mipct evaluation update
DESCRIPTION
MiPCT Evaluation Update. Clare Tanner March 14, 2014. CMS Evaluation. Question: What would have happened in Michigan without the MiPCT demonstration? Conducted by: Research Triangle Institute (RTI). RTI Measures. Cost. Utilization. All-cause hospitalizations - PowerPoint PPT PresentationTRANSCRIPT
MiPCTEvaluation Update
1
Clare TannerMarch 14, 2014
CMS Evaluation
Question: What would have happened in Michigan without the MiPCT demonstration?
Conducted by: Research Triangle Institute (RTI)
RTI Measures
Cost• Average PMPM• Measured as Medicare
payments
QualityDiabetes care:• LDL-C screening • HbA1c testing • Retinal eye examination • Medical attention for
nephropathy• All 4 diabetes tests
Ischemic Vascular Disease: • Total lipid panel test
Patient experience survey
Utilization• All-cause hospitalizations• ACSC hospitalizations (PQI) • All-cause ED visits • % ED visits that do not lead to
hospitalization• Discharges from short-term
general, rehabilitation, and SNF with (billed) clinical follow-up within 14 days
• Rate of 30-day unplanned readmissions (CMS definition developed by the Yale New Haven Health Services Corporation)
To be considered a success:Outcomes of MiPCT beneficiaries must improve at a greater rate than comparison beneficiaries
4
MiPCT Medicare Beneficiaries
5
3 4 5 6 7 8 9 10 11 12 13 14 15 16$500
$600
$700
$800
$900
$1,000
Total PMPM cost
High risk average Low risk average
Quarters (Jan 2010 - Jun 2013)
MiPCT Medicare Beneficiaries
6
3 4 5 6 7 8 9 10 11 12 13 14 15 1660
70
80
90
100
All hospital admissions per 1000 beneficiaires
High risk Low risk
Quarters (Jan 2010 - Jun 2013)
Demo quarters
MiPCT Medicare Beneficiaries
7
Jan 10 - Dec 10 Jan 11 - Dec 11 Jul 12 - Jun 13363738394041424344
Percent of diabetes beneficiaries who had all 4 diabetes exams
High risk Low risk Demo period
8
HbA1c Testing Rate
50%
60%
70%
80%
90%
100%
Based on Medicare FFS Beneficiaries Assigned January, 2012-June, 2013Quality of Care Measures: July 1, 2012 – June 30, 2013
National benchmark: 96%
9
Retinal Eye Examination Rate
Northern
Physician O
rganizatio
n Inc
Physician O
rganizatio
n of Mich
igan
United Physic
ians, PC
St. Mary
's of M
ichigan PHO
Metro H
ealth PHO
Upper Penin
sula H
ealth Plan
Michigan State U
niversity
Health
Team
Sparrow Physic
ian's Health
Netw
ork
Integra
ted Health
Ass
ociates
Genesys
Advantage Health
Physicians
Holland PHO
Oakland Physician N
etwork
Service
s
Physician H
ealthca
re N
etwork
, PC
Medical N
etwork
One
ProMed H
ealthca
re
McLare
n PHO
Bronso
n Medica
l Gro
up
Henry Ford
Medica
l Gro
up50%
60%
70%
80%
90%
100%
Based on Medicare FFS Beneficiaries Assigned January, 2012-June, 2013Quality of Care Measures: July 1, 2012 – June 30, 2013
National benchmark: 82%
10
Nephropathy Rate
50%
60%
70%
80%
90%
100% National benchmark: 94%
11
LDL-C Screening Rate
50%
60%
70%
80%
90%
100%
Based on Medicare FFS Beneficiaries Assigned January, 2012-June, 2013Quality of Care Measures: July 1, 2012 – June 30, 2013
National benchmark: 94%
Cost Savings?
Demonstration effect:
The change in outcomes during the demonstration period among beneficiaries assigned to MAPCP Demonstration practices compared to the change in outcomes for beneficiaries assigned to comparison PCMH practices.
12
MiPCT in Comparison (Medicare)
13
14
Quarterly Trend Comparison: Medicare PMPM Payments
15
Quarterly Trend Comparison: Payments to PC and Specialty Physicians
16
Quarterly Trend Comparison: Hospital Admissions
Michigan DataA Multi-payer Perspective
17
18
Inpatient Admissions per 1000 Attributed PatientsG
reat
er M
acom
b PH
OO
akla
nd P
hysi
cian
Net
wor
...M
ercy
Phy
sici
an C
omm
un...
Oak
woo
d AC
OHe
nry
Ford
Med
ical
Gro
upU
OP,
LLC
Jack
son
Phys
icia
n Al
lianc
eHV
PAIn
tegr
ated
Hea
lth P
artn
ers
Med
ical
Net
wor
k O
nePr
ofes
sion
al M
edic
al C
or...
Gen
esys
McL
aren
PHO
St. J
ohn
Prov
iden
ce P
artn
e...
CIPA
Mic
higa
n St
ate
Uni
vers
it...
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row
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Heal
...Br
onso
n M
edic
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roup
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ed H
ealth
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pper
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alth
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ated
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ichi
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alth
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ealth
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et...
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nd P
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lth P
HOW
est M
ichi
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n...
0
50
100
150
200
250
300
19
30-Day All-Cause Readmission Rate
Michigan Sta
te U
niversity
Health
Team
United Physic
ians, PC
Oakland Physician N
etwork
Service
s
St. John Pro
vidence
Partners
in Care
, LLC
University
of Mich
igan Health
System
Advantage H
ealth Physic
ians
Genesys
Oakland Southfie
ld Physicians
Physician O
rganiza
tion of M
ichigan
HVPA
Profess
ional M
edical C
orpora
tion, P
CCIP
A
Jackso
n Physician Allia
nce
Spectrum
Health
Medica
l Gro
up
Sparrow Physic
ian's Health
Netw
ork
Metro H
ealth PHO
Upper Penin
sula H
ealth Plan
Physician H
ealthca
re N
etwork
, PC
020406080
100120140160180
20
Diabetes HbA1c Testing Rate
Physicia
n Healthca
re Netw
ork, PC
Holland PHO
Oakland Physi
cian N
etwork
Servi
ces
Physicia
n Orga
nization of M
ichiga
n
Integrated Health
Partners
Greater Maco
mb PHO
Northern
Physicia
n Orga
nization In
c
Integrated Health
Associa
tes
United Physi
cians,
PC
Genesys
Primary
Care Partners,
Inc (
Covenant)
Sparro
w Physicia
n's Health
Netw
ork
Universi
ty of M
ichiga
n Health Sy
stem
UOP, LLC
West
Michiga
n Physicia
n's Netw
ork
Medical N
etwork
One
St. Jo
hn Provid
ence Partn
ers in Care, L
LC
Henry Fo
rd M
edical G
roup
7880828486889092949698
Diabetes % with A1C: Change 2012-2013
21
Northern Physician Organization
Upper Peninsula Health Plan
ProMed Healthcare
Jackson Physician Alliance
Physician Organization of Michigan
Lakeshore Health Network
Oakland Southfield Physicians
CIPA
HVPA
Integrated Health Partners
Michigan State University
McLaren PHO
United Physicians
Sparrow Physician's Health Network
Medical Network One
Holland PHO
Oakland Physician Network Services
Physician Healthcare Network
-10.00% -5.00% 0.00% 5.00% 10.00%
Care Management ActivitySource: PO quarterly reporting, 2013
22
23
Q1 Q2 Q3 Q4*0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
Care Manager Activity2013 Q1 to Q3
Face-to-Face Phone
* Data missing from one PO
Typical Daily Care Manager Activity
Quarter 4
24
Care Manager Role
50th PercentileQuarterly Encounters/FTE
Translates to:Encounters per day
Complex 134 2 encounters per day
Hybrid 162 3 encounters per day
Moderate 103 2 encounters per day
Care Manager Activity Benchmark Performance
Quarter 4
25
Care Manager Role
90th PercentileQuarterly Encounters/FTE
Translates to:Encounters per day
Complex 439 7 encounters per day
Hybrid 362 6 encounters per day
Moderate 352 6 encounters per day
Care Manager SurveySource: Surveys conducted May 2013 and Dec 2013/January 201450% response rate
26
27
Average Self-reported Patient Caseload
May December0
10
20
30
40
50
60
70
80
90
100
39
6367
95
60
74
Complex Care ManagerHybrid Care ManagerModerate Care Manager
Care Manager Survey Results
Other
Fax discharge summaries
Patient self-referrals
Review in advance the practice visit schedule
Electronic admit discharge notifications
Physician referrals
5%
17%
21%
28%
30%
40%
54%
57%
63%
79%
91%
How Care Managers Build Caseloads
28
Care Manager Survey Results
Other
Fax discharge summaries
Patient self-referrals
Review in advance the practice visit schedule
Electronic admit discharge notifications
Physician referrals
Another staff member is designated to assist with:
29
22% of all respondents specifically noted that no other staff member is designated to assist with any of the tasks
Care Manager Survey Results30
December 2013
May 2013
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
69
48
79
107
32
39
5
9
3
12
Physicians that Care Managers work with support the concepts of the MiPCT care management team-based
care
Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
Care Manager Survey Results31
December 2013
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
49 86 41 6 5
Practice staff, other than physicians that Care Managers work with support the concepts of the
MiPCT care management team-based care
Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
Care Manager Survey Results
May 2013 December 201350%
60%
70%
80%
90%
100%
Proportion of Care Managers who have the following amenities at ALL practice locations
WorkstationPrivate workspaceDeskComputer
32
Next Steps
33
Care Manager Self-assessment PO Survey
Provider & Staff
Survey
Patient Survey
Ongoing Claims Analyses
March - April 2014
April - May 2014
May-June 2014
October 2014
Contact: [email protected]