1. 1
Medical Network One
MiPCT UPDATE
WEBINAR #1
February 22, 2012
8:30am – 9:00am
2. 2
Agenda
• Status of MiPCT Project
• Communication Plan
• Self management training
• Moderate and Complex Care manager training and
on-boarding
• Patient registry
• Patient portal
• Transformation payments
• Pay for Performance
3. 3
2012 Launch Preparedness
Workstream Launch Readiness Activities Advantage
Communication • PO Webinar/Call Series • Establishes communication channels
• Website Expansion and peer network building
• Newsletter 2012 • Delivers consistent messaging in
• March Invitational Meeting in Troy, Gaylord, Grand Rapids multiple platforms for user
• Practice Champions and Contacts Identified convenience
• Quarterly Best Practice Sessions
• Webinars ever 2 weeks
Michigan Data • Report Template Production • User needs incorporated in report
Collaborative • PO Interviews for Report Preferences design
• Population Analysis Readiness • Begins data loads
• Payer Intake Meetings
Provider Files • Payment Elements Verified with CMS • Minimizes payment delays
• Intense Response File Investigation experienced by other states
• Establishes platform for future files
Strategic • Discussions with Organizational Groups (MHA, MAHP, • Builds on common interests
Partnerships MSMS, MOA, etc.) • Leverages strength of membership
groups
PO/PCMH • Implementation Plan Reviews • Allows insight on strengths and
Readiness • PO Personalized Calls opportunities of partners
• Provides customized support
Budget Neutrality • Research on Promising Interventions • Incorporates experience of health
• Payer Recommendations plans data insights
4. 4
Participating Practices (and Affiliated POs)
January and April 2012* Participants
Start Date # PCMH # POs # Physicians # Patients
Jan 1, 2012 388 29 1631 1,111,290
April 1, 2012* 70 3 154 127,961
TOTAL 458 32 1785 1,239,251
*Dependent on submission of signed contracts, implementation plans, etc. by February 8, 2012
5. 5
Medical Network One/PCMH
Implementation Plan Reviews
• Process for Responses to POs:
▫ Responses returned by January 20, 2012
▫ 3 Categories: Approved, Approved but requires clarification via a follow-
up phone discussion, or Requires Resubmission.
▫ Criteria Used for Categorization: 1) whether or not the PO (and its
practices) plan to (or already) have 80% of their care managers on board
by end of Year One; 2) whether or not the care managers are to be
integrated w/in and serving at the practice site (or acceptable
alternative); and 3) Adequacy of the four tier activities
6. 6
MiPCT
Performance Incentive Program
• One component the additional funds provided
through the Demonstration to support PCMH
transformation
• Designed by a multi-stakeholder MiPCT Committee
o Metrics for 2012 have been selected
o 2013 and 2014 metrics will be identified in 2012
7. MiPCT Performance Incentive Program
Objectives
Provide financial rewards to support transformation
to enhance current PCMH activities
PCMH
• Reward transformation efforts and achieving
desired outcomes
POs
• Reward transformation efforts and achieving
desired outcomes
• Compensate for services to participating practices
9. 9
Performance Incentive Payment Process
• Health plans contribute $3.00 PMPM to the incentive
program pool
• Metrics are assessed every six months and points are
calculated for each PO
• POs are ranked by total points and grouped into
payment categories
10. 10
Performance Incentive Payment Process
• Entire pool is paid out in variable amounts based on
ranking
• PO retains the agreed upon percentage 20%
• PO distributes 80% to the PCMH
11. 11
Division of Performance Incentive Funds
Between POs and their PCMH
• 80% of funds flow to the providers of care:
Primary Care Physicians and their staff
• PCMH may include POs that employ care
managers or care team members
• Health systems should ensure incentive funds
are passed to the practice unit level
12. 12
Incentive Fund Portion Retained by POs
May be used for one or more of the following:
• Implementation of tools and care processes that enable the
practices to achieve practice transformation
• Clinical leadership support (Quality Improvement Specialist)
• Analytical and reporting support to measure and report
transformation progress
13. 13
POs Will Account for Incentive Funds*
PO Level
• Amount of incentive dollars retained
• How retained funds were used
PCMH Level
• Amount distributed to each practice
• Distribution criteria
• How were funds used: education, pay raise, hiring
new staff
* POs will submit regular MiPCT financial reports
14. 14
The Performance Metrics Reflect the MiPCT
Focus for Each of the 3 Years
2012 Incentive Program Focus
• Develop primary care practice infrastructure
Enhance access
Create and use an all-patient registry system
HEDIS measure imporovement
• Embed care managers within the PCMH
• Employ standardized processes for transitions of
care
15. 15
Data Sources for Metrics
1. Claims Data: The Michigan Data
Collaborative will receive claims data from
participating Health Plans
Utilization and cost metrics will be
calculated for each Payer and
aggregated across all contracted plans.
Confidence intervals at 95% will be
provided
16. 16
Data Sources for Metrics
2. MiPCT Quarterly Reports: Each PO will
complete and submit a MiPCT Quarterly
Report that includes
Updates to their Implementation Plans
PCMH/PO progress on development of
PCMH infrastructure capabilities and
implementation of clinical initiatives.
17. 17
Data Sources for Metrics
3. Self-Reported Data (SRD): Reported by POs
to PGIP twice yearly on practice PCMH
capabilities
Accuracy, validity and inter-rater
reliability checks and balances by BCBSM
Financial penalties are imposed for
inaccurate reporting of capabilities
18. 18
6 Month Performance Metrics for 2012
Advanced Access
• 30% Same Day Appointments - SRD Report 5.7
• Appointments Outside Regular hours: 8 hrs/week SRD
Report 5.3.
Electronic Patient Registry Functionality
• Electronic Patient Registry
Practice has electronic registry (*Must meet)
Registry has interface capability
Incorporates evidence-based care guidelines
Identifies individual attributed practitioner
19. 19
6 Month Performance Metrics for 2012
Electronic Patient Registry
• Information is available and used by the practice unit team
at the point of care (2.4)
• Used to generate communications to patients regarding
gaps in care (2.6)
• Used to flag gaps in care (2.7)
• Information on patient demographics (2.8)
• Registry identifies and tracks care for patients with at least
2 of the following (2 points maximum): Diabetes (2.1),
Asthma (2.10), Cardiovascular disease (2.11), Pediatric
obesity (2.17)
20. 20
6 Month Performance Metrics for 2012
Care Managers
• Moderate care managers trained and
working (10 points)
• Complex care managers trained and working
(10 points)
21. 21
Adult Clinical Quality Metrics y
Chronic Care
Diabetes: (ages18-75 years & type 1 or 2 diabetes) HEDIS
1. A1C Test
2. Poor Control A1c>9
3. Control A1c< 8
4. LDL-C Test
5. LDL-C Controlled < 100 mg/dl
6. BP <140/90
7. Retinal Eye Exam
8. Nephropathy Screen or Evidence of Nephropathy*
y
9. Asthma: Self-Management Plan or Asthma Action Plan
y
(ages 5-50) Non HEDIS
10. Hypertension: Controlled BP <140/90 (ages 18-85) HEDIS
22. 22
Adult Chronic Care (Cont)
11. Cardiovascular Disease (CVD): BP management
<140/90 mmHg (ages 18-75) HEDIS
12. CVD: LDL-C Management <100 mg/dl (ages 18-85) HEDIS
13. Obesity: Adult BMI (Meaningful Use)
Adult Preventive Care
14. Tobacco: Percent Current Smokers (ages 13 and older)
(non HEDIS)
15. Breast Cancer Screening: (ages 40-69) HEDIS
16. Cervical Cancer Screening: (ages 21-64) HEDIS
17. Colorectal Cancer Screening: (ages 50-75) HEDIS
18. Chlamydia Screening: (sexually active women ages 16-24) HEDIS
23. 23
Pediatric Clinical Quality Measures
1. Asthma: Self-Management Plan or Asthma Action Plan
(ages 5-50) Non HEDIS
2. Obesity: Child BMI (ages 2-17yrs) Meaningful Use
3. Lead Screening: (Medicaid only) (Age 2) HEDIS**
4. Tobacco Use: (ages 13 and older)
5. Chlamydia Screening: (sexually active women ages 16–24) HEDIS
6. Childhood Immunizations: Age 2 HEDIS**
7. Childhood Immunizations: Adolescent Age 13 HEDIS**
8. Well Child Visits: 15 Months and 3-6 years HEDIS
9. Well Child Visits: Adolescent (ages12-21) HEDIS
**MCIR reports may be counted if practice accesses MCIR for point of care use
and can run reports for patient outreach
24. 24
Adult and Pediatric Clinical Metrics
Chronic Care
y
1. DM*: A1C Test + Poor Control A1c>9 + Control A1c< 8
2. DM: LDL-C Test + LDL-C Controlled < 100 mg/dl
3. DM: BP <140/90
4. DM: Retinal Eye Exam
5. DM: Nephropathy Screen or Evidence of Nephropathy*
6. Asthma: Self-Management Plan or Asthma Action Plan
(ages 5-50) Non HEDIS
7. Hypertension: Controlled BP <140/90 (ages 18-85) HEDIS
8. CVD**: BP<140/90 mmHG (ages 18-75) HEDIS
9. CVD: LDL-C < 100 mg/dl (ages 18-85) HEDIS
10. Obesity : BMI (ages 2-99) Meaningful Use
w
*DM = Diabetes Mellitus Type 1 or 2 (ages 18-75) HEDIS
**CVD = Cardiovascular Disease
25. 25
Adult and Pediatric Clinical Metrics (cont)
Preventive Care
y
11. Tobacco: Percent Current Smokers (ages 13 and older)
(non HEDIS)
12. Breast Cancer Screening: (ages 40- 69) HEDIS
13. Cervical Cancer Screening: (ages 21-64) HEDIS
14. Colorectal Cancer Screening: (ages 50-75) HEDIS
15. Chlamydia Screening: (sexually active women ages 16-24)
HEDIS
16. Childhood Immunizations – Age 2: HEDIS**
17. Childhood Immunizations – Adolescent: (Age 13) HEDIS**
18. Well Child Visits: 15 months, 3-6 yrs and 12-21 yrs HEDIS
y
**MCIR reports may be counted if practice accesses MCIR for point of
care use and can run reports for patient outreach
