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MiPCT Webinar 06/13/2012


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MiPCT Webinar 06/13/2012

  1. 1. Michigan Primary Care TransformationDemonstration Project June 13, 2012 Webinar #10
  2. 2. Agenda Medicaid Payments Medicare Payments Care Managers MiPCT Committee Metrics 2
  3. 3. Doing the Impossible 3
  4. 4. Performance One year look back for quality scores Ongoing testing for patient registry data dumps Patient registry data utilized for distribution of funds Patient registry submission in time for 12.31.2012 performance payments 4
  5. 5. Pay for Performance Data Source Claims Data: All participating health plans 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. 6. Pay for Performance Data Source 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. 7. Pay for Performance Data Source Self-Reported Data (SRD): MNO currently reports to BCBSM PGIP twice a year on each practice’s PCMH capabilities BCBSM applies accuracy, validity and inter-rater reliability checks and balances to the reports Financial penalties are imposed for inaccurate reporting of capabilities and are reflected proportionally on the distribution of funds 7
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  9. 9. Pay for Performance: Six Month Metrics - Access Extended access: • 30% same day appointment (10 points) Appointments outside regular hours: • 8 hours/week (10 points) 9
  10. 10. Pay for Performance: Six Month Metrics – eRegistry1) Practice has electronic registry2) Registry has interface capability3) Incorporates evidence-based care guidelines4) Identifies individual attributed practitioner5) Information available and used by the practice unit team at the point of care6) Used to generate communications to patients regarding gaps in care 10
  11. 11. Pay for Performance: Six Month Metrics - eRegistry7. Used to flag gaps in care8. Patient demographics9. Registry identifies and tracks care for patients with at least 2 of the following: diabetes asthma cardiovascular disease pediatric obesity 11
  12. 12. Pay for Performance: Six Month Metrics - eRegistry 0 points for entire metric if no eRegistry 1 point each for numbers 1-8 Up to 2 points for number 9 12
  13. 13. Role Comparison Review Moderate Risk Care Manager Complex Care Manager (MCM) (CCM) • Moderate risk patients identified by • High risk patients identified by PCP Patient registry, PCP referral for proactive referral and input, risk stratification, Population and population management patient MiPCT list • Caseload 500 (approx. 90 - 100 active • Caseload 150 (approx. 30 - 50 active Patient patients); one MCM per 5,000 patients) Caseload patients • One CCM per 5,000 patients • Proactive, population management • Targeted interventions to avoid • Work with patients to optimize hospitalization, ER visitsFocus of Care control of chronic conditions and • Ensure standard of care, coordinateManagement prevent/minimize long term care across settings, help patients complications understand optionsDuration of • Frequency of visits high at times, Care • Typically a series of 1 to 6 visits duration of monthsManagement 13
  14. 14. Pay for Performance: Six Month Metrics - Care Manager Number of Moderate Care Managers hired/ contracted by practices and/or PO • 10 points Number of Moderate Care Managers within PO that have completed the required training • 10 points 14
  15. 15. Patient Engagement 15
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  17. 17. Pay for Performance: Six Month Metrics - Care Manager Number of Complex Care Managers hired/ contracted by practices and/or PO • 10 points Number of Complex Care Managers within PO that have completed the required training • 10 points 17
  18. 18. Performance Incentive Process $3.00 PMPM paid into incentive pool* Performance incentive metrics are assessed and all funds paid out every 6 months • 1st period for April starters is 3 months • Payments will be made about 2 months after performance period ends • Payment range is 82% to 118 % of mean ($18.00 per member) or $14.76 to $21.24 18
  19. 19. Payment Distribution POs retain approved portion (not to exceed 20%) POs distribute remaining funds to participating practices. • Equally: a fixed dollar amount times the number of beneficiaries or • Variable amounts: dollar amount is based on additional performance criteria including participation in workshops and collaborative events 19
  20. 20. Care Managers Each practice has a Hybrid Care Manager assigned and actively engaged Dietitian, Certified Diabetes Educator, Behavior Health Specialist, Health Coach, Health Educator, Certified Asthma Educator, Pharmacist (as needed) 20
  21. 21. PDCM Codes and FeesCODE SERVICEG9001 Initial assessmentG9002 Individual face-to-face visit (per encounter)98961 Group visit (2-4 patients) 30 minutes98962 Group visit (5-8 patients) 30 minutes98966 Telephone discussion 5-10 minutes98967 Telephone discussion 11-20 minutes98968 Telephone discussion 21+ minutes 21
  22. 22. Registration for CCM Workshop MiPCT moved to an open registration process for Complex Care Management (CCM) training CCMs and HCMs that have not previously registered online for the CCM course to the section of the MiPCT website entitled “CCM Online Registration page 22
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  24. 24. PCMH CAHPS Survey To be collected on a representative sample of MiPCT and comparison beneficiaries Multi-modal (mail with phone follow-up) Content areas: • Access • Communication • Coordination • Comprehensiveness • Shared decision making • Self-management support 24
  25. 25. Adult Clinical Quality Metrics 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 25
  26. 26. Adult Clinical Quality Metrics Asthma: Self-Management Plan or Asthma Action Plan (ages 5-50) Non HEDIS Hypertension: Controlled BP <140/90 (ages 18-85) HEDIS 26
  27. 27. Adult Clinical Quality Metrics Cardiovascular Disease (CVD): BP management <140/90 mmHg (ages 18-75) HEDIS CVD: LDL-C Management <100 mg/dl (ages 18-85) HEDIS Obesity: Adult BMI (Meaningful Use) 27
  28. 28. Adult Clinical Quality Metrics Tobacco: Percent Current Smokers (ages 13 and older) (non HEDIS) Breast Cancer Screening: (ages 40-69) HEDIS Cervical Cancer Screening: (ages 21-64) HEDIS Colorectal Cancer Screening: (ages 50-75) HEDIS Chlamydia Screening: (sexually active women ages 16-24) HEDIS 28
  29. 29. Pediatric Clinical Quality Measures Asthma: Self-Management Plan or Asthma Action Plan (ages 5-50) Non HEDIS Obesity: Child BMI (ages 2-17yrs) Meaningful Use Lead Screening: (Medicaid only) (Age 2) HEDIS** Tobacco Use: (ages 13 and older) Chlamydia Screening: (sexually active women ages 16–24) HEDIS 29
  30. 30. Pediatric Clinical Quality Measures Chlamydia Screening: (sexually active women ages 16–24) HEDIS Childhood Immunizations: Age 2 HEDIS** Childhood Immunizations: Adolescent Age 13 HEDIS** Well Child Visits: 15 Months and 3-6 years HEDIS Well Child Visits: Adolescent (ages12-21) HEDIS 30
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  32. 32. MNO Expectations Attendance at webinars • Share current information • Brief training moments • 100% practice representation • eMail addresses of physicians • Hold each other accountable and create buddy relationships • Create inter-professional collaborative care teams 32
  33. 33. Questions 33