1. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 1 Michigan IPIP/PCMH Transformation of Primary Care Practice Project with ABMS & RWJF

2. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 2 Sponsors & Gold Supporters for Michigan IPIP/PCMH Project Diabetes Section

3. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 3 Spring 2007 – Michigan was ready for IPIP! MPCC – The Michigan Primary Care Consortium formed a Practice Transformation Committee to evaluate practice needs and opportunities for improving care delivery AIAG – The Automotive Industry Action Group Health Focus group, in collaboration with Michigan Medical Group Management Society, was piloting the use of industry trained quality improvement experts to redesign health care facilities. Industry/Health Care Collaboration IPIP offered a great partnership opportunity

4. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 4 Improving Performance in Practice (IPIP) A state-based, nationally led quality improvement initiative Created and sponsored by the American Board of Medical Specialties to Primary care physicians that include participation in quality improvement activities Funded in large part by the Robert Wood Johnson Foundation. Four phases: –Cohort 1: Prototype through CO and NC (2006) –Cohort 2: Re-focus with MI and PA (2007) –Cohort 3: Spread through MN, WA and WI (2008) –Cohort 4: Associate Partners www.ipip.qiteamspace.com

5. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 5 Mission & Purpose for Michigan IPIP/PCMH Project A Primary Care Quality Improvement Initiative & Collaboration between industry (AIAG) & primary health care (MPCC) Goals: –Improve the chronic care practices of patient populations –Move primary care practices towards PCMH –Target inefficiencies & waste –Increase spread to other practices

6. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 6 IPIP Project Development 2004 State begins addressing challenges in primary care & options for addressing them June - Aug 2007 IPIP idea is born, ABMS/RWJF Grant submission, August 6, 2007 2008 Planning & strategizing IPIP MI model detail; Establishing Committees & focus groups November 2008 First wave of IPIP practice teams start & begin reporting to IPIP National MATCHING FUNDS: Secured with Sanofi-Aventis, Pfizer, Allergan, & MDCH IN KIND: MDCH Diabetic Educator, Automotive sector QI coaches & SSMBB from Ford September 2007 Champions are identified & ABMS notifies team of award Jan - May 2008 Full-time Director MI IPIP, Program Manager, & Project Support hired May & June 2008 MAY: Recruitment of practices begins JUNE: Interviewing & screening IPIP project coaches start August 2008 Interviewing & screening IPIP practices for Readiness 2005 - 2006 MMGMA/AIAG process improvement pilot projects

7. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 7 Michigan IPIP/PCMH Methodology Use methods successful in the manufacturing environment to improve the quality in the healthcare environment Select coaches with backgrounds in: –Quality Improvement –Lean –Quality System Management –System Integration Select practices ready to “change” Match practice + 2 coaches Facilitate the transformation

8. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 8 IPIP Project Implementation Mar 2010 Learning Collaborative III: Outcomes & Lessons Learned November & December 2008 End of Year 1 of ABMS/RWJF Grant February & July 2009 Learning Collaborative I: Introduction to PCMH & CCM (repeated to roll in later practices) Jan 2010 Changing of the guards (State Director) June 2010 IPIP MI project & funding is complete IPIP MI sharing of data & metrics Sept 2009 Learning Collaborative II: Understanding Diabetes, Asthma & Self Management June 2009 Second wave of IPIP practice teams Final wave of IPIP practice teams Sept 2010 Final evaluation & project summary

9. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 9 Sharing the Data The Final Report Data: –IPIP Leadership Team Evaluation –MPHI External Evaluation Organization: –Project Outcomes –Clinical Outcomes –Lessons Learned –Next Steps

10. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 10 IPIP Project: Start to Finish StatsJan 2009June 2010 Number of Practices 18 (Diabetic) 33 (Diabetic + Asthma) Number of Coaches 3061 * Number of Physicians Involved 106206 Total Population of Patients Potentially Affected 148,080276,499 Number of Practices with an EHR/EMR 1023 Number of Practices with a Registry 824 Number of Practices with PCMH /BCBSM Designation 1227 Coach Time Estimated versus Coach Time Needed for project (hours per week) 410 * Data gathered from formal MPHI evaluation

11. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 11 Diabetic Measures (30 practices) OUTCOMES: More practices engaged PCPs measuring & monitoring their populations PCPs are getting closer to goal PCPs are tracking more clinical information Start of ProjectClose of Project

12. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 12 Asthma Measures (3 Practices) OUTCOMES: More practices engaged PCPs measuring & monitoring their populations PCPs are getting closer to goal Integration of IT systems will allow for further measuring Percent Start of Project Close of Project

13. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 13 MeasureJan 2009June 2010% Change PROCESSPROCESS ACE/ARBs836388% Aspirin Use723229% Referrals for Eye Exams 2053165% Foot Exams3066120% Flu Vaccine264262% Nephropathy Screening 58603.4% Pneumo Vaccine828250% Self Management1127145% Smoking Cessation Counseling 63653.2% Statin Use1249308% OUTCOMEOUTCOME A1C>9101440% A1C<743442.4% BP<130/8044476.8% LDL<100424916.7% Diabetic Measure Changes

14. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 14 MeasureJan 2009June 2010% Change PROCESSPROCESS Controller Meds778814.3% Assessment of Control 1866267% Flu Vaccines1053430% Queried on Smoking 631417% Counseled on Smoking 50 0% 3 Care Components514180% OUTCOMEOUTCOME Patients >1 ER visit3.53.911.4% Patients >1 Hospitalization No data NA Asthma Measure Changes

15. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 15 Date of LCFocus Attendance / Occurrences February 2009 Introduction to PCMH, CCM & the need for change 142 July 2009 Repeat of February 2009 to bring second wave of practices on board 42 September 2009 Diabetes, Asthmas & Self Management efforts 156 March 2010 Practices sharing to build community amongst IPIP team, seeing some best practice examples 118 Monthly Practice LC Call-ins (March 2009 – June 2010) Webex conducted 3 rd Wednesday & 4 th Thursday of the month Average 10 practices per call Monthly QICs meetings (June 2008 – June 2010) First Monday of month at AIAG offices & via webex Average 34 coaches per meeting Individual JIT & Assistance Weekly handled based on needs of practice or coach 2 incidences per week Learning Collaborative

16. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 16 Summation: Lessons Learned Practices found IPIP project to be helpful –Increase in knowledge of PDSA –Increase in satisfaction of care –Increase in QI efforts Practices made improvements because of the IPIP model –Office efficiencies –Registries Small successes drove momentum Transformation takes longer than initially expected Build a more sustainable funding model Practice Coaching added value to the program –Industry engineers can assist in transformation –Strong fits Practice Coaches needed to: –Be strong facilitators & change managers –Start simply (PDSA & standardization) –Eliminate waste –Start measuring & monitoring Learning Collaboratives + continually learning are helpful in the process MI IPIP Model was visionary, valuable, viable & exemplary

17. CJSI: JNG 10.14.10 Working Together for a Healthier Michigan 17 Next Steps for Michigan IPIP/PCMH Project IPIP ABMS/RWJF Project ended June 30, 2010 Finalizing official reports Sharing our story IPIP National in process of defining how to proceed MPCC & AF4Q discussing ways to make an IPIP-like experience with coaching available October 2010 www.mipcc.org