1. The Michigan Primary Care Transformation (MiPCT) Project PGIP Meeting Update September 12, 2014 1

2. Agenda 1.Welcome and Overview 2.Evaluation Update 3.Diabetes Performance and Practice Coaching Update 4. Billing Collaborative, Payer Updates and CMS Response Letter 5. Best Practice Workgroup Update 2

3. Evaluation Update 3

4. Topics National Evaluation Update ▫ Most recent cost and utilization analysis ▫ Patient experience Michigan Evaluation Update ▫ Cost and utilization analysis ▫ Key survey findings to date: multiple perspectives on Care Management 4

5. National Evaluation Results from Research Triangle Institute 5

6. 6 Quarterly Trend Comparison: Medicare PMPM Payments

7. 7 Quarterly Trend Comparison: Payments to PC and Specialty Physicians

8. 8 Quarterly Trend Comparison: Hospital Admissions

9. Patient Survey – PCMH CAHPS Medicare Beneficiaries Analysis adjusted for demographic and other factors for purposes of comparison StateResponse Rate (%)# Completed ME46.2643 MI42.6599 MN43.3602 NC45.3634 NY44.6630 PA41.6584 RI46.1544 VT44.3627

10. Access to Care Composite

11. Communication with Providers Composite

12. Shared Decision-Making Composite

13. Self-Management Support Composite

14. Comprehensive Orientation Composite

15. Michigan Evaluation Michigan Public Health Institute 15

16. Status ActivityStatus Cost, quality and utilization analysis MiPCT practice level analysis underway Comparison data supplied by all payers through December 2013 Being processed – expected Delivery to MPHI: October PO SurveyComplete Care Manager SurveyThree time points available, additional survey planned Practice/Staff SurveyStill open for response Patient Survey Mail/phone follow-up Using claims data to randomly select respondents We could use your help to encourage response 16

17. Survey Data Multiple Perspectives on Care Management 17

18. Care Manager Survey 18 Survey 1:Survey 2:Survey 3: May 2013Dec. 2013June 2014 Data Collected via Survey Monkey ® May 20th - June 12th, 2013 Dec. 16th, 2013 - Jan. 5th, 2014 June 9th - June 26th, 2014 Number of Care Managers emailed invitations to participate434424421 Care Managers who completed the survey #(%) 228 (53%)213 (50%)209 (50%) New respondents # (%)228 (100%)83 (39%)58 (28%) Repeat respondentsN/A130 (61%)151 (72%) Data cleaning and analysis performed using SPSS v19

19. Average Percent of Time Spent at the Following Locations: 19 Min: 0% Max: 100% Min: 0% Max: 100% Min: 0% Max: 25% Min: 0% Max: 90%

20. Physicians’ Availability 20

21. Physicians Support for Care Management 21

22. Staff Support for Care Management 22

23. Provider/Staff Survey Preliminary Results, n=1,032

24. 24 Provider/Staff Survey Preliminary Results (questions not asked of Care Managers) Percent Agree/Strongly Disagree (5 point scale, remaining responses largely neutral)

25. Please help us encourage response to the Provider/Staff Survey Deadline extended to end of next week 25

26. PO Feedback: MiPCT should do differently next time Clear and consistent expectations (n=13) ▫ In general ▫ Related to performance incentives ▫ Consistency across payers ▫ Consistency over time, fewer program changes ▫ Better and more timely communication More help (n=10) ▫ Better data sooner ▫ More access to data ▫ Assistance with physician engagement ▫ Assistance with care management implementation More responsiveness to local variation and capacity(n=2) Different model (n=2) ▫ Over-reliance on Geisinger and/or nursing model

27. PO Lessons Learned: PO should do differently next time Care Management Embedment (almost everyone!) ▫ Better define practice roles from the beginning, better planning ▫ Physician engagement, incentives, requirements ▫ Pair practice coaches with Care Managers ▫ More oversight of Care Managers by POs, more meetings with practices, PO hire CMs not practices ▫ Software investment ▫ Develop alternatives to the MiPCT patient list Be more selective, include fewer practices, assess practice readiness earlier (n=6) Collaborate with other POs, contract for CM services (n=3) We did it right! (n=1)

28. Diabetes Performance and Practice Coaching Update 28

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34. MiPCT 2014 Annual Summits 34

35. 2014 Summit Overview 35 Morning Session – Open to All The morning session is an all-stakeholder meeting that is open to all. The theme for the morning is: “The Future of Primary Care: MiPCT in 2015 and Beyond”. Practice teams attending with a physician are eligible to earn 4 Practice Learning Credits Afternoon Session – Care Manager Training Designed for MiPCT Care Managers though other interested team partners are welcome to attend as well Topics include a Palliative Care RN Expert Presentation and Update on the MiPCT Care Management Best Practice Work Group Update. The MiPCT 2014 Summit Care Manager Session has been submitted to the Michigan Nurses Association for approval to award contact hours. The Michigan Nurses Association is an approver of continuing nursing education is the State of Michigan Board of Nursing.

36. 2014 Summit Logistics 36 Morning Summits – Two in-person locations:  Ann Arbor – University of Michigan North Campus Research Center (NCRC), October 7, 2014 – 8:00 AM to Noon; and  Grand Rapids – Frederik Meijer Gardens, October 9, 2014 – 8:00 AM to Noon (this location will also have a live webinar link allowing those who cannot travel to participate). Afternoon Care Manager Education – Three in-person locations:  Ann Arbor – University of Michigan North Campus Research Center (NCRC), October 7, 2014 – 1:00 pm-4:30pm  Grand Rapids – Frederik Meijer Gardens, October 9, 2014 – 1:00 pm-4:30pm  Gaylord –Ostego Conference Center October 1, 2014 – 11:30am – 4:30 pm Note: The Gaylord morning Summit session will not take place this year. Instead, Gaylord afternoon Care manager training will begin with a special hour-long briefing session with MiPCT Leadership on MiPCT evaluation and 2015 sustainability/continuity. The Grand Rapids morning summit on October 9 th will also be available via webinar link and will be recorded and available on the mipctdemo.org site soon afterward.

37. 2014 Summit Registration 37 Register by visiting the mipctdemo.org website and clicking on the “2014 MiPCT Annual Summits” tab. Registration is key to practices receiving Practice Learning Credits Tab contains detailed information on locations, hotel block codes for travelers, parking information Meeting material will also be posted here in advance of the summits To allow for processing time for materials registration will close on September 30 th so register now! Registration is at no cost to attendees; lunch is provided

38. Billing Collaborative, Payer Updates and CMS Response Letter 38

39. MiPCT Multipayer Billing and Coding Collaborative Led by Mary Ellen Benzik Practice Learning Credits Awarded: Four credits Focus: Accelerated support to POs and practices for robust billing and coding infrastructures and processes Structure – Each PO is invited to join with one to three practices for: ▫ A half day in-person session ▫ Monthly Webinars Sign up by emailing micptdemo@michigan.gov by 9/17 with: PO name, practice participants and roles (practice manager; billers and coders; Care Managers, etc.) 39

40. MiPCT Multipayer Billing and Coding Collaborative 40 Payer-led briefings The business case for care management Learning from the leaders: Best processes and practices

41. MiPCT 2015 Plan Care Management Funding Recap (regardless of CMS demonstration period extension decision) Medicaid: $7.50 PMPM continues BCBSM: E&M Uplift and G/CPT Codes Priority Health: $3.25 PMPM Care Management Incentive and G/CPT Codes BCBSM Medicare Advantage: G/CPT Codes BCN evaluation in process Medicare FFS payment will continue as $9.50 PMPM (with demo period extension) or at the $41.92 PBPM for engaged chronic patients) 41

42. CMS Chronic Care Management Monthly G Code: The MiPCT Response Submitted on September 2, 2014 Main themes: ▫ Insufficiency of payment rate proposed to fund effective care management ▫ Non-Face-to-Face Care Management not included ▫ Patient financial liability may pose barrier to patient engagement ▫ EHR certification level ▫ Clarification needed regarding definition of clinical staff 42

43. Best Practice Workgroup Update 43

44. MiPCT Care Management Best Practice Work Group – Background Care management activity across the state is varied. Statewide the volume of care management encounters are lower than expected. Care management best practices do exist and it will be beneficial to gather and analyze these best practice activities via a MiPCT work group to identify models and improvement processes.

45. MiPCT Care Management Best Practice Work Group – SOW Deliverables High Level Deliverable: Create a Generic Framework which can be individualized to meet the needs of the practice /PO Identify best practice for Care Manager time management, caseload, patient encounters, positive patient outcomes Care Management delivery best practice model for complex and moderate risk patients Preliminary findings, best practice infrastructure to support care management

46. A Unique Opportunity To recognize and highlight collective workgroup expertise To create an evidence based toolkit for MiPCT Care Management delivery based on best practice To share this work with ▫ MiPCT Leadership ▫ MiPCT POs/practices/care managers ▫ Participating MiPCT payers ▫ Potentially other health care leaders

47. MiPCT Care Management (CM) Best Practice Work Group Participants MiPCT Statewide Representation Invitation based on performance criteria of CM encounter data, MiPCT quality and utilization metrics for Adult population  PO Leaders  Care Managers  Clinical Leads  Physician(s)

48. CM Best Practice Participants MiPCT PO Leaders and MiPCT Clinical Leads Anne Levandoski- UPHP Susan Viviano- Advantage Health Margaret Jacobs- UMHS Maureen Braun- IHA Karen Bennett- Sparrow Health Medical Group Chris Rusin- United Physicians Ruth Clark- Integrated Health Partners Lynn King- Lakeshore Health Network, MiPCT Clinical Lead

49. CM Best Practice Participants cont. MiPCT PO Leaders, Care Managers, and MiPCT Clinical Leads Belinda Fish- UMHS Mary Kramer- UPHP Victoria Lee- Advantage Health Physicians Diane McLeod- Sparrow Medical Group Lindsay Schohl- Lakeshore Health Network Robin Schreur- Spectrum Health Medical Group, MiPCT Clinical Lead Della Slavsky- UPHP, MiPCT Clinical Lead Tammy Starks- IHP Heidi Steinhebel- IHA Juliann Testy- Henry Ford Medical Group, MiPCT Clinical Lead Loretta Warda- CIPA/MAG, MiPCT Clinical Lead MiPCT Clinical Leadership: Dr. Kevin Taylor, Dr. Jean Malouin, Marie Beisel, Paula Amormino

50. Individual Care Manager Daily work: CM Role, CM Skill, Patient Acuity System Factors, Practice Embedment Individual Care Manager (CM): How does the care manager complete daily work? System Factors: Leadership, Infrastructure & Practice embedment

51. Four Focus Areas Care Management Fundamentals ▫ 5 Step CM process for moderate and complex patients Sharing Innovative Best Practices ▫ Identify what is working “New work” development ▫ Focus on topics with high level of impact to contribute to efficient and effective care management delivery ▫ CM best practice participants form a sub group – develop guidelines CM activity – what does effective and efficient care management look like? ▫ Non direct patient care such as care coordination

52. Potential Outcomes of this Work Group Shared learning of CM Best practice innovative work ▫ Document “what works” to achieve increased Care Management encounters / benchmark goals and quality outcomes Document “what has been tried and does not work”

53. Potential Outcomes of this Work Group cont. Evidence based best practice model utilizing patient acuity as the driver for care interventions. ▫ Address Complex and moderate risk patients and improved patient outcomes Toolkit ▫ Resources, tools, workflows developed by MiPCT participants ▫ Crosswalk key elements required by MiPCT participating health plans, CMS Chronic Care codes which will be effective Jan 2015 Reference list ▫ Evidence based resources, articles and websites

54. Timeline 7/17/14 Kick off webinar 8/5/14 In person meeting 8/12/14 Webinar 8/26/14 In person meeting 9/18/14 Webinar 9/26/14 In person meeting Plan one additional in person meeting Nov/Dec 2014 Share statewide ▫ Toolkit and Best Practice materials

55. Progress to date cont. Care Management Fundamentals – group work, report out, documentation ▫ 5 Step Care Management process – patient identification, screening, assessment, intervention/management, case closure  Moderate care management  Complex care management Identification of 7 Innovative topics: ▫ Chart audit, coaching and mentoring CMs, social determinants of health, care giver action plan, case closure criteria, advance directives and inpatient/out patient Care Manager Care Coordination.

56. Progress to date cont. CM Best Practice Participants- survey distributed 9.8.14 ▫ 7 Innovative topics current state  assess each participants level of implementation  goal – report out Best Practice sharing, gather documentation ▫ Prioritize potential “New topics” Gathering: resources, work flow, tools

57. Questions?