MiPCT Webinar 09/25/2013
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MiPCT Webinar 09/25/2013 MiPCT Webinar 09/25/2013 Presentation Transcript

  • Michigan Primary Care Transformation Demonstration Project September 25, 2013 Webinar
  • Attendance  Anchor Bay Clinic  Ricardo Cabrera, MD/Jeetender Matharu, MD  Center for Preventive Medicine  Country Creek Family Physicians  Country Creek Pediatricians  Everingham Clinic  Douglas Hames, MD  Hampton Medical 2
  • Attendance  Lifetime Family  Macomb Pediatrics  Meadowbrook Internists  Monroe Medical  Oakland Medical Group – Family Medicine  Partridge Family Physicians  Woodhaven Pediatrics 3
  • Learning Event: YOUR DECISION  Update for practice teams including physicians  Saturday, September 28 from 8:30am-1:00pm  Physicians Training Center: Madison Heights  Topics: • New billing codes • Advance Care Planning • Advance Directives • POLST • Durable Power of Medical Attorney • QI Process: PDSA 4
  • Best Practice  Woodhaven Pediatrics: 9/25  Country Creek Pediatrics: 10/9  Douglas Hames, MD: 10/23  Partridge Family Physicians: 11/6  Country Creek Family Physicians: 11/20  Drs. Matharu and Cabrera: 12/4  Monroe Medical: 12/18 5
  • Best Practice  Everingham Clinic: 1/15  Center for Preventive Medicine: 1/29  Oakland Medical Group – Family Medicine: 2/12  Lifetime Family: 2/26  Meadowbrook Internists: 3/12  Hampton Medical: 3/26  Anchor Bay Clinic: 4/9 6
  • CMS Proposal  Proposal allows practices to submit a bill once every 90 days for delivery of complex care management services for patients with multiple complex chronic conditions that place the patient at a significant risk of death, acute exacerbation/decompensation, or functional decline  Must be nationally recognized PCMH, meet MU, access a care manager 7
  • Number of Referrals from PCP 8
  • Match the Numbers 1. $24,033.46 2. $31,803.11 3. 46% 4. 82% 5. 2749 6. 250 A. Adjustments Jan - Jun B. Cancellation rate YTD C. Number of encounters Jan – Jun D. Payments Jan – Jun E. Encounter to outreach rate YTD F. Avg. encounters per CM Jan - Jun 9
  • Matching Answers 1. $24,033.46 2. $31,803.11 3. 46% 4. 82% 5. 2749 6. 250 A. Payments Jan – Jun B. Adjustments Jan - Jun C. Cancellation rate YTD D. Encounter to outreach rate YTD E. Number of encounters Jan – Jun F. Avg. encounters per CM Jan - Jun 10
  • 11 113 84 124 100 89 0 50 100 150 200 250 300 350 400 450 Apr May Jun Jul Aug Encounters 98961 CMGroup 2-4 pts 30 min 98962 CMGroup 5-8 pts 30 min 98966 CMCoaching Call 5-10 min 98967 CMCoaching Call 11-20 min 98968 CMCoaching Call 21+ min 99487 COMPLX CHRON CARE COORD W/O PT VST 1ST HR PER M G9001 CCM Initial Assessment G9002 CM Maintenance New Encounters
  • Objectives  Define Multi-payer Advanced Primary Care Practice Demonstration (MAPCP)  Define Advanced Primary Care Practice (APCP)  Define purpose and goals of MAPCP Demo  Define method of evaluation  Define care management 12
  • MAPCP Demonstration  What is it? 13
  • MAPCP Demonstration  THIS IS MIPCT  Largest demonstration of the Advanced Primary Care Practice to date  Eight states participating • Maine, Vermont, New York, Rhode Island, Pennsylvania, North Carolina, Michigan, Minnesota  Each state has its own name for MAPCP Demo 14
  • Advanced Primary Care Practice  What is it? 15
  • Advanced Primary Care Practice  This is the CMS terminology for the Patient Centered Medical Home Model  The APCP/PCMH: • Uses the leading model for efficient management and delivery of quality health care • Uses a team approach with the patient at the center • Emphasizes prevention, HIT, care coordination and shared decision making (patient and provider)  Therefore: MAPCP/MIPCT is a DEMO OF THE PCMH MODEL 16
  • MAPCP Demo  WHY? What is the purpose?  GOALS? What are the expectations? 17
  • MAPCP Demo Purpose  Determine if the APCP/PCMH: • Reduces unjustified variation in utilization and expenditures • Improves the safety, effectives, timeliness and efficiency of health care • Increases the ability of beneficiaries to participate in decisions concerning their care • Increases the availability and delivery of care consistent with evidence based guidelines 18
  • MAPCP Expectations  Each of the demo projects will be “budget neutral” over the course of the three years • Budget neutrality: all payments under this demo will be LESS THAN or EQUAL TO costs incurred for similar population in the absence of this demonstration (control group) • “significant savings” to Medicare while improving quality of care provided to beneficiaries 19
  • MAPCP Demo Evaluation  HOW will our work be appraised? 20
  • MAPCP Demo Evaluation  Each state executes evaluation plan to monitor performance and provide feedback to payers, providers and communities  How have we affected: • Access • Quality • Patterns of utilization  This is the Michigan Data Collaborative 21
  • MAPCP Demo Evaluation  CMS undertakes its own evaluation through an independent research organization • RTI International (Douglas Kamerow, MD) • Dr. Kamerow spent more than 20 years in the U.S. Public Health Service, initiating and leading key federal research, health policy, public health, and clinical programs. • Dr. Kamerow has already interviewed MNO and will be back • Findings will be compared to control population 22
  • Care Management  What is it? 23
  • Care Management  Care Management has been defined as a set of activities designed to assist patients and their support systems in managing medical conditions and related psychosocial problems more effectively, with the aim of improving patients’ health status and reducing the need for medical services. 24
  • Care Management  Care management involves providing clinical and support services, including care coordination, provided by a nurse or other clinically trained provider. The intensity of follow-up and clinical interventions varies depending on the complexity of the individual patient’s health care needs. Care management is an essential function of a Patient- Centered Medical Home. 25
  • Care Management  Goals of Care Management: • Improve patient’s functional health status • Enhance coordination of care • Eliminate duplication of services • Reduce the need for unnecessary, costly medical services 26
  • Care Management  Key Components of Care Management: • Identify patients most likely to benefit from care management. • Assess the risks and needs of each patient. • Develop a care plan together with the patient/family. • Teach the patient/family about the diseases and their management, including medication management. • Coach the patient/family how to respond to worsening symptoms in order to avoid the need for hospital admissions. • Track how the patient is doing over time. • Revise the care plan as needed. 27
  • 28
  • Open Discussion 29