Mipct 04 03_2013
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  • 1. Michigan Primary Care TransformationDemonstration Project April 3, 2013 Webinar
  • 2. Agenda Year One metrics What’s being measured in Year Two Training 2
  • 3. Committee Composition David Livingston, UnitedHealthcare Community Plan of Michigan Dr. Paul Ponstein, POM ACO and MCCSI Carol Callaghan, Michigan Department of Community Health Ruth Clark, Integrated Health Partners Dr. Jim Forshee, Molina Healthcare of Michigan Margaret Mason BCBSM Betsy Wasilevich, BCBSM alternate Ewa Matuszewski, Medical Network One Dr. Kimberlee Coleman, United Physicians (N) Christina Hildreth, Metro Health PHO (N) Susan Dolby, MSU Health Team (N) 3
  • 4. Goals Year One (2012): Develop primary care practice infrastructure including enhanced access, all patient registry system and embedding care managers within the primary care practices. Year Two (2013): Optimize care management, improve quality metrics and avoid high cost care. Year Three (2014): Achieve the “Triple Aim” of improved quality of care, improved patient and primary healthcare team experience of care and reduced /stabilized costs of care. 4
  • 5. Data Sources Claims Data: All participating health plans will submit claims data to the Michigan Data Collaborative which can be used to calculate utilization and cost metrics. Claims data will be calculated for each Health Plan and aggregated across all contracted plans. Confidence intervals at 95% will be provided. 5
  • 6. Data Sources MiPCT Quarterly Reports: The report will document updates to the MiPCT Implementation Plan and progress to date in developing PCMH infrastructure capabilities and carrying out MiPCT clinical initiatives. 6
  • 7. Data Sources Self-Reported Data (SRD): PGIP POs currently report to BCBSM twice a year on their practice’s PCMH capabilities. BCBSM applies accuracy, validity and inter-rater reliability checks and balances to the reports. Financial penalties are imposed on POs for inaccurate reporting of capabilities and are reflected proportionally on the distribution of funds to the PO. 7
  • 8. Data Sources Registry/EHR data: PO’s/practices will submit requested clinical data from EHR or registry systems in a specified format to the Michigan Data Collaborative for calculation of clinical quality metrics. 8
  • 9. 6 Month Ranking After PO # MiPCT 30% SD hours Registry MCM MCM CCM CCM Total Rank ID Practices appoint appoint. Function hired trained hired trained 8 hr/wkA 7 10 10 10 5 5 5 5 50.00 1B >25 10 10 10 5 5 5 5 50.00 1C <5 10 10 10 5 5 5 5 50.00 1D <5 10 10 10 5 5 5 5 50.00 1E 6 10 10 9.3 5 5 5 5 49.30 5F 15 9.3 10 9.7 5 5 5 5 48.70 6G 5 10 10 8.8 5 5 5 5 47.80 7H 6 10 10 8.7 5 5 5 5 47.50 8I 18 10 9.4 9.2 5 5 5 5 46.50 9J 11 9.1 9.1 9.8 5 5 5 5 46.73 10 9
  • 10. Care Managers Six MonthModerate MiPCT 1. Number of MCM 1. Number ofcare Quarterly hired/ contracted required MCM permanagers report by practices and/or PO(MCM) PO 2. Number of MCMtrained and 2. Number of MCM hired/ contracted 10 pointsworking within PO that have completed the required trainingComplex care MiPCT 1. Number of CCM 1. Number ofmanagers Quarterly hired/ contracted required CCM per(CCM) trained report by practices and/or POand working PO 10 points 2. Number of CCM 2. Number of CCM in hired/ contracted PO that have completed the required training 10
  • 11. Complex Care Manager 12 MonthsComplex care MiPCT IM/FP: Number of Number of 15managers (CCM) Quarterly CMC trained and attributed MiPCTtrained and report providing services to members in PO asworking* and Care practices in PO of June 30, 2012 Manager Plus divided by 5000 Resource (may be a lower Peds: Number of Center ratio for pediatric CMC trained and Verificati practices providing services on compared to within PO internal and family medicine practices) 11
  • 12. Moderate Care Manager 12 MonthsModerate care MiPCT Internal Medicine & Number of attributed 15managers (MCM) Quarterly Family Practice (IM/FP): MiPCT members astrained and report Number of MCM of June 30, 2012 inworking trained and providing PO divided by 5000 services to practices in (may be a higher PO ratio for pediatric practices compared Pediatrics (Peds.): to internal and family Number of MCM medicine practices) trained and providing services within PO (Trained means completed MiPCT approved Moderate Care Manager course and will be self-reported by the PO.) 12
  • 13. 12 Month Transitions and EDNotification of MiPCT Number of Number of 15admissions and Quarterly practices Practices in POdischarges for at report reportingleast 50% of MiPCT capabilitybeneficiariesPrimary care Change in PO PCS PO Baseline Rate 10sensitive ED visits Claims ED visits/1000 (Mean of 2010 &(NYU algorithm) Data (Baseline Rate – 2011 2012 rate ED visits/1000) 13
  • 14. Patient RegistryElectronic patient a. MDC Number of Total number of 5registry attestation practices with practices in POfunctionality: ability toTracking chronic b. Electronic transmit clinicalillness care and report of the data to the Total number of 20preventive clinical metrics MDC practices in POservices PLUS Sum of the points practices received for summary report of clinical measures 14
  • 15. Access30% same day SRD Number of Number of 10appointments report practices in PO practices in PO (5.7) with capabilityAccess outside SRD Number of Number of 10regular hours: report practices in PO practices in PO12 hr/week (5.5) with capability 15
  • 16. Outcome MeasuresUtilization (Improvement over baseline) 55Primary care sensitive ED visits (NYU algorithm) 30Ambulatory Care Sensitive Hospitalizations 15Readmissions 10 16
  • 17. Outcome MeasuresClinical Quality Metrics - Claims Based ( Improvement over baseline) 15Diabetes: AIC tests completedDiabetes: Annual retinal eye examsBreast Cancer ScreeningCervical Cancer ScreeningWell Child Visits - 15 monthsWell Child Visits - 3-6 yearsAdolescent immunizations 17
  • 18. Process MeasuresClinical Quality Metrics – EHR or registry (Pay for Reporting) 15Diabetes Control (adults): a. AIC < 81. Diabetes Poor Control (adults): AIC > 91. Diabetes (adults): Blood Pressure < 140/901. Cardiovascular Disease (adults): Blood Pressure < 140/901. Hypertension (adults): Blood Pressure < 140/901. Asthma (ages 5-64): Asthma Action Plan or self-management plan for a. all asthma and b. persistent asthma1. Tobacco Use ( 13 years and older): Percent smokers1. Obesity - children: BMI Percentile 18
  • 19. Process MeasuresNotification of hospital admissions & discharges 3Tracking referrals of high-risk patients to community resources. 3(10.7)Follow-up of high-risk with community referrals for next steps. 3(10.8)At least one member of PO or practice unit has completed formal 3training in a nationally or internationally-accredited self-management support program and works with/educates practiceunit staff members to actively use self-management supportconcepts and techniques. (11.8)Self-management support is offered to all patients with the 3chronic condition selected for initial focus (based on need,suitability, and patient interest. (11.2) 19
  • 20. 2014 Measures ADD/ADHD Depression Screening Pediatric/Adult Obesity 20
  • 21. One Year Refresher Workshop Each PU team participates 5 hour training • Three Sessions: Saturday and weekdays Each Care Manager participates in training • Ten Sessions: Saturday and weekdays 21
  • 22. Open Discussion 22