mipct webinar 06/13/2012
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Michigan Primary Care Transformation
Demonstration Project
June 13, 2012 Webinar #10
Agenda
Medicaid Payments
Medicare Payments
Care Managers
MiPCT Committee
Metrics
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Doing the Impossible
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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
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.
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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
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
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Pay for Performance: Six Month Metrics - Access
Extended access:
• 30% same day appointment (10 points)
Appointments outside regular hours:
• 8 hours/week (10 points)
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Pay for Performance: Six Month Metrics – eRegistry
1) Practice has electronic registry
2) Registry has interface capability
3) Incorporates evidence-based care guidelines
4) Identifies individual attributed practitioner
5) Information available and used by the practice
unit team at the point of care
6) Used to generate communications to patients
regarding gaps in care
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Pay for Performance: Six Month Metrics - eRegistry
7. Used to flag gaps in care
8. Patient demographics
9. Registry identifies and tracks care for patients
with at least 2 of the following:
diabetes
asthma
cardiovascular disease
pediatric obesity
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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
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Role Comparison Review
Moderate Risk Care Manager (MCM)
Complex Care Manager (CCM)
Patient Population
• Moderate risk patients identified by registry, PCP referral for proactive and population management
• High risk patients identified by PCP referral and input, risk stratification, patient MiPCT list
Patient Caseload
• Caseload 500 (approx. 90 - 100 active patients); one MCM per 5,000 patients
• Caseload 150 (approx. 30 - 50 active patients)
• One CCM per 5,000 patients
Focus of Care Management
• Proactive, population management • Work with patients to optimize
control of chronic conditions and prevent/minimize long term complications
• Targeted interventions to avoid hospitalization, ER visits
• Ensure standard of care, coordinate care across settings, help patients understand options
Duration of Care
Management • Typically a series of 1 to 6 visits
• Frequency of visits high at times, duration of months
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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
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Patient Engagement
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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
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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
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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
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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)
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PDCM Codes and Fees
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CODE SERVICE
G9001 Initial assessment
G9002 Individual face-to-face visit (per encounter)
98961 Group visit (2-4 patients) 30 minutes
98962 Group visit (5-8 patients) 30 minutes
98966 Telephone discussion 5-10 minutes
98967 Telephone discussion 11-20 minutes
98968 Telephone discussion 21+ minutes
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
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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
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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
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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
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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)
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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
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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
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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
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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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Questions
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