The Michigan Primary Care
Transformation (MiPCT) Project
November 2015
PO Quarterly Webinar
2
Agenda
1.
Final 2016 CMS Physician Fee Schedule and the MiPCT (10 min)Diane Marriott
2. PO/Practice/MDHHS 2016 Agreement Overview/Status (20 min)Theresa Landfair
3. Tiger Team Update (15 min)- Mary Ellen Benzik
4. MPHI Evaluation Update (10 min)-Jason Forney, Clare Tanner
5. MDC Update (15 min) – Cindy Adams,
Susan Stephans
6. Summit 2016 Dates (5 min) – Jean Malouin
7.
Announcements and Open Q&A – Amanda First and Jean Malouin
3
1. Final 2016 CMS Physician Fee
Schedule and the MiPCT
4
The Final PFS (Issued 10/30/15)Implications for the MiPCT
• 1) New Advance Care Planning Codes
▫ Purpose: To pay for a provider's time discussing
patient choices for advance directives and
completing necessary forms.
▫ Code Detail:
 Coverage of first 30 minutes
 Additional 30-minute blocks
▫ Beginning 1/1/16, CMS will reimburse CPT codes 99497 and
99498.
5
The Final PFS (Issued 10/30/15)Implications for the MiPCT
1) New Advance Care Planning Codes, cont.
▫ Does NOT waive beneficiary copay for discussions
(except for discussions at annual wellness visits)
▫ Also billable for FQHCs and RHCs
▫ Payment estimated at $86 for 99497 (initial 30-minutes)
and $75 for 99498 (subsequent 30 minutes).
6
The Final PFS (Issued 10/30/15)Implications for the MiPCT
2) Transitional Care Management (99495 and
99496)
▫ Now allows submission of claim when the face-toface visit is completed
3) Still Waiting……..New Collaborative Care Model
Code for Beneficiaries with Common Behavioral
Conditions…Potentially in 2017
7
The Final PFS (Issued 10/30/15)Implications for the MiPCT, cont.
4) The Bigger Issue for Us – Potential Comprehensive Primary
Care Expansion
• Our “sister program” that parallels the Multipayer Advanced
Primary Care Demonstration (MAPCP) approach.
▫ CPCI focus areas (milestones) largely similar to MiPCT
programming





Enhanced patient access and continuity of care,
Planned chronic and preventive care,
Risk-stratified care management,
Patient and caregiver engagement, and
Coordination of care across a “medical neighborhood”
• CMS staff acknowledge that (if expanded), an announcement
early in 2016 is key to continuity of staffing and servicing
8
2. PO/Practice/MDHHS 2016
Agreement Overview/Status
9
See MS Word document labeled: “Substantive
Changes in the MiPCT 2016 Paricipation
Agreement” and Draft 2016 Agreement
Redline
10
3. Tiger Team Update
Managing Populations:
Stratified approach to patient care and
care management
IV. Most complex
(e.g., Homeless,
Schizophrenia)
III. Complex
Complex illness
Multiple Chronic Disease
Other issues (cognitive,
frail elderly, social,
financial)
II. Mild-moderate illness
Well-compensated multiple
diseases
Single disease
I. Healthy Population
<1% of population
Caseload 15-40
3-5% of
population
Caseload 50-200
50% of population
Caseload~1000
Michigan Primary Care Transformation Project
Advancing Population Management
PCMH Services
Complex Care
Management
Functional
Tier 4
Care Management
Functional Tier 3
Transition Care
Functional Tier 2
Navigating the Medical
Neighborhood
Functional Tier 1
PCMH Infrastructure
All Tier 1-2-3 services plus:
 Home care team
 Comprehensive care plan
 Palliative and end-of life care
All Tier 1-2 services plus:
 Planned visits to optimize
chronic conditions
 Self-management support
 Patient education
 Advance directives
All Tier 1 services plus:
 Notification of admit/discharge
 PCP and/or specialist follow-up
 Medication reconciliation
 Optimize relationships with
specialists and hospitals
 Coordinate referrals and tests
 Link to community resources
Prepared Proactive Healthcare Team
Engaging, Informing and Activating Patients
P O P U L A T I O N
Health IT
- Registry / EHR registry functionality *
- Care management documentation *
- E-prescribing (optional)
- Patient portal (advanced/optional)
- Community portal/HIE (adv/optional)
- Home monitoring (advanced/optional)
Patient Access
- 24/7 access to decision-maker *
- 30% open access slots *
- Extended hours *
- Group visits (advanced/optional)
- Electronic visits (advanced/optional)
Infrastructure Support
- PO/PHO and practice determine
optimal balance of shared support
- Patient risk assessment
- Population stratification
- Clinical metrics reporting
*denotes requirement by end of year 1
M A N A G E M E N T
Where do we go from
Demonstration?
• Key areas to be addressed
▫ Social determinants of health
▫ Integration of Behavioral health
Creating the Model – Engaging
with the POs
• Created Tiger Teams to address each area
• Representatives from PO, practices, payers ,
and state wide
Expertise on these topics
• Met monthly – every other in person
• Created model and tool kits for the
addressing
social determinants and integrating
behavioral health
MiPCT INTEGRATION and INTER RELATEDNESS OF MENTAL HEALTH AND
SOCIAL DETERMINANTS OF HEALTH
PCMH Neighborhood – partnering on social
Determinants of health
Advanced Medical Home: collaborative
Care model with behavioral health partnerships
PCMH functionality: registry utilization,
Process redesign for screening tool utilization
Panel management, treat to target, integration of
Brief cognitive therapy
Creating necessary infrastructure
Registry development, partnerships with
Mental health and community agencies
Planning steps for integration of Mental Health integration
at the PO level
Financial 1. Business case for behavioral
integration monograph PDF
analysis
2.
Business case proforma
and
3.
AIMS Center U of W ,
implementation guide step 2
business
4.
http://www.integration.sam
plan
5.
6.
Addressing Social Determinants
Addressing Patient’s Social Needs: Business Case
ADDRESSING PATIENTS’ SOCIAL NEEDS: An Emerging
Business Case for Provider Investment.
Reasons to invest in social determinants, examples
and strategies of various projects/programs payment
hsa.gov/financing/Sustainabi
lity_Checklist_revised_2.pdf models.
http://www.integration.sam http://www.commonwealthfund.org/~/media/files/pu
blications/fundhsa.gov/financing/billingreport/2014/may/1749_bachrach_addressing_patients
tools\
http://www.integration.sam _social_needs_v2.pdf
hsa.gov/financing/Michigan.
pdf
Assessmen
t of current
state of
integration
Assessmen
t of
resources
at practice,
PO and
community
Current state assessment of
community partnerships and joint
planning of intervention
Integrated tool #1
Compass self-assessment
OATI #4
Collaborative care principles and
components - AIMS center
CMS funding brief DBM
reference
Identification of the
relationships with psychiatric
partners for developing care
collaborative model
Partnership checklist OATI tool
1
Practical Playbook; Primary Care and Public Health Together
Community Commons Interactive Maps: Poverty levels,
education and more by census tract.(Log in is required). See Maps
and Data Tab
http://assessment.communitycommons.org/Footprint/
Frieden: Health Impact Pyramid
Linking with your community health team works
Planning steps for
integration of at the
practice level
Financial analysis
and business plan
Assessment of
current state of
integration
Assessment of
resources at
practice, PO and
community
Current state
assessment of
community
partnerships and joint
planning of intervention
Current state assessment
for readiness for change
Behavioral Health integration
Addressing Social Determinants
SBIRT basics utilization and
financial aspects
MeHAF
Assessing Chronic Illness Care (ACIC)
Integrated practice assessment tool particularly sections 2, 7
(IPAT)
CHIS framework
American Academy of Pediatrics
integration tool Bright Future
CHIS quick start decision tree
section workforce and clinical
practice
Same as PO
*assessment of health literacy ,
cultural competency – see SD tool
kit
AIMS center organizational
readiness
GROW Pathway Planning Worksheet
AAP MH Practice Readiness
Inventory
http://pediatrics.aappublications.org/
Doing the work at the Practice
Level – Defining new Workflow
Measurements strategy
Implementation plan
Pilot, test of scale, spread
Registry development
Referral /
partnerships for
collaborative model
Panel management
and follow up
Optimization of
behavioral health
care
Implementation of
screening tool
Treatment
intensification
Registry utilization for
positive screen
Addressing social
determinants
Toolkit for the Practices to Change
Workflow
Social determinants of health
Practice level
steps –
operationalizing
the change
Overview
document
Tools to support Poverty
(more in website –
these starting
documents )
Community
Commons
Interactive Maps
Measurement
strategy
GROW tool
Behavioral
Adverse
factors
childhood
(smoking, at risk events
substance use )
The Childhood
Adversity
Narratives
CAN.
Capturing Social
and Behavioral
Domains and
Measures in
EHRs: Phase 2.
Integration of behavioral health
http://www.improvingprimaryca
re.org/work/behavioral-healthintegration
http://integrationacademy.ahrq.
gov/atlas/overviewofmeasures#r
eviewmeasures
Measuring Vital
Signs
Implementation
plan
Strengthening
Families- A
https://aims.uw.edu/collaborativ
e-care/implementation-guide
Protective
Factors
Framework
Guidebook for professional
practices for implementation
Suicide prevention tool kit
Screening tools
HealthBegins
Social screening
Resiliency and
ACES
Depression tool kit
Toolkit for the Practices to Change
Workflow
Social determinants of health
Practice level
steps –
operationalizin
g the change
Tools to
Poverty
support (more
in website –
these starting
documents )
Behavioral
Adverse
factors
childhood
(smoking, at events
risk substance
use )
Integration of behavioral
health
Registry
utilization
http://aims.uw.edu/sites/default
/files/ClinicalWorkflowPlan.pdf
http://aims.uw.edu/collaborative
-care/implementationguide/plan-clinical-practicechange/identify-populationbased
Treatment
intensification
AIMS Center – commonly
prescribed psychotropic meds
Primary Care Psychiatry –Pocket
Guide V. 1.5 Feb 2014
http://aims.uw.edu/collaborativecare/implementation-guide/planclinical-practice-change/createclinical-workflow
Panel
management
and follow up
MiICCSI Community
Addressing Team Factors: Health
Literacy and Cultural Competency
Team based
factors
impacting
integration
Framework /
toolkits
Health literacy
AHRQ Health Literacy Ten Attributes of Health In Plain Words - Tr
Universal Precautions Literate Health Care
Effective Communication Tools for
Organizations
Toolkit
The Health Literacy
Environment of
Hospitals & Health
Centers: Making Your
Healthcare Facility
Literacy-Friendly
Ethnicity/Cultur
al Competency
Assessment of
PO/ practice
capabilities
The Health Literacy
Environment Activity
Packet: First
Impressions and A
Walking Interview
PO/practice care team process/ Patient Tools / educational
tools and training
materials
Ask Me 3- Partnership
for Clear Health
Healthcare Professionals (Tr video) Communication—
National Network of Libraries of
Ask Me 3 Medicine: Health literacy (Tr – info http://www.npsf.org
to include in training)
/?page=askme3
Measures to Assess a
Health-literate
Organization
Effective Communication Tools for
Healthcare Professionals (tr video)
Guide to Providing Effective
Communication and Language
Assistance Services?
National Standards for Culturally
and Linguistically Appropriate
Thank You
• Mary Ellen Benzik
mebenzik@gmail.com
Mipctdemo.org
Resources tab
Clinical areas
Social Determinants
23
4. MPHI Evaluation Update
24
25
5. MDC Update
26
MDC Agenda
• Where do I get information?
• What’s New?
▫ Coming soon – new MDC web page
▫ All Payer Patient Lists
▫ Report Writer
▫ Standard Cost Enhancement
27
Dashboard
• Accessing Dashboard and Support Documentation
▫ Michigan Data Collaborative Website
www.MichiganDataCollaborative.org
• Support page includes the following materials:
▫
▫
▫
▫
Dashboard general reference and user guides
Dashboard release notes
Information about the data included in the Dashboard
All Payer Patient List reference document
28
New MDC Web Page
29
Support Page
Page 29
30
Dashboard Reference Materials
General info,
user guides
Provides more
detail about
each report
Page 30
31
Release Notes
Page 31
32
Data Reference Material
Page 32
33
Data Timeline
Page 33
34
All-Payer Patient List Changes - 2015
• Addition of High Risk Flag (April)
• Healthy MI Flag (coming soon)
▫ Identifies members who have signed up for
coverage in the Affordable Care Act
▫ Only set in the Medicaid population (not
traditional Medicaid recipients)
35
All-Payer Patient List - Helpful Documentation
Page 35
36
All-Payer Patient List Information Document
Page 36
37
All-Payer Patient List - Details
Page 37
38
Dashboard – What’s New?
• Report Writer Enhancements (August 2015)
▫ Added Totals
▫ Added Overall measures
 Quality
 Adult Preventive
 Diabetes
 Pediatric Preventive
▫ Trends – Diabetes Overall
Note: The enhancements are documented in the Report Writer August 2015 Enhancement
Release Notes
39
Dashboard – Accessing Report Writer
40
Report Writer –
Totals & Overall checkboxes
41
Report Writer – Selecting What You Want
42
Report Writer – Viewing Results
43
Standard Cost Background
• Truven Health provides standard cost valuation utilizing their MarketScan
database that includes large state and national Employer/Commercial data for
over 180 million patients
• MarketScan provides the mean unit price based on:
▫
▫
▫
▫
DRG for inpatient claims
ICD, CPT, and HCPCS Procedure and Revenue Codes for facility claims
CPT and HCPCS Procedure Codes for professional claims
NDC for pharmacy claims
• As new codes are implemented, they flow into the Truven system; however, unit
prices are not published until all data has been submitted and analyzed
• MarketScan data is currently based on 2012 data
• When claims are processed on the dashboard, some procedures and revenue
codes do not have standard costs associated with them
44
Standard Cost Enhancement
• Released with Enhancement 14.01 on 11/10/15
• When MarketScan standard costs are updated with
new codes, MDC re-evaluates previously received
claims with no standard cost and applies the new
rate(s)
• Increased claims and members are included in
standard cost rates adding over 50,000 members in
the current measurement period
45
Standard Cost Enhancement
• High and Very High Risk groups show the largest rate
increases since they are higher utilizers
• Medicare populations show a larger rate increase
because they contain more patients in the High and
Very High risk groups
• Because the updates from Truven are based on
claims through 2012, earlier trend periods are
enhanced the most by updating standard costs for
previously-blank codes
46
6. 2016 Summit Dates
47
2016 Summits – Save the Date!
• October 13, 2016 – Thompsonville Summit
(North)
• October 18, 2016 – Grand Rapids Summit
(West)
• October 26, 2016 – Ann Arbor Summit
(Southeast)
48
Announcements and
Open Q and A