2. Quality Measures in a Multi-Payer Environment
EVENT
MiHIN Connecting Michigan for Health
June 8, 2016
PRESENTER
Ellen Bunting
Manager
Michigan Data Collaborative (MDC)
Information and Data Management (I&DM)
Medical Center Information Technology (MCIT)
University of Michigan Health System (UMHS)
The Michigan Primary Care Transformation Project (MiPCT)
Quality Improvement
Goals and Measurement
Aligning HEDIS measures in the Multi-Payer Environment
Changing the perspective with a Multi-Payer View

3. MiPCT PCMH Practices working with Physician Organizations in Michigan
Demonstrating the value of the PCMH model in a Multi-Payer environment

4. Key Elements in the PCMH Model
Data is best used for learning. Finding variation and identifying the best performers.
Goal setting in Primary Care needs information by all payer measures, not just by health plan.

5. Measuring Performance in a Clinical Setting
Performance and Payment measured through clinical data and all payer claims data.
Clinical and claims data serve many masters…

6. Challenges in the Multi-Payer Environment Context
HEDIS Measures are designed to measure populations within a Health Plan
With some changes, the HEDIS measures will work for an expanded all payer population.
We just need a different kind of screwdriver

7. Modifications in a Multi-Payer Environment
Age
Reporting Period
Multiple Plans
Continuous Enrollment
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
BCBSM
Medicaid
Patients who qualify as continuously enrolled as a result of counting all insured months
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Priority H
Medicaid
Patients who are continuously enrolled over non-calendar year reporting periods

8. The Multi-Payer MiPCT Database
PHYSICIAN ORGANIZATIONS
PAYERS
Medicaid
Medicare
BCBSM
BCN
Priority Health
EHR Data
Claims Data
= Electronic Clinical Quality Measures

9. Measuring in the Multi-Payer Environment
Success factors when measuring all payer data
Using all data available from Physician Organization EHRs and Claims from participating payers
Linking patients’ data internally by demographic and carrier specific ID – Need a common identifier
Identifying the denominator by population regardless of payer

11. Change is hard, but not impossible
The Carter Center starts an initiative during the decade of water, makes it their mission to eradicate Guinea Worm.
1986
2015
3.5 Million Cases
22 Cases
Obstacles
Accomplishments
No Vaccine or medicine for prevention
From 21 countries to 4 countries with active cases of Guinea Worm
Logistics – visiting and teaching in more than 300,000 villages
Changed Behavior: prevent people from entering bodies of water with emerging worm.
War
Also taught to filter water and treat it with chemicals to kill the larvae.
88 million cases prevented at about $3 per case
I hope the last guinea worm dies before I do.
Former President Jimmy Carter

12. Thank-you for your Attention Questions or Comments for the Panel
Thank-you for your Attention Questions or Comments for the Panel? Jason Werner, MDHHS Joe Neller, MSMS Ellen Bunting, MDC