1. The Michigan Primary Care Transformation (MiPCT) Project MiPCT Update PGIP Quarterly Meeting March 13 th, 2015

2. Agenda Evaluation Update/RTI Reports Clinical Focus Areas 2015 Incentive Program PO/Practice Level Success Story Program Physician Champion Program Announcements/MiPCT Summit Dates 2

3. Update 3

4. RTI Methodology What would have happened in Michigan without the MiPCT demonstration? Initial answer: how different are our outcomes from the single payer model? Two comparison groups: PCMH and non-PCMH “Difference-in-difference” model: compares change in trend from baseline Cost savings: sum all quarter by quarter differences and compare to total fees paid 4 Basis of cost savings

5. First Annual MAPCP Report MiPCT’s year 1 estimated savings = $27.8 million ▫$147 per full-year eligible Medicare FFS beneficiary Results are preliminary ▫Future years of evaluation are required to confirm whether results persist over time Future reports will address quality 5

6. RTI Quarterly Reports (Medicare) Draft received March 2014 PRELIMINARY, not public!! “ During the first 10 quarters of the demonstration, there is strong evidence of cost savings when comparing beneficiaries assigned to MiPCT Demonstration practices to those assigned to comparison PCMH practices.” Compared to non-PCMH – cost trends inconclusive 6

7. MiPCT Compared to Other PCMH (Quarterly Report 11, Medicare FFS) Acute-care expenditures Post-acute care expenditures Outpatient expenditures Primary care/specialty physician expenditures All-cause admissions Chronic PQI admissions ER visits Unplanned readmissions 7

8. Update 8

9. Data Collection Status Comparison Group Claims Data 2010-2013 Payers have delivered, in process at MDC & MPHI 2014Coming in Patient Experience Survey Phone follow-up begins March 20 Additional response needed: ▫Children ▫Non-Medicare Adults 9

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11. 2015 Clinical Focus Areas (approved by MiPCT Steering Committee) Addressing social determinants of health and overcoming barriers Patient registry and data support for population health Integrating behavioral health Integrating palliative and end-of-life care Addressing appropriateness of care (e.g., Choosing Wisely program, etc.) 11

12. Clinical Subcommittee “Retooling” Will have a work group dedicated to each Clinical Focus Area This work group will in next 90 days: ▫Define the key intervention they would like to champion to support the PO/practices in those improve in those areas ▫Define metrics for success of that intervention 12

13. Clinical Subcommittee “Retooling” Clinical Subcommittee will oversee the deliverables of the interventions Seeking additional members interested in shaping these interventions Monthly 2 hour meetings for 6 months, then every other month 13

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16. Proposed 2015 Incentive Metrics Very similar to 2014 Incentive Metrics, with a few tweaks: ▫PCS ED visit rate will be replaced with risk- adjusted Overall ED Visit Rate per 1000 attributed patients (due to move to ICD-10) ▫Childhood Immunization/Combo 3 metric on MDC dashboard to be added ▫Three process metrics to be deleted ▫Points to shift slightly 16

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19. 2015 MiPCT Success Stories – Adding Team Based Practice, Physician Organization New for 2015: ▫Team Based Practice Success Stories ▫Physician Organization Success Stories Purpose: ▫Highlight MiPCT Success Stories ▫Share and learn from each other ▫Spread “what works” Potential for MiPCT Practice Learning Credits 19

20. MiPCT Team Based Practice and Physician Organization Success Stories Suggestion - to align topic of Success Stories with the 2015 MiPCT Clinical focus areas ▫Addressing social determinants of health and overcoming barriers ▫Patient registry and data support for population health ▫Integrating behavioral health ▫Integrating palliative and end-of-life care ▫Addressing appropriateness of care (e.g., Choosing Wisely program, etc.) However, not limited to MiPCT 2015 Clinical focus areas Submission of stories may be completed by MiPCT Practice team members, MiPCT PO Leaders 20

21. Team Based Practice Success Story – Web Based Submission Template Identify the practice staff involved in the team based practice success What problem is the team trying to address? What changes were made to address the challenge or problem? What barriers did your team recognize and address during this practice change? What improvements have been recognized as a result of the team-based change? 21

22. Physician Organization Success Story – Web Based Submission Template What are you trying to accomplish? Please describe the project aim. What will be improved, by how much, for whom, by when? Why are you doing this project? Describe assessment Key leadership involved Describe the metrics collected 22

23. Physician Organization Success Story - Web Based Submission Template cont. What changes have you made that resulted in the improvement? How did you know your change was an improvement?  Please submit data 23

24. MiPCT Success Story Process Steps 24

25. Step 1 – Submit the Team Based Practice and PO Success Stories Website link for submission will be available on MIPCTdemo.org ▫Separate Web link template for each type of MiPCT success story  Team Based Practice Success Stories  PO Success Stories  CM Success Stories 25

26. Step 2: Gather the Details Once the story is submitted, the practice team member or PO Leader who submitted the story will be contacted for a discussion about the story This discussion allows the MIPCT Master Trainer and/or Clinical Lead to write up the story  questions which will help to “build the story” 26

27. Step 3: Write the Success Story, Review and Approve Draft version: Write the narrative Team Based Practice or Physician Organization Success Story ▫Draft version: Master Trainer and/or Clinical Lead write the story ▫Review and edits by the individual who submitted the story Final version: Review and Approval by Practice Leader and PO Leader 27

28. Step 4: Share the Team Based Practice and PO Success Stories How will the MiPCT Team Based Practice and PO success stories be shared? MiPCT Practice Flash Newsletter MiPCT Implementation Guide Presentations - regional and statewide ▫In person meetings  PGIP Quarterly meetings, MiPCT Summit ▫Webinars  MiPCT Care Management Webinars, MiPCT PO Webinars 28

29. Getting Started MiPCT Practices and PO Leaders ▫Please share your Team Based Practice and PO Success Stories  Via mipctdemo.org - new Team Based Practice and PO Success Story Web templates available end of March 2015  Announcement and details will be in the MiPCT FLASH newsletter Plan: ▫Practice FLASH – publish the Team Based Practice Success and/or Physician Organization success story every two months 29

30. 30 Sample Success Story: Add your MiPCT Practice Team PHOTO!

31. Questions 31

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33. PO Physician Champion Role (one per PO) 2015 Contract Expectations: ▫The intent of the PO Physician Champion as per the contract, is to communicate with the physicians in the PO and practice about team care and the PO/practices’ deployment of the MiPCT clinical model. ▫This includes the PO and practices’ work on clinical focus areas, practice learning activities, care management oversight and support, etc. 33

34. Physician Champion Leadership Training (Open to All Interested MiPCT Physicians) 2015 MIP CT learning activity requirements: ▫Physician champion leadership training (4 hours). This option consists of physicians to physician training and best practice sharing that supports team based care and embedded care management. ▫Plan to provide Webinars  What are you currently doing with physician leadership training?  What would be helpful for physician leadership training? 34

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36. Save the Dates! 2015 MiPCT Summits Western: September 16, 2015 ▫ Frederik Meijer Gardens & Sculpture Park – Grand Rapids ▫ 8am to noon general session open to all; Afternoon care management training Northern: October 20, 2015 ▫ Crystal Mountain Resort – Thompsonville (new location) ▫ 11 to noon Project Leadership briefing followed by afternoon care management training Southeastern: October 29, 2015 ▫ U of M NCRC, Building 18 Dining Hall – Ann Arbor ▫ 8am to noon general session open to all; Afternoon care management training 36