1. Michigan Primary Care
Transformation
Demonstration Project
April 3, 2013
Webinar

2. Agenda
 Year One metrics
 What’s being measured in Year Two
 Training
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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)
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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.
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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.
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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.
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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.
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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.
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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/wk
A 7 10 10 10 5 5 5 5 50.00 1
B >25 10 10 10 5 5 5 5 50.00 1
C <5 10 10 10 5 5 5 5 50.00 1
D <5 10 10 10 5 5 5 5 50.00 1
E 6 10 10 9.3 5 5 5 5 49.30 5
F 15 9.3 10 9.7 5 5 5 5 48.70 6
G 5 10 10 8.8 5 5 5 5 47.80 7
H 6 10 10 8.7 5 5 5 5 47.50 8
I 18 10 9.4 9.2 5 5 5 5 46.50 9
J 11 9.1 9.1 9.8 5 5 5 5 46.73 10
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10. Care Managers Six Month
Moderate MiPCT 1. Number of MCM 1. Number of
care Quarterly hired/ contracted required MCM per
managers report by practices and/or PO
(MCM) PO 2. Number of MCM
trained and 2. Number of MCM hired/ contracted 10 points
working within PO that have
completed the
required training
Complex care MiPCT 1. Number of CCM 1. Number of
managers Quarterly hired/ contracted required CCM per
(CCM) trained report by practices and/or PO
and working PO 10 points
2. Number of CCM
2. Number of CCM in hired/ contracted
PO that have
completed the
required training
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11. Complex Care Manager
12 Months
Complex care MiPCT IM/FP: Number of Number of 15
managers (CCM) Quarterly CMC trained and attributed MiPCT
trained and report providing services to members in PO as
working* 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)
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12. Moderate Care Manager
12 Months
Moderate care MiPCT Internal Medicine & Number of attributed 15
managers (MCM) Quarterly Family Practice (IM/FP): MiPCT members as
trained and report Number of MCM of June 30, 2012 in
working 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.)
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13. 12 Month Transitions and ED
Notification of MiPCT Number of Number of 15
admissions and Quarterly practices Practices in PO
discharges for at report reporting
least 50% of MiPCT capability
beneficiaries
Primary care Change in PO PCS PO Baseline Rate 10
sensitive ED visits Claims ED visits/1000 (Mean of 2010 &
(NYU algorithm) Data (Baseline Rate – 2011
2012 rate ED visits/1000)
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14. Patient Registry
Electronic patient a. MDC Number of Total number of 5
registry attestation practices with practices in PO
functionality: ability to
Tracking chronic b. Electronic transmit clinical
illness care and report of the data to the Total number of 20
preventive clinical metrics MDC practices in PO
services PLUS
Sum of the
points practices
received for
summary report
of clinical
measures
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15. Access
30% same day SRD Number of Number of 10
appointments report practices in PO practices in PO
(5.7) with capability
Access outside SRD Number of Number of 10
regular hours: report practices in PO practices in PO
12 hr/week (5.5) with capability
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16. Outcome Measures
Utilization (Improvement over baseline) 55
Primary care sensitive ED visits (NYU algorithm) 30
Ambulatory Care Sensitive Hospitalizations 15
Readmissions 10
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17. Outcome Measures
Clinical Quality Metrics - Claims Based ( Improvement over baseline) 15
Diabetes: AIC tests completed
Diabetes: Annual retinal eye exams
Breast Cancer Screening
Cervical Cancer Screening
Well Child Visits - 15 months
Well Child Visits - 3-6 years
Adolescent immunizations
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18. Process Measures
Clinical Quality Metrics – EHR or registry (Pay for Reporting) 15
Diabetes Control (adults): a. AIC < 8
1. Diabetes Poor Control (adults): AIC > 9
1. Diabetes (adults): Blood Pressure < 140/90
1. Cardiovascular Disease (adults): Blood Pressure < 140/90
1. Hypertension (adults): Blood Pressure < 140/90
1. Asthma (ages 5-64): Asthma Action Plan or self-management plan
for
a. all asthma and b. persistent asthma
1. Tobacco Use ( 13 years and older): Percent smokers
1. Obesity - children: BMI Percentile
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19. Process Measures
Notification of hospital admissions & discharges 3
Tracking 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 3
training in a nationally or internationally-accredited self-
management support program and works with/educates practice
unit staff members to actively use self-management support
concepts and techniques. (11.8)
Self-management support is offered to all patients with the 3
chronic condition selected for initial focus (based on need,
suitability, and patient interest. (11.2)
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20. 2014 Measures
 ADD/ADHD
 Depression Screening
 Pediatric/Adult Obesity
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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
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22. Open Discussion
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