The Michigan Primary Care Transformation (MiPCT) Project Update PGIP June 8, 2012 Meeting

Agenda Special Guest: Dr. Paul Grundy Payment Update: Real Progress! BCN Attribution Lists: A Helpful Guide Learning Collaborative Brainstrorming Reporting and Survey Findings Care Management Update

Payment Update: Real Progress

Medicare Care Coordination Payment Distribution from UMHS Checks successfully distributed! Distribution will transition to a monthly basis (including any new payments AND any adjustments received from CMS in the previous months) An explanation of payment (EOP) report will allow tracking of claims and payments by month of service Send your questions to

Other Payment Progress Medicaid care coordination payments successfully distributed Working to minimize the gap between completing the incentive period and distribution of funds for incentive payments Much work on speeding payments across payers and on establishing regular cadences for distribution

BCN Member Lists: A Handy Guide

7 Access Health e-Blue. 1 2 Click on BCN Health e-Blue. Log in to Provider Secured Services. If you don’t have a Provider Secured Services user name and password, you’ll need to apply to get them. Make sure you apply for access to both web-DENIS and Health e-Blue.

8 Open the Patient - Eligibility panel. 3 Click on Panel - Patient Eligibility.

9 Search the records. Select your PCG or office. 5 To get a full report, set the Practice Group/Solo Physician, PCP and Product Line fields to “All” and set the Report Year field to “2012YTD.” You can do all the sorting once you have the entire file and have converted it to an Excel ® spreadsheet. Click Search Records. 6 4

10 Export the file as a CSV file. When the search is complete, click Export as CSV File. Save the CSV file. 7

Open the CSV file and save it as an Excel file (.xls). Save the file as an Excel file.

12 Sort and filter the data in Excel. Open the Excel file. 10 Sort by product. Refer to the table of BCN Plan Codes with Plan Names (next page). 11 Note the risk score for each member. (ADCG2 column) The higher the score, the sicker the member. Members with scores of 3,4 and 5 are flagged for review by BCN Care Management. 12 To see how to access more information on the members followed by BCN Care Management, keep reading... Member names PCP names Continue to sort and filter the data to meet your needs. Open the Help function in Excel to get instructions. Keep your original file intact, just in case.

13 Table of plan codes + plan names. In the Excel file, be sure to filter out plans that are not a part of MiPCT* or your data will not be correct. *Michigan Primary Care Transformation Project

14 Search for Patient Condition data. A Select the conditions. Click Search Records. C B Click on Panel – Patient Conditions.

15 Export and save the file. View the data. When the search is complete, click Export as CSV File. D Convert the CSV file into an Excel file and open the Excel file. E View the data on members’ risk scores and conditions. A “CM FLAG” of 1 identifies members being followed by BCN’s Care Management department. F

16 Special thanks! In the spirit of provider partnerships and collaboration, I would like to recognize Dana Getz from IHA, who provided the layout and direction for this presentation. Thank you, Dana! J.H.H. IV D.G.

Learning Collaboratives Brainstorming

MiPCT Learning Collaboratives Goals To enhance effectiveness of care management at the practice level To develop and share best practices in areas essential to MiPCT success Your input, preferences, and experiences are essential to developing the best model!

MiPCT Learning Collaboratives: Considerations Approach (regional, statewide) Format: In-Person, Conference Call, Webinar, Combination Frequency of sessions

MiPCT Learning Collaboratives: Considerations Frequency of sessions Topics Potential Partners

Reporting and Survey Findings - PO MiPCT Quarterly Reporting - Provider Survey Findings

PO MiPCT Quarterly Reporting Q Findings Summary Only January starters were required to submit for the first quarter Two Types of Reporting Financial Reporting Narrative Reporting POs coordinate with their practices and submit reporting

Q PO Reporting Financial Reporting Highlights Majority sent back for revision; however, given the first submission, not unexpected Care coordination funding tended to exceed expenses, again not unexpected given that the time period (first three months of project launch)

Q PO Reporting – Narrative Reporting Highlights Majority of POs report difficulty in meeting hiring goals and are using current staff as care managers Majority of POs currently do provide point of care prompts for chronic disease services, gaps in care Most POs report admission/ discharge notifications within 24 hours are in place now or on track for 2012 What are they saying? Excitement Some Anxiety Many Questions Key foci for POs: Care Manager hiring, IT

# POs Reporting Yes Percent POs Reporting Yes # POs Reporting No # POs with No Response 1. Have you faced any difficulties meeting your Hybrid or Complex Care Manager hiring goals? 1659% Have you faced any difficulties meeting your Moderate Care Manager hiring goals? 1037% Have you assigned current practice, PO, or Health System staff to function as MiPCT Complex, Hybrid, or Moderate Care Managers? 2168%42 5. If yes, please answer the following questions: 1768%64 Do they retain duties other than Care Management as defined in the MiPCT model? Q Narrative Reporting Summary Care Manager Hiring Issues

MiPCT Provider/Staff Survey Areas Assessed Work perceptions, Stress, Burnout Communication Openness & Organizational Learning Relationships, Leadership, Teamwork

MiPCT Provider and Staff Experience Survey Demographics Analyses are based on responses submitted by 5/21/12 AM

Care Management Update

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MiPCT Complex Care Manager Training Partnership with Geisinger Addresses: How to identify patients for care management Tools for care management deliver that draw from best practices How to integrate within your practice G-code billing 98 care managers trained! Sessions scheduled through August 20 th

Features of Successful Care Management Models Close collaboration between care manager and PCP High level of “in-person” contact between care manager and patient Close attention to transitions of care ▫ “Handoffs” are where many errors occur ▫ Need timely information on hospital/SNF discharges Medication reconciliation is regularly performed ▫ Need access to patient record/EHR ▫ Assess adherence to medication regimens Target patients at high risk for hospitalization

MiPCT Care Management Priorities Care managers work in close proximity to PCP team ▫ In PCP office as much as possible ▫ Work with PCP team to meet their needs ▫ Evidence supports this model as superior to vendor- based Ensure Complex Care Management coverage ▫ Manage high-complexity, high-cost patients ▫ Patients selected based on risk score plus PCP input Focus on evidence-based interventions ▫ Medication reconciliation ▫ Care transitions ▫ In-person contact with patients whenever possible ▫ Comprehensive care plan for complex patients 16

Questions and Discussion