1. MiPCT Evaluation Update 1 Clare Tanner March 14, 2014

2. CMS Evaluation Question: What would have happened in Michigan without the MiPCT demonstration? Conducted by: Research Triangle Institute (RTI)

3. RTI Measures Cost Average PMPM Measured as Medicare payments Quality Diabetes care: LDL-C screening HbA1c testing Retinal eye examination Medical attention for nephropathy All 4 diabetes tests Ischemic Vascular Disease: Total lipid panel test Patient experience survey Utilization All-cause hospitalizations ACSC hospitalizations (PQI) All-cause ED visits % ED visits that do not lead to hospitalization Discharges from short-term general, rehabilitation, and SNF with (billed) clinical follow-up within 14 days Rate of 30-day unplanned readmissions (CMS definition developed by the Yale New Haven Health Services Corporation)

4. To be considered a success: Outcomes of MiPCT beneficiaries must improve at a greater rate than comparison beneficiaries 4

5. MiPCT Medicare Beneficiaries 5

6. 6

7. 7

8. HbA1c Testing Rate 8

9. Retinal Eye Examination Rate 9 National benchmark: 82%

10. Nephropathy Rate 10 National benchmark: 94%

11. LDL-C Screening Rate 11 National benchmark: 94%

12. Cost Savings? Demonstration effect: The change in outcomes during the demonstration period among beneficiaries assigned to MAPCP Demonstration practices compared to the change in outcomes for beneficiaries assigned to comparison PCMH practices. 12

13. MiPCT in Comparison (Medicare) 13

14. 14 Quarterly Trend Comparison: Medicare PMPM Payments

15. 15 Quarterly Trend Comparison: Payments to PC and Specialty Physicians

16. 16 Quarterly Trend Comparison: Hospital Admissions

17. Michigan Data A Multi-payer Perspective 17

18. Inpatient Admissions per 1000 Attributed Patients 18

19. 30-Day All-Cause Readmission Rate 19

20. Diabetes HbA1c Testing Rate 20

21. Diabetes % with A1C: Change 2012-2013 21

22. Care Management Activity Source: PO quarterly reporting, 2013 22

23. 23 * Data missing from one PO

24. Typical Daily Care Manager Activity Quarter 4 24 Care Manager Role 50 th Percentile Quarterly Encounters/FTE Translates to: Encounters per day Complex1342 encounters per day Hybrid1623 encounters per day Moderate1032 encounters per day

25. Care Manager Activity Benchmark Performance Quarter 4 25 Care Manager Role 90 th Percentile Quarterly Encounters/FTE Translates to: Encounters per day Complex4397 encounters per day Hybrid3626 encounters per day Moderate3526 encounters per day

26. Care Manager Survey Source: Surveys conducted May 2013 and Dec 2013/January 2014 50% response rate 26

27. 27 Average Self-reported Patient Caseload

28. Care Manager Survey Results 28

29. Care Manager Survey Results 29 22% of all respondents specifically noted that no other staff member is designated to assist with any of the tasks

30. Care Manager Survey Results 30

31. Care Manager Survey Results 31

32. Care Manager Survey Results 32

33. Next Steps 33 Ongoing Claims Analyses March - April 2014 April - May 2014 May-June 2014 October 2014 Contact: ctanner@mphi.org