1. The Michigan Primary Care Transformation (MiPCT) Project All-Partner Launch Event March 13, 2012 1

2. Agenda U.S. Health Care Trends (the burning platform) The Michigan Primary Care Transformation Project ▫ CMS MAPCP Background Information ▫ MiPCT Vision ▫ Participants ▫ Financial Model ▫ Clinical Model ▫ Resources Available ▫ How Will We Define Success? Summary Questions and Discussion 2

3. U.S. Health Care Trends 3

4. Page 4 Average Health Spending Per Capita ($US): The ubiquitous and non-sustainable cost curve K. Davis et al. Slowing the Growth of U.S. Health Care Expenditures: What Are the Options?, The Commonwealth Fund, January 2007, updated with 2007 OECD data

5. Where is the silver lining? Accountable Care Organizations? Patient Centered Medical Homes? Health Care Reform? All/None of the above? 5

6. PCMH as the Foundation for ACO Population Management 6 Source: Premier Healthcare Alliance The goal of Accountable Care Organizations should be to reduce, or at least control the growth of, healthcare costs while maintaining or improving the quality of care patients receive (in terms of both clinical quality, patient experience and satisfaction). - Harold Miller

7. CMS Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration Project 7

8. CMS Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration Centers for Medicare & Medicaid Services is exploring the role of the PCMH in improving US health care ▫ Participating in state-based PCMH demonstrations CMS Demo Stipulations ▫ Must include Commercial, Medicaid, Medicare patients ▫ Must be budget neutral over 3 years of project ▫ Must improve cost, quality, and patient experience 8 states selected for participation, including Michigan Michigan start date: January 1, 2012 8

9. MAPCP Demo: Participating States Maine 22 practices  42 (year 3) Michigan 410 practices Minnesota159 practices  340 (year 3) New York 35 practices North Carolina 54 practices Pennsylvania 78 practices Rhode Island 13 practices Vermont110 practices  220 (year 3) _____________________________________________ TOTAL 881 practices  1,192 (year 3) 9

10. Michigan: Some fun facts Total population (2010 census): 9,883,640 11th largest state in the United States Home to more than 11,000 lakes The longest freshwater shoreline in the world The largest State Forest system in the nation Favorite vacation spot of Ernest Hemingway Birthplace of Charles Lindbergh, Henry Ford, Stevie Wonder, Gilda Radner, Madonna, “Magic” Johnson and (who can forget...) Alice Cooper

11. And, last but not least… Although Michigan is called the "Wolverine State" there are no longer any wolverines in Michigan

12. Michigan: Selected health statistics 45 th (of 50 states) in coronary heart disease deaths 41 rd in percent of obese adults 34 th in infant mortality rate 34 th in percent of adults who smoke 34 th in overall cancer death rate 20 th in percent of adults who exercise regularly 12 th in adults receiving colon cancer screening 5 th in childhood immunization rate Source: Comparison of Michigan Critical Health Indicators and Healthy People 2010 Targets, Michigan Department of Community Health, May 2011

13. The Michigan Primary Care Transformation (MiPCT) Model

14. 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 ▫ Support development of evidence-based care models Create a model that can be broadly disseminated ▫ Facilitate measurable, significant improvements in population health for our Michigan residents ▫ Bend the current (non-sustainable) cost curve ▫ Contribute to national models for primary care redesign Form a strong foundation for successful ACO models 14

15. Guiding Principle: The “Triple Aim” 15

16. MiPCT Participants 16

17. 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 Agree to work on the four selected focus initiatives: o Care Management o Self-Management Support o Care Coordination o Linkage to Community Services 17

18. Participating Provider and Payer Partners As of April 2012 18 # Practices*# POs# Physicians# Payers 410 Practices36 POsOver 1700 Physicians 4 (Medicaid, Medicare, BCBSM, BCN) *Choice of a January 1 or April 1 start date; no additional practice or PO starting date opportunities post 4/1/12

19. MiPCT Financial Model 19

20. MiPCT Funding Model $0.26 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 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 20

21. MiPCT Clinical Model: Optimizing Patient Engagement, Improving Population Health 21

22. Developing a Framework to assist POs/PHOs/Practices with MiPCT Population Management Build on the great work you’ve 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/practice needs

23. 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 15-40 3-5% of population Caseload 50-200 50% of population Caseload~1000 Managing Populations: Stratified approach to patient care and care management

24. 24

25. MiPCT PO/Practice Expectations Care management ▫ Performed for appropriate high and moderate risk individuals Population management ▫ 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 25

26. 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 26

27. What can MiPCT practices expect? Additional resources available to help support team-based approach to care ▫ Develop a model that suits the unique circumstances of each practice while maintaining consistency across state ▫ Preserve local autonomy Information for population management ▫ Multi-payer claims based database ▫ Provide risk stratification, utilization reports Goal: To support Michigan primary care 27

28. Resources Available 28

29. 29 www.mipctdemo.org

30. Care Management Resources Care Management Resource Center ▫ UMHS/BCBSM collaboration ▫ Web-based resource for templates, tools, evidence-based information, care manager job descriptions, etc. ▫ Free care management consultation service ▫ Care management implementation guide Care Manager Training and Support ▫ National and local evidence-based models ▫ Also allow credit for existing PO/PHO training models

31. Team Development Resources Goal: Build on PCMH team-based capabilities ▫ Using team members to the maximum capability of their roles and licenses ▫ Clearly define roles for physicians, nurses, medical assistants, front office staff, and all other team members (social workers, pharmacists, dieticians, etc.) Facilitated learning opportunities for practice teams ▫ Examples: Learning Collaboratives, Lean workshops, Practice Coaching, webinars and seminars ▫ Training contracts awarded to state resources

32. MDC – the Michigan Data Collaborative 32 The Michigan Data Collaborative (MDC) is a data collection and provisioning group at the University of Michigan. Collect claims data from Medicare, Medicaid, BCBSM, and BCN Collect other data such as registry, immunization, self-reported data, and others Build “multi-payer claims database” Create reports Provide reports and data to POs

33. Multi-Payer Claims Database 33 Collect data from multiple Payers (insurance carriers) and aggregate it together in one database  Creates a more complete picture of a patient’s information when they: Receive benefits from multiple insurance carriers Visit physicians from different Practices or Physician Organizations  Collects more complete information on a patient’s: Procedures Diagnosis Visits Tests Test Results (if results are collected) Prescriptions (if Rx data are collected) Multi-Payer Claims Database Medicare Medicaid BCN BCBSM MiPCT

34. Reporting 34 Summary level and PO-specific Delivered to POs  POs will distribute to Practices PO Multi-Payer Claims Database datasets reports Practice datasets reports datasets reports PO Retrospective Reports  Quality and Utilization performance metrics chosen for the project  Only claims-based metrics for Year 1 Requires 2-3 month run-out to ensure availability of complete data Prospective Reports  Timely feedback about attributed population for use in care management Providers are not being measured/scored Incentive Payments Reports  Incentive scores and payments

35. How Will We Define Success? 35

36. Superb Access to Care Patients can easily make appointments and select the day and time. 24/7 access to a clinical decision maker Waiting times are shorter. eMail and telephone consultations are offered. Off-hour service is available. Patient Engagement in Care Patients have the option of being informed and engaged partners in their care. Practices provide information on treatment plans, preventative and follow-up care reminders, access to medical records, assistance with self-care, and counseling. Clinical Information Systems These systems support high-quality care, practice-based learning, and quality improvement. Practices maintain patient registries; monitor adherence to treatment; have easy access to lab and test results; and receive reminders, decision support, and information on recommended treatments. 8 Source: Health2 Resources 9.30.08 MiPCT Builds Patient-Centered Medical Home Capacity in Michigan Care Coordination Specialist care is coordinated, and systems are in place to prevent errors that occur when multiple physicians are involved. Follow-up and support is provided. Patient Feedback and Reporting Metrics Team Care Integrated and coordinated team care depends on a free flow of communication among physicians, nurses, care managers, and other health professionals (including behavioral health professionals) Duplication of tests and procedures is avoided Patients are surveyed to assess their experience Performance on operational metrics is assessed regularly via a performance dashboard to ensure program integrity and inform improvement opportunities and budget neutrality 36

37. Success = Improvements in Population Health + Cost + Patient Experience 37

38. Reduction in Unnecessary and Non- Value-Added Costs 38 The tie to budget neutrality and ROI

39. Budget Neutrality and ROI Budget Neutrality ▫ The minimum required ▫ Amount expended in additional payments to providers (practices and POs) plus administrative costs must be equal to or less than the amount saved by avoiding unnecessary services (e.g., ambulatory care-sensitive ED visits and inpatient stays, redundant testing, etc.) ▫ Must trend toward budget neutrality at the end of Year Two (2013) ROI ▫ The GOAL ▫ “Return on Investment” ▫ Saving more in avoidable costs than is spent on additional payments to providers and administrative costs 39

40. Strategies for achieving… SHORT TERM SAVINGS High-risk patient intensive care management 24/7 clinical decision maker access 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 “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 40

41. MiPCT Evaluation - Overview Unprecedented opportunity to measure the outcomes of investing in primary care across a diverse state 1.Quality, cost, efficiency 2.Experience of care 3.Population health It’s about the relationship between the changes you make in the clinic and patient outcomes

42. What does this involve? Statistical analysis of the effect of your work (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 gathering from practice and PO representatives

43. Summary 43

44. Key Dates 44 Webinar Schedule (Select Thursdays, 3-5pm) March 22 – Financial Reporting and Templates Recommend your topics! We want to be helpful! CCM Rollout Training – 2 Q 2012 Quarterly Report and Financial Templates Quarter 1 (Due May 1, 2012): Brief interim reports Quarter 2 (Due August 1, 2012): Documentation for the 6 month performance incentive metrics Quarter 3 (Due November 1, 2012): Brief interim reports Quarter 4 (Due February 1, 2013): Updated Implementation Plans Incentive Metrics Six month metrics (Jan-June 2012) Twelve month metrics (August – December 2012)

45. No magic bullet - the key to better health care delivery at lower cost will involve multiple solutions The Patient Centered Medical Home, as a foundation for the ACO/OSC model, offers one promising solution The Michigan Primary Care Transformation Project will help shape the future of primary care in our state TOGETHER, WE CAN MAKE A DIFFERENCE FOR MICHIGAN!! 45

46. MiPCT Contacts MiPCT Demo Mailbox:mipctdemo@michigan.gov Carol Callaghan (Co-Chair) callaghanc@michigan.govcallaghanc@michigan.gov Jean Malouin, MD MPH (Co-Chair, Medical Director) jskratek@med.umich.edu jskratek@med.umich.edu Sue Moran (Co-Chair) MoranS@michigan.govMoranS@michigan.gov Diane Bechel Marriott, DrPH (Project Manager) dbechel@umich.edu dbechel@umich.edu 46

47. Questions and Discussion 47