1. The Michigan Primary Care Transformation (MiPCT) Project PO Quarterly Webinar July 28, 2015 Noon to 1:30

2. Agenda Tiger Team Update - Mary Ellen Benzik (30 minutes) Briefing on the 2016 CMS Physician Fee Schedule: MiPCT-Relevant Proposed Changes – Diane Marriott (20 minutes) Best Practices for Clinical Data Submission MDC – Chris Reid (20 minutes) 2

3. Tiger Team Update 3

4. Tiger Team AIM Statement: The clinical subcommittee will be subdivided into tiger teams related to the 2015-2017 MiPCT Clinical focus areas: Impacting social determinants of health (SDH) and Integration of behavioral and mental health (IBMH ) into primary care teams The teams will be charged to: Create a framework for the POs to assess their current state in addressing these areas Synthesize existing evidence based tools and measurement strategies related to the two clinical areas Creation of a tool kit from findings in #2 for the use of the Physician Organizations in impacting MiPCT clinical focus areas of SDH and IBMH Creating foundational documents and partnership with the evolving state of Michigan SIM

5. Social Determinants of Health Healthy People 2020 https://www.youtube.com/watch?v=5Lul6KNI w_8&feature=player_embedded://www.youtube.com/watch?v=5Lul6KNI w_8&feature=player_embedded

6. Creating the Michigan Model – distilling the evidence, making it actionable Gray Year 1- 3 Blue Year 3- 5

7. Defining Component of “Michigan Model” *General literacy and health literacy are two separate capabilities that are inter- related but not interchangeable.

8. Polling Question #1 Which of the following is the most important for your PO to address ? A. Addressing the social factors that impact health B. Addressing the integration of mental health into practice workflow C. We haven’t decided which we would be most likely to address D. We have decided that we will not be able to address these issues

9. Polling question #2 – Of the social factors which would be the one you would like the most help with addressing? A.Literacy / health literacy B.Abuse of ETOH, drugs, tobacco C.Financial Constraints D.Transportation E.History of adverse childhood events F.Suitable housing G.Safe Housing ( ie mold exposure, fall risk) H.Other (please fill in the blank)

10. Polling Question #3 – Which of these is the most important deliverable for the POs related to impacting social determinants of health? A.Screening tool B.Grid of resources related to area identified C.Training related to that area for practice teams D.Information / best practices on community partnerships and best practices E.Other – please fill in the blank

11. Polling Question #4 – Related to the integration of mental health in the primary care practice–which area do you consider the most important for your PO ? A.Depression B.Anxiety C.Substance use D.Adverse Events of Childhood ( and the impact on adult functioning) E.Other

12. Polling question #5 – What is the most important deliverable related to mental health integration for the POs? A.Screening tools B.Resource grid for applicable available services C.Training for the practices on interventions D.Evidence based practices and best practices examples E.Other

13. 2016 Proposed Physician Fee Schedule (PFS) Release and Comment Preparation 13

14. MiPCT-Relevant Proposals: ▫1) New Advance Care Planning Codes  Purpose: To pay for a provider's time discussing patient choices for advance directives and completing necessary forms.  Code Detail:  One code would cover the first 30 minutes and the other would cover any additional 30-minute blocks that are needed.  Consideration of making it “an optional element” of a beneficiary's annual wellness visit 14 PFS Highlights Overview (Issued 7/8/15)

15. ▫2) Comprehensive Primary Care Initiative Potential Expansion  Our “sister program” that parallels the Multipayer Advanced Primary Care Demonstration (MAPCP) approach.  MAPCP: CMS joins existing State efforts  CPCI: CMS leads with multipayer partner participation  CPCI focus areas (milestones) largely similar to MiPCT programming  Enhanced patient access and continuity of care,  Planned chronic and preventive care,  Risk-stratified care management,  Patient and caregiver engagement, and  Coordination of care across a “medical neighborhood” 15 PFS Highlights Overview

16. ▫2) Comprehensive Primary Care Initiative Potential Expansion, cont.  7 CPCI areas currently (AK, CO, NJ, OR, Captial District- Hudson Valley; Cincinnati/Dayton; Greater Tulsa)  Payment approx $15 PMPM with shared savings option (distributed by relative quality performance)  Practices must report at least 9 of 31 electronic clinical quality measures (aligned with PQRS; Meaningful Use)  Expansion potential in 2017 (as CPCI expires 12/31/16) 16 PFS Highlights Overview

17. CMS Comment Invitation Areas What support is needed by practices? How ready are payers and self-insured employers to join? Would Medicaid participate (FFS, managed care)? Are practices ready to report clinical quality measures?; Are payers interested in using results (vs payer population) for incentive distributions? How can actionable data for performance improvement be provided to practices with an emphasis on cost of care? 17

18. ▫3) Other Proposals of Interest  Improved Care Management payment for TCM and CCM Codes that considers the resources required for a particular beneficiary  Reduced TCM and CCM reporting burden  Collaborative Care Model (for chronic conditions and/or behavioral health)  Beneficiary financial responsibility waiver for coordination services invisible to patient  TCM and CCM eligibility for FQHCs and RHCs 18 PFS Highlights Overview

19. Proposed Process for 2015 Comment Submission Comments due by 5pm September 8th. Leverage our standard process from prior years Draft comment preparation Operations Group review Steering Committee review and refinement via email Also coordinating with our State partners from other demonstration sites (MAPCP and CPCI) and Milbank

20. Best Practices for Clinical Data Submission 20