Michigan Primary Care Transformation

Demonstration Project

April 4, 2012Webinar #4

Agenda

Definition of MiPCT and brief explanation Statewide Rollout Update Participation Update Funding Update including Metric Update Care Management Training Update Next Steps…

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Clarification of MiPCT

Michigan Primary Care Transformation Demonstration Project (MiPCT)

Eight states selected other states, besides Michigan are Maine, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island and Vermont

Practices eligible to participate in MiPCT were either NCQA PCMH Level 2 or 3 before July 1, 2010 and/or BCBSM PCMH designation 2010 and 2011

No PCMH is obligated to participate

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MiPCT Rollout

Day-long, all-partner MiPCT Launch Meeting occurred on March 28, 2012

MNO Care Manager Team attended MNO PCMH teams participated

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MiPCT Funding

Practice transformation payment - $1.50 per member per month ($2.00 for Medicare)

Performance incentives - $3.00 per member per month

Care coordination payment - $3.00 per member per month ($4.50 for Medicare)

Additionally, a $.26 per member per month administrative fee is contributed by payers

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MiPCT Expectations

In return for receiving these payments, practices and providers are being held accountable for achieving gains in • efficiency• appropriateness • quality of care that in turn should improve the

patient’s experience of care and the health status of the patient population

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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

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Moderate Care Manager Training

Required by all including Master Trainers and Leaders Formal training curriculum with competency

assessment Certificate of Completion Must be well versed in “self management strategy”“self management strategy”

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Definition of Self Management Support

Self-management support is the systematic provision of education and supportive interventions by health care team members to increase patients’ skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support.

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Definition of Self Management

Self-management is the tasks that individuals must undertake to live well with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management, and emotional management of their conditions.

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Self Management Training

Certain existing training programs are not acceptable• Stanford Chronic Disease Self- Management

Training: Peer led by 2 lay leaders

Clinician guided plans• Flinders• Teamlet: Dr. Bodenheimer• Generic

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Moderate Care Manager Training

Moderate Care Manager (PA-C, CNP, RN, APRN, or MSW)• Focus on Self Management Support and Skills• Completed by June 30, 2012• Calendar, offerings and curriculum emailed to all and

MNO online • Physicians do not qualify for Care Manager designation• Moderate Care Manager Job Description

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Care Team Composition

Lead Care Manager• RN, MSW, CNP, PA-C, APRN• Must complete Care Manager Training

Other Qualified Healthcare Professionals• LPN, CDE, RD, nutritionist, clinical pharmacist,

respiratory therapist, certified asthma educator, certified health educator specialist (bachelor’s degree or higher), licensed professional counselor, licensed mental health counselor, certified health educator specialist (bachelor’s degree or higher), licensed

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PCMH Care Planner

Works in concert with Care Manager “What should they be called” population coach, care

designer

Focus on Self Management • Completed by June 30, 2012• Calendar, offerings and curriculum emailed • It is recommended that each PCMH identify a team

member to complete the training

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Complex Care Manager Training

Geisinger: PROVENHEALTH® NAVIGATOR program Selected by MiPCT Steering Committee• Steering committee comprised of mix: primary care

physicians, researchers• Sub committees: Primary care physicians,

researchers and operations

First cohort will be trained on April 19, 2012 8 MNO “complex” care managers attending first

training event

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Pay for Performance: 6 Months(August 2012)

Moderate Care Manager in place Complex/Hybrid Care Manager in place Patient e-Registry orEMR/EHR with registry

capabilities HEDIS Quality Scores for the population Extended Access

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Pay for Performance: 12 Months(February 2013)

Moderate Care Manager in place Complex Care Manager in place Patient Registry or EMR/EHR with registry

capabilities: Generate Trend Reports HEDIS Extended Access Additional items: Depression Screening PHQ-2,

PHQ-9

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12 Month Metrics: Challenge

Metrics for care managers• Difficult to reach agreement • What should be measured• How does a patient’s experience fall into the mix

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Next Steps

By April 20, 2012 schedule a one hour all practice meeting to begin planning with your care manager

By May 1, 2012 with the assistance of your care manager your practice should complete “community mapping”

Locate a spot in your practice that a care manager can call “home”

With the assistance of your care manager plan a process to complete “population profiling”

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Next Steps

With the assistance of your care manager review specialty linkages such as • Home health care• Community resources• Payer connection

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Issues in 3 x

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