mipct webinar 09/25/2013
TRANSCRIPT
Michigan Primary Care Transformation
Demonstration Project
September 25, 2013Webinar
Attendance
Anchor Bay Clinic Ricardo Cabrera, MD/Jeetender Matharu, MD Center for Preventive Medicine Country Creek Family Physicians Country Creek Pediatricians Everingham Clinic Douglas Hames, MD Hampton Medical
2
Attendance
Lifetime Family Macomb Pediatrics Meadowbrook Internists Monroe Medical Oakland Medical Group – Family Medicine Partridge Family Physicians Woodhaven Pediatrics
3
Learning Event: YOUR DECISION
Update for practice teams including physicians Saturday, September 28 from 8:30am-1:00pm Physicians Training Center: Madison Heights Topics:
• New billing codes• Advance Care Planning• Advance Directives• POLST• Durable Power of Medical Attorney• QI Process: PDSA
4
Best Practice
Woodhaven Pediatrics: 9/25 Country Creek Pediatrics: 10/9 Douglas Hames, MD: 10/23 Partridge Family Physicians: 11/6 Country Creek Family Physicians: 11/20 Drs. Matharu and Cabrera: 12/4 Monroe Medical: 12/18
5
Best Practice
Everingham Clinic: 1/15 Center for Preventive Medicine: 1/29 Oakland Medical Group – Family Medicine: 2/12 Lifetime Family: 2/26 Meadowbrook Internists: 3/12 Hampton Medical: 3/26 Anchor Bay Clinic: 4/9
6
CMS Proposal
Proposal allows practices to submit a bill once every 90 days for delivery of complex care management services for patients with multiple complex chronic conditions that place the patient at a significant risk of death, acute exacerbation/decompensation, or functional decline
Must be nationally recognized PCMH, meet MU, access a care manager
7
Number of Referrals from PCP
8
Match the Numbers
1. $24,033.46
2. $31,803.11
3. 46%
4. 82%
5. 2749
6. 250
A. Adjustments Jan - Jun
B. Cancellation rate YTD
C. Number of encounters Jan – Jun
D. Payments Jan – Jun
E. Encounter to outreach rate YTD
F. Avg. encounters per CM Jan - Jun
9
Matching Answers
1. $24,033.46
2. $31,803.11
3. 46%
4. 82%
5. 2749
6. 250
A. Payments Jan – Jun
B. Adjustments Jan - Jun
C. Cancellation rate YTD
D. Encounter to outreach rate YTD
E. Number of encounters Jan – Jun
F. Avg. encounters per CM Jan - Jun
10
11
113
84
124
10089
0
50
100
150
200
250
300
350
400
450
Apr May Jun Jul Aug
Encounters
98961 CM Group 2-4 pts 30 min 98962 CM Group 5-8 pts 30 min
98966 CM Coaching Call 5-10 min 98967 CM Coaching Call 11-20 min
98968 CM Coaching Call 21+ min 99487 COMPLX CHRON CARE COORD W/O PT VST 1ST HR PER M
G9001 CCM Initial Assessment G9002 CM Maintenance
New Encounters
12
Objectives
Define Multi-payer Advanced Primary Care Practice Demonstration (MAPCP)
Define Advanced Primary Care Practice (APCP) Define purpose and goals of MAPCP Demo Define method of evaluation Define care management
13
MAPCP Demonstration
What is it?
14
MAPCP Demonstration
THIS IS MIPCT Largest demonstration of the Advanced Primary
Care Practice to date Eight states participating• Maine, Vermont, New York, Rhode Island,
Pennsylvania, North Carolina, Michigan, Minnesota
Each state has its own name for MAPCP Demo
15
Advanced Primary Care Practice
What is it?
16
Advanced Primary Care Practice
This is the CMS terminology for the Patient Centered Medical Home Model
The APCP/PCMH:• Uses the leading model for efficient management and
delivery of quality health care• Uses a team approach with the patient at the center• Emphasizes prevention, HIT, care coordination and
shared decision making (patient and provider)
Therefore: MAPCP/MIPCT is a DEMO OF THE PCMH MODEL
17
MAPCP Demo
WHY? What is the purpose? GOALS? What are the expectations?
18
MAPCP Demo Purpose
Determine if the APCP/PCMH:• Reduces unjustified variation in utilization and
expenditures• Improves the safety, effectives, timeliness and
efficiency of health care• Increases the ability of beneficiaries to participate
in decisions concerning their care• Increases the availability and delivery of care
consistent with evidence based guidelines
19
MAPCP Expectations
Each of the demo projects will be “budget neutral” over the course of the three years• Budget neutrality: all payments under this demo
will be LESS THAN or EQUAL TO costs incurred for similar population in the absence of this demonstration (control group)• “significant savings” to Medicare while improving
quality of care provided to beneficiaries
20
MAPCP Demo Evaluation
HOW will our work be appraised?
21
MAPCP Demo Evaluation
Each state executes evaluation plan to monitor performance and provide feedback to payers, providers and communities
How have we affected:• Access• Quality• Patterns of utilization
This is the Michigan Data Collaborative
22
MAPCP Demo Evaluation
CMS undertakes its own evaluation through an independent research organization• RTI International (Douglas Kamerow, MD)• Dr. Kamerow spent more than 20 years in the U.S.
Public Health Service, initiating and leading key federal research, health policy, public health, and clinical programs. • Dr. Kamerow has already interviewed MNO and will
be back• Findings will be compared to control population
23
Care Management
What is it?
24
Care Management
Care Management has been defined as a set of activities designed to assist patients and their support systems in managing medical conditions and related psychosocial problems more effectively, with the aim of improving patients’ health status and reducing the need for medical services.
25
Care Management
Care management involves providing clinical and support services, including care coordination, provided by a nurse or other clinically trained provider. The intensity of follow-up and clinical interventions varies depending on the complexity of the individual patient’s health care needs. Care management is an essential function of a Patient-Centered Medical Home.
26
Care Management
Goals of Care Management:• Improve patient’s functional health status• Enhance coordination of care• Eliminate duplication of services• Reduce the need for unnecessary, costly medical
services
27
Care Management
Key Components of Care Management:• Identify patients most likely to benefit from care
management.• Assess the risks and needs of each patient.• Develop a care plan together with the patient/family.• Teach the patient/family about the diseases and their
management, including medication management.• Coach the patient/family how to respond to worsening
symptoms in order to avoid the need for hospital admissions.• Track how the patient is doing over time.• Revise the care plan as needed.
28
Open Discussion
29