities it is easier to provide as a network or that can’t be done by individual physician practices Credentialing Technology Group Purchasing Programs
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United Physicians, Inc. Owned and lead by Physicians
Board of Directors consists of 21 physicians 2,400+ physician members Multispecialty Assist both employed and independent physicians Cover 400,000 managed lives Contracts run the spectrum (ffs->risk) 6 geographic regions 113 employees All Specialty and Initiative workgroups lead by physicians
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What is UP looking for in HIE?
Aggregating data from doctors Submitting supplemental data to health plans Performance reporting and network analytics Disseminate performance reports back to doctors Enable Transitions of Care ADT notifications, care management, etc Ingenium subsidiary
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What is UP looking for in MiHIN?
Convene/coordinate activity within the state Enable exchange of information Legal agreements Basis for sharing of information Maximize Investment in Technology Limited funds – need to know we are investing correctly Help simplify life for independent physicians
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United Physicians MiHIN Activities
MiHIN Use Case Participation Public Health Reporting State-wide notifications ADT Medication Reconciliation/Discharge Summaries Physician Payer Quality Collaborative (PPQC) Supplemental Data Reporting Quality Reporting Gap Identification
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Why do We participate in the Physician Payer Quality Collaborative?
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PPQC MiHIN and MSMS convened and lead
Collaboration between physicians and payers 3 main goals: Common set of measures Common method for sending/receiving quality data Common methodologies for reporting performance and closing gaps in care This is the real power of MiHIN and its ability to pull together disparate groups for a common cause Joe Neller gave an overview of this yesterday (?), so I will just give a quick refresher and then explain what it means to UP
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Physician Organizations
Participants to Date Payers Physician Organizations Other Stakeholders Blue Care Network of Michigan Affinia Michigan Quality Improvement Consortium Blue Cross Blue Shield of Michigan Answer Health Ingenium Health Alliance Plan Huron Valley Physicians Association Michigan Dept of Health & Human Services Molina Healthcare of Michigan Northern Physicians Organization Michigan Public Health Institute Meridian Health Plan Oakland Southfield Physicians McLaren Health Care Physician Healthcare Network Priority Health United Physicians Total Health Care Wayne State University Physician Group Upper Peninsula Health Plan Copyright 2016 Michigan Health Information Network Shared Services
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Supplemental data – status quo
“Group to BCN” Format eCW NextGen Allscripts Wellcentive HL7 Format Meridian Format HEDIS NCQA PO 1 PO 2 PO 3 PO 4 Copyright 2016 Michigan Health Information Network Shared Services
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PPQC 27 core set measures Adult BMI Assessment
Childhood Immunization Status Well Child Visits 15 months Well Child Visits 3-6 years Colorectal Cancer Screening Immunizations for Adolescents Adolescent Well Care Visits Follow-up for ADHD Appropriate Treatment for URI Appropriate testing for pharyngitis Lead Screening Imaging Studies for Low Back Pain Consider overlay of UP scorecard CDC: Hemoglobin A1c Testing CDC: Hemoglobin A1c Poor Control CDC: Eye Exam Performed CDC: Medical Attention for Nephropathy CDC: Blood Pressure Control Controlling High Blood Pressure Weight Assessment + Counseling Tobacco Use Screening and Cessation Screening for Depression + Follow-up Avoidance of Antibiotics for Bronchitis Prenatal & Postpartum Care Cervical Cancer Screening Breast Cancer Screening Chlamydia Screening Anti-depression Medication Management Copyright 2016 Michigan Health Information Network Shared Services
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Quality Measure Data Flow
All-payer / All-patient Quality Data NPO WSUPG UP OSP MIHIN QMI Payer Specific-Filtered Data Physician Organizations One format and one location for: POs to submit quality measures Payers to submit Gaps in Care POs to close Gaps in Care Health Plans or Government This work made possible by funding from the Michigan Department of Health and Human Services Copyright 2016 Michigan Health Information Network Shared Services
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Supplemental data – United Physicians
eCW NextGen Allscripts Wellcentive NCQA PO 1 8 Health Plans HL7 Format 40 EMRs PO 2 NCQA HEDIS 47 Measures Over 100 goals PO 3 Meridian Format 200+ PCP practices PO 4 NCQA “Group to BCN” Format Copyright 2016 Michigan Health Information Network Shared Services
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Alignment of goals PPQC Goals Common set of measures
Common method for sending/receiving quality data Common methodologies for reporting performance and closing gaps in care UP HIE Goals Simplification/consistency across the payers Less confusion for the doctors Maximizing Investment in technology We know our role/where to focus
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How does this help UP? Even though we’ve already invested in interface…. Less confusion for doctors (which measures, whether data is reported, which interfaces are needed, etc) Maintenance (measures change) Consistency across payers Confidence in our investments Not duplicating other efforts
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Other Factors This is not a mature process
CMS is evolving new standards QRDA CAT I CAT III CMS/CAID requirements EMR vendors Health Plans NCQA HEDIS ECDS Updates (Electronic Clinical Data Systems) Expands our toolbox and allow us options in transitioning to new program requirements/standards Work with MiHIN to develop translations of data to meet various program requirements Allows us more options to engage our network (variety of EMR’s)
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Sharpens UP Focus Reduces attention to data movement and format
Emphasis on Quality Improvement Inbound Data Quality Physician/Practice Performance Distribution of Information Panel management Care management
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Next Steps Verify patient matching (no data lost)
Receive GAP reports from payers Continue to enhance data quality
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John Vismara Vice President jvismara@updoctors.com
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