1. Re-Defining a Paradigm of Care: Transforming Payment Models to Better Match With Physician Time and Effort
Grant M. Greenberg, M.D., M.A., M.H.S.A.
Joel J. Heidelbaugh, M.D., FAAFP, FACG
David C. Serlin, M.D.
University of Michigan Department of Family Medicine

2. Disclosures
None to Report for any of the presenters

3. 26,000 faculty, staff, students, trainees, & volunteers
3 hospitals with 990 beds, 45,000 stays annually
40 outpatient locations, 120 clinics, 1.9 million outpatient visits annually
Research – $453 million annually
Affiliations – AAVA, ACOs, state-wide collaboratives, others
Department of Family Medicine: 6 Clinics, 90+ Faculty, 75,000+ patients

4. BURNING PLATFORM You/We are going out of business!
Shifting Payer Mix: demographics and Medicare
No Quick Fix- ongoing changes (effectiveness, efficiency)
Physicians are a key part of the problem, and solution
(apprentice model: do what I do vs change
what I do)

5. Our Current State: Clinical Payment Model
wRVU (work-Relative Value Units)
Based on Patients Seen
Accounts for Complexity
$ Amount per wRVU paid from Medical Group to Department, reflecting payment from Payer to Medical Group
The more you see, and the more complex they are, the higher the payment

6. Other Relevant Models:
Concierge/Direct Primary Care
Cash Only
Pure Capitation (Per Member Per Month)
Performance Payment (Quality, Efficiency)

7. Current Payment Model GAPS for Population Management
Based on Visits, not population based (Passive System)
Driven by individual productivity, not team
No inherent incentive to improve quality
No direct accounting for asynchronous work

8. HOW CAN WE DO BETTER? Better equate reimbursement to effort
“Panel” Management
Complexity Based
Quality Based
Asynchronous Care
Reward for reducing utilization

9. Patient Panel How do we determine attribution?
(Activity based? Patient selection? Insurance Card ID?)
What is the right number?
How do we account for and define complexity across patients?

10. Attribution Models Activity Based (current)
2 visits in past 2 years, one within past 13 months
Assignment Based (proposed)
PCP “ID” in EHR
Seen within 3 years

11. Panel Size UM Fam Med Source: University of Michigan Medical Group
Unpublished Data, September 2015

12. urrent State: Payment Highly Correlated with Visits

13. Current State: Patient Calls Loosely Related to Office Visit Volume
Source: UMHS EHR, Family Medicine Faculty
10/1/14 -9/1/15 Unpublished data

14. Current State: Follow up Work Correlates with Office Visits
Source: UMHS EHR, Family Medicine Faculty
10/1/14 -9/1/15 Unpublished data

15. Payment for Quality
Based on clinic-level performance and number of eligible patients for select chronic disease & preventive care measures
Focuses on measures that are clinically relevant and/or are tracked by external organizations (e.g., HEDIS, BCBSM, BCN)

16. Transition Plans
How do we transition care models in coordination with the uncertain transition of payment models?
Creative commons license. Photo by Subhro Ganguly

17. Payment Reform Cost Containment
Link payment to evidence and outcomes
Bundle payments by episode/condition
Reimburse for coordination of care in a medical home
Accountability for Results
Transparency Accountability No Outcome/No Income

18. Discussion What are you doing to get “there”?
-culture changes, less reliance on “autonomy”
-evidenced based practice
-reduction in variation
-continuous measurement/feedback
-patient engagement

19. Please evaluate this presentation using the conference mobile app
Please evaluate this presentation using the conference mobile app! Simply click on the "clipboard" icon on the presentation page.