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All-Partner Launch Event
MiPCT 101

• U.S. Health Care Trends (the burning platform)
• The Michigan Primary Care Transformation Project
▫ MiPCT Vision
▫ Financial Model
▫ Clinical Model
▫ Resources Available
▫ How Will We Define Success?
• Summary
• Questions and Discussion
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Average Health Spending Per Capita ($US):
The ubiquitous and non-sustainable cost curve
7000
6000
United States
Germany
Canada
France
Australia
United Kingdom
5000
4000
3000
2000
1000
0
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K. Davis et al. Slowing the Growth of U.S. Health Care Expenditures: What Are the Options?, The
Commonwealth Fund, January 2007, updated with 2007 OECD data
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• Accountable Care Organizations?
• Patient Centered Medical Homes?
• Health Care Reform?
• All/None of the above?
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PCMH as the Foundation for ACO
Population Management
Source: Premier Healthcare Alliance
The goal of Accountable
Care Organizations should be to reduce, or at least control the growth of, healthcare costs while maintaining or improving the quality of care patients receive (in terms of both clinical quality, patient experience and satisfaction).
- Harold Miller
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• Total population (2010 census): 9,883,640
• 11th largest state in the United States
• Home to more than 11,000 lakes
• The longest freshwater shoreline in the world
• The largest State Forest system in the nation
• Favorite vacation spot of Ernest Hemingway
• Birthplace of Charles Lindbergh, Henry Ford, Stevie
Wonder, Gilda Radner, Madonna, “Magic” Johnson and
(who can forget...) Alice Cooper

• Although Michigan is called the "Wolverine State" there are no longer any wolverines in Michigan

• 45 th (of 50 states) in coronary heart disease deaths
• 41 rd in percent of obese adults
• 34 th in infant mortality rate
• 34 th in percent of adults who smoke
• 34 th in overall cancer death rate
• 20 th in percent of adults who exercise regularly
• 12 th in adults receiving colon cancer screening
• 5 th in childhood immunization rate
Source: Comparison of Michigan Critical Health Indicators and Healthy People 2010
Targets, Michigan Department of Community Health, May 2011

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• Use the CMS Multi-Payer Advanced Primary Care
Practice demo as a catalyst to redesign MI primary care
▫ Multiple payers will fund a common clinical model
▫ Allows global primary care transformation efforts
• Create a model that can be broadly disseminated
▫ Facilitate measurable improvements in population health for our Michigan residents
▫ Contribute to national models for primary care redesign
• Form a strong foundation for successful ACO models

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• PCMH-designated in 2010, and maintain PGIP or
NCQA designation over the 3-year demonstration
• Part of a participating PO/PHO/IPA
• Agree to work on the four selected focus initiatives: o Care Management o Self-Management Support o Care Coordination o Linkage to Community Services
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Participating Provider and Payer Partners
As of April 2012
# Practices* # POs # Physicians # Payers
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410 Practices 36 POs Over 1700
Physicians
4 (Medicaid,
Medicare, BCBSM,
BCN)
*Choice of a January 1 or April 1 start date; no additional practice or PO starting date opportunities post 4/1/12

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$0.26 pmpm Administrative Expenses
$3.00 pmpm *, ** Care Management Support
$1.50 pmpm *, ** Practice Transformation Reward
$3.00 pmpm *, ** Performance Improvement
$7.76 pmpm Total Payment by non-Medicare
Payers***
* Or equivalent
** Plans with existing payments toward MiPCT components may apply for and receive credits through review process
*** Medicare will pay additional $2.00 PMPM to cover additional services for the aging population
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Developing a Framework to assist
POs/PHOs/Practices with
MiPCT Population Management
• Build on the great work you’ve already done!
• Develop working definitions for MiPCT focus areas
• Define evidence-based interventions and metrics for each focus area, categorized by risk status and population tier
• Develop resources and training models to meet
PO/PHO/practice needs

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
<1% of population
Caseload 15-40
3-5% of population
Caseload 50-200
50% of population
Caseload~1000
I. Healthy Population

Michigan Primary Care Transformation Project 23
Advancing Population Management
PCMH Services
Complex Care
Management
Functional
Tier 4
All Tier 1-2-3 services plus:
 Home care team
 Comprehensive care plan
 Palliative and end-of life care
Care Management
Functional Tier 3
Transition Care
Functional Tier 2
Navigating the Medical
Neighborhood
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
PCMH Infrastructure
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
Functional Tier 1
Prepared Proactive Healthcare Team
Engaging, Informing and Activating Patients
*denotes requirement by end of year 1
P O P U L A T I O N M A N A G E M E N T

• Care management
▫ Performed for appropriate high and moderate risk individuals
• Population management
▫ Registry functionality by end of year 1
▫ Proactive patient outreach
▫ Point of care alerts for services due
• Access improvement
▫ 24/7 access to clinician
▫ 30% same-day access
▫ Extended hours
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• Overview of PO/PHO Role in MiPCT implementation
• High-level, jointly-developed Implementation
Plan (one per practice)
▫ Current and planned division of care management responsibilities between Practice and PO
▫ Care Management Staffing Plans
▫ Practice Information (EHR, Registry, Key Contacts)
• Description of the planned distribution of care coordination and incentive payments between
PO and practice
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• Additional resources available to help support team-based approach to care
▫ Preserve local autonomy while maintaining consistency across the state
• Information for population management
▫ Multi-payer claims based database
▫ Provide risk stratification, utilization reports
• Goal: To support Michigan primary care
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• UMHS/BCBSM collaboration
• Goal is to help disseminate effective, evidencebased care management models throughout
Michigan
• Initial focus is MiPCT practices - available to all
Michigan PO/PHOs /practices
▫ Web-based resource for templates, tools, evidencebased information
▫ Webinars, workshops and mentoring in care management

Data collection and provisioning group based at the
University of Michigan.
• Builds “multi-payer database”
• Creates and distributes reports that:
• Helps to identify high risk and at-risk patients
• Establishes baseline performance
• Identifies opportunities for improvement
• Supports report interpretation and practice use
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• Learning Sessions aimed at:
▫ Building on PCMH team-based capabilities
 Team members working at the top of their role and license
 Clearly defining roles for the entire practice team
▫ Nurturing a culture of support and respect
▫ Optimizing practice workflow and change management
Quarterly
Best
Practice
Sharing
Learning
Collaboratives
LEAN
Workshops
Practice
Coaching

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Reduction in Unnecessary and Non-
Value-Added Costs
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The tie to budget neutrality and
ROI
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Budget Neutrality and ROI
• Budget Neutrality
▫ The minimum required
▫ Amount expended in additional payments to providers
(practices and POs) plus administrative costs must be equal to or less than the amount saved by avoiding unnecessary services (e.g., ambulatory care-sensitive ED visits and inpatient stays, redundant testing, etc.)
▫ Must trend toward budget neutrality at the end of Year Two
(2013)
• ROI
▫ The GOAL
▫ “Return on Investment”
▫ Saving more in avoidable costs than is spent on additional payments to providers and administrative costs
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Strategies for achieving…
SHORT TERM SAVINGS
• High-risk patient intensive care management
LONG TERM SAVINGS
• Focus on all “tiers” of patient population
• 24/7 clinical decision maker access to prevent unnecessary ED utilization and inpatient admissions
• Baseline data analysis for utilization outliers and focused root cause analysis
• Recognize and reward performance on intermediate markers of chronic conditions to prevent long-term complications (BP in diabetes, etc.)
• Focus on primary prevention/screening
• Educate on evidence-based approaches to care (e.g., low back pain management)
• Work to build self-sustaining healthy communities
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Unprecedented opportunity to measure the outcomes of investing in primary care across a diverse state
• State and National Levels
▫ MPHI (State)
▫ RTI (National)

• Statistical analysis of the effect of your work
(care management, care transitions, community linkages, IT, patient access) on quantifiable outcomes, using:
▫ Claims data
▫ Clinical quality indicators
▫ Patient survey on experience of care
▫ Provider/clinic staff survey on work life satisfaction
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Key interviews and feedback gathering from practice and PO representatives

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• Webinar and Q/A Calls --- (Alternate Thursdays, 3-5pm)
• CCM Rollout Training – 2 Q 2012
• Quarterly Report and Financial Templates
• Quarter 1 (Due May 1, 2012): Brief interim reports
• Quarter 2 (Due August 1, 2012): Documentation for the
6 month performance incentive metrics
• Quarter 3 (Due November 1, 2012): Brief interim reports
• Quarter 4 (Due February 1, 2013): Updated
Implementation Plans
• Incentive Metrics
• Six month metrics (Jan-June 2012)
• Twelve month metrics (August – December 2012)
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• Evidence-based, Goal-Oriented Care + Engaged Patient
+ Invested Care Team = MiPCT
• No magic bullet - the key to better health care delivery at lower cost will involve multiple solutions
• The Michigan Primary Care Transformation Project will help shape the future of primary care in our state
• TOGETHER, WE CAN MAKE A DIFFERENCE FOR
MICHIGAN!!

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James D. Reschovsky, Ph.D., Arkadipta Ghosh, Ph.D., Kate Stewart, Ph.D., and Deborah Chollet , Ph.D.; “Can Promoting Primary Care Help Bend the Cost Curve?”; Commonwealth Fund, March 21, 2012

• MiPCT Demo Mailbox: mipctdemo@michigan.gov
• Carol Callaghan (Co-Chair) callaghanc@michigan.gov
• Jean Malouin, MD MPH (Co-Chair, Medical Director) jskratek@med.umich.edu
• Sue Moran (Co-Chair) MoranS@michigan.gov
• Diane Bechel Marriott, DrPH (Project Manager) dbechel@umich.edu
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Questions and Discussion
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