The Michigan Primary Care Consortium and its Initiatives

The Michigan Primary Care The Michigan Primary Care Consortium and its Consortium and its

InitiativesInitiatives

March 2009March 2009

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Presentation OutlinePresentation Outline• Origin of the MI Primary Care ConsortiumOrigin of the MI Primary Care Consortium• The MPCC OrganizationThe MPCC Organization• Current Priorities and Plans of the MPCCCurrent Priorities and Plans of the MPCC• The Patient-Centered Medical HomeThe Patient-Centered Medical Home• ““Improving Performance in Practice” (IPIP) Improving Performance in Practice” (IPIP)

ProgramProgram• Vision for a Healthy MichiganVision for a Healthy Michigan

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Broken Health Care SystemBroken Health Care System• Rising costs of health care Rising costs of health care • Rising rates of uninsured, underinsuredRising rates of uninsured, underinsured• Flat or worsening health status Flat or worsening health status

indicatorsindicators• Significant health disparities Significant health disparities • Unimpressive quality indicatorsUnimpressive quality indicators• Rising dissatisfactionRising dissatisfaction• Aging population greater demands Aging population greater demands

on health care systemon health care system

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Primary Care System in Primary Care System in CrisisCrisis• Fragmented, uncoordinated patient careFragmented, uncoordinated patient care• Inconsistent delivery of evidence-based Inconsistent delivery of evidence-based

care, especially preventive and chronic care, especially preventive and chronic carecare

• Misaligned reimbursement systemMisaligned reimbursement system• Increasing expectations/demands by Increasing expectations/demands by

payers, purchaserspayers, purchasers• Shrinking primary care workforce, Shrinking primary care workforce,

especially physiciansespecially physicians• Survival of primary care is questionedSurvival of primary care is questioned

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Why Is Primary Care Why Is Primary Care Important?Important?

Better health outcomes

Lower costs

Greater equity in health

Source: Barbara Starfield, October 2006

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Michigan Primary Care Michigan Primary Care ConsortiumConsortium

BACKGROUNDBACKGROUNDIn 2005-06, 134 Michigan professionals In 2005-06, 134 Michigan professionals developed strategic recommendations to developed strategic recommendations to resolve key primary care system barriersresolve key primary care system barriers

Five barriers to effective primary care:Five barriers to effective primary care:• Under-use of community resourcesUnder-use of community resources• Under-use of patient registries, other HITUnder-use of patient registries, other HIT• Under-use of evidence-based guidelinesUnder-use of evidence-based guidelines• Inappropriate reimbursement systemInappropriate reimbursement system• Practices not designed to deliver preventive or Practices not designed to deliver preventive or chronic chronic carecare

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MISSIONMISSION

The Michigan Primary Care Consortium is a The Michigan Primary Care Consortium is a collaborative public/private partnershipcollaborative public/private partnership created to created to improve the system of deliveryimprove the system of delivery ofof preventionprevention and chronic disease and chronic disease servicesservices and other conditions in primary care and other conditions in primary care settings throughout the state, by settings throughout the state, by aligningaligning existing quality improvement initiatives, existing quality improvement initiatives, addressing gapsaddressing gaps, and engaging in , and engaging in problem-problem-solving solving strategies to strategies to assure a patient-assure a patient-centered medical homecentered medical home for everyone. for everyone. 20082008

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The OrganizationThe Organization

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MPCC MembershipMPCC MembershipProfessional & Trade Professional & Trade

AssociationsAssociationsInsurers and PayersInsurers and PayersHealth SystemsHealth SystemsBusinessesBusinessesRegional QI InitiativesRegional QI InitiativesPublic Health AgenciesPublic Health AgenciesConsumer OrganizationsConsumer OrganizationsOthersOthers

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MPCC Membership:MPCC Membership:Diverse StakeholdersDiverse Stakeholders

Professional/Trade AssociationsProfessional/Trade Associations• American College of Physicians, MI Chapter American College of Physicians, MI Chapter • MI Academy of Family PhysiciansMI Academy of Family Physicians• MI Academy of Physician AssistantsMI Academy of Physician Assistants• MI Association for Local Public HealthMI Association for Local Public Health• MI Association of Health PlansMI Association of Health Plans• MI Association of Osteopathic Family PhysiciansMI Association of Osteopathic Family Physicians• MI Chapter, American Academy of PediatricsMI Chapter, American Academy of Pediatrics• MI Council of Nurse PractitionersMI Council of Nurse Practitioners• MI Health and Hospital AssociationMI Health and Hospital Association

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Professional/Trade AssociationsProfessional/Trade Associations (continued) (continued)• MI Osteopathic AssociationMI Osteopathic Association• MI Pharmacists AssociationMI Pharmacists Association• MI Primary Care AssociationMI Primary Care Association• MI State Medical SocietyMI State Medical Society

Insurers Insurers • AetnaAetna• Blue Cross Blue Shield of MichiganBlue Cross Blue Shield of Michigan• MedicaidMedicaid

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Health SystemsHealth Systems• Genesys Health SystemGenesys Health System• Henry Ford Health SystemHenry Ford Health System• Karmanos Cancer Institute of Wayne State Karmanos Cancer Institute of Wayne State

UniversityUniversity• University of Michigan Health SystemUniversity of Michigan Health System

Consumer OrganizationsConsumer Organizations• MI Consumer Health CoalitionMI Consumer Health Coalition• MI Council for Maternal and Child HealthMI Council for Maternal and Child Health

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Regional Health InitiativesRegional Health Initiatives• Alliance for Health, Western MIAlliance for Health, Western MI• Detroit/Wayne County Health AuthorityDetroit/Wayne County Health Authority• Greater Detroit Area Health CouncilGreater Detroit Area Health Council• School & Community Health AllianceSchool & Community Health Alliance

Public Health OrganizationsPublic Health Organizations• Detroit Dept of Health and Wellness PromotionDetroit Dept of Health and Wellness Promotion• MI Department of Community HealthMI Department of Community Health

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BusinessesBusinesses• Automotive Industry Action GroupAutomotive Industry Action Group• Chrysler LLCChrysler LLC• Ford Motor Co.Ford Motor Co.• General Motors, Inc. General Motors, Inc. • GlaxoSmithKline Pharmaceuticals, Inc.GlaxoSmithKline Pharmaceuticals, Inc.• Merck & Company, Inc.Merck & Company, Inc.• Pfizer, Inc.Pfizer, Inc.• Pyper Products, Inc.Pyper Products, Inc.

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Others Others • Gratiot Family PracticeGratiot Family Practice• Integrated Health AssociatesIntegrated Health Associates• Medical Network OneMedical Network One• MI Health CouncilMI Health Council• MI Peer Review OrganizationMI Peer Review Organization• MI State University Institute for Healthcare StudiesMI State University Institute for Healthcare Studies

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MPCC CommitteesMPCC Committees• Steering (and Executive) - Chair, Janet Olszewski, Steering (and Executive) - Chair, Janet Olszewski,

MDCHMDCH• Priorities – Chair, Kim Sibilsky, MPCAPriorities – Chair, Kim Sibilsky, MPCA• Communications – Chair, Rebecca Blake, MSMSCommunications – Chair, Rebecca Blake, MSMS• Governance – Chair, Dennis Paradis, MOAGovernance – Chair, Dennis Paradis, MOA• Funding – Chair, Lody Zwarensteyn, AFHFunding – Chair, Lody Zwarensteyn, AFH• Strategic Planning – Chair, Larry Wagenknecht, Strategic Planning – Chair, Larry Wagenknecht,

MPAMPA

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““White Paper” Work GroupsWhite Paper” Work Groups• Primary Care in Crisis – Lead: MOAPrimary Care in Crisis – Lead: MOA• Consumer Engagement and Activation Consumer Engagement and Activation

– Lead: MSMS– Lead: MSMS• Rebuilding Primary Care Workforce – Rebuilding Primary Care Workforce –

Lead: MSU and WSULead: MSU and WSU• Practice Transformation and Payment Practice Transformation and Payment

Reform – Lead: AIAGReform – Lead: AIAG

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2009-2010 MPCC Action 2009-2010 MPCC Action GroupsGroups1.1. Consumer Engagement and Consumer Engagement and

EmpowermentEmpowerment2.2. Rebuilding the Primary Care Rebuilding the Primary Care

WorkforceWorkforce3.3. Practice TransformationPractice Transformation4.4. Payment ReformPayment Reform

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Other MPCC Work GroupsOther MPCC Work Groups• Multi-Payer Group working on MI consensus Multi-Payer Group working on MI consensus

on PCMH definition, metrics, recognition, on PCMH definition, metrics, recognition, payment payment

• Task Group drafting PCMH DefinitionTask Group drafting PCMH Definition• Task Group drafting PCMH Metrics Task Group drafting PCMH Metrics • Task Group working on collaboration Task Group working on collaboration

between MPCC and MI Health Information between MPCC and MI Health Information Technology CommissionTechnology Commission

• Primary Care Summit Planning GroupPrimary Care Summit Planning Group

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Priorities for 2009-2010Priorities for 2009-2010

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Michigan Primary Care Michigan Primary Care Consortium’s Consortium’s

Priority Projects for 2009/2010Priority Projects for 2009/20101.1. Increase transparency for consumers Increase transparency for consumers

regarding health care quality and cost, regarding health care quality and cost, improve self- management and improve self- management and empowerment, and increase health literacy. empowerment, and increase health literacy.

2.2. Address primary care workforce shortages.Address primary care workforce shortages.3.3. Increase transformation of primary care Increase transformation of primary care

practices to create Patient-Centered Medical practices to create Patient-Centered Medical Homes that provide efficient and effective Homes that provide efficient and effective preventive and chronic care management.preventive and chronic care management.

4.4. Work toward payment reform concurrent with Work toward payment reform concurrent with transformation.transformation.

5.5. Support and evaluate the MPCC’s “Improving Support and evaluate the MPCC’s “Improving Performance in Practice” (IPIP) program.Performance in Practice” (IPIP) program.

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MPCC Recommendations to MPCC Recommendations to its Action Groupits Action Group

1.1. Consumer Empowerment Consumer Empowerment – focus – focus on:on:– TransparencyTransparency– Self ManagementSelf Management– Health LiteracyHealth Literacy

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CONSUMER ENGAGEMENTCONSUMER ENGAGEMENT Transparency Transparency • The MPCC should support and encourage efforts to The MPCC should support and encourage efforts to

provide transparent information on health care costs, provide transparent information on health care costs, quality of services, and what insurance covers.quality of services, and what insurance covers.

• The MPCC should promote that payers provide The MPCC should promote that payers provide eligibility and coverage information at point-of-eligibility and coverage information at point-of-service through a “smart card” or a web portal in service through a “smart card” or a web portal in order to reduce administrative logjams and order to reduce administrative logjams and paperwork, improve transparency, and help prevent paperwork, improve transparency, and help prevent fraud and abuse. (Information minimally should fraud and abuse. (Information minimally should include the patient’s deductibles and co-pays, what include the patient’s deductibles and co-pays, what their insurance policies cover, and what portion of their insurance policies cover, and what portion of the cost may be borne by the patient).the cost may be borne by the patient).

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CONSUMER ENGAGEMENTCONSUMER ENGAGEMENT Self-ManagementSelf-Management• The MPCC should urge medical schools and other The MPCC should urge medical schools and other

health care professional training programs to health care professional training programs to develop and utilize educational programs that develop and utilize educational programs that include patient self-management, motivational include patient self-management, motivational interviewing, and patient-centered primary health interviewing, and patient-centered primary health care in their curricula.care in their curricula.

• The MPCC should evaluate methods to engage The MPCC should evaluate methods to engage patients in self-management (e.g., PAM, Motivational patients in self-management (e.g., PAM, Motivational Interviewing), assess their feasibility for use by Interviewing), assess their feasibility for use by diverse primary care practices in Michigan, and diverse primary care practices in Michigan, and communicate results to MI practices statewide.communicate results to MI practices statewide.

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CONSUMER ENGAGEMENTCONSUMER ENGAGEMENT Health LiteracyHealth Literacy• The MPCC should encourage updates to The MPCC should encourage updates to

the statewide ‘Michigan Model for the statewide ‘Michigan Model for Comprehensive School Health Education’ Comprehensive School Health Education’ to improve health literacy of Michigan to improve health literacy of Michigan youth (K-12).youth (K-12).

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2.2. Primary Care Workforce Primary Care Workforce – focus – focus on:on:– State PlanState Plan– Incentives for ExpansionIncentives for Expansion– Financial Help for StudentsFinancial Help for Students– Mentoring New PractitionersMentoring New Practitioners

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PRIMARY CARE PRIMARY CARE WORKFORCEWORKFORCE State Plan State Plan • The MPCC should support development of The MPCC should support development of

a State Plan based on analysis of a State Plan based on analysis of workforce data to address the gap workforce data to address the gap between projected workforce needs and between projected workforce needs and the projected number of primary care the projected number of primary care workers (all disciplines) who will be workers (all disciplines) who will be employed in the State, paying special employed in the State, paying special attention to geographically and attention to geographically and economically underserved areas. economically underserved areas.

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PRIMARY CARE PRIMARY CARE WORKFORCEWORKFORCE Incentives for ExpansionIncentives for Expansion• The MPCC should advocate for granting The MPCC should advocate for granting

State funding preference to health State funding preference to health professional schools that meet or exceed professional schools that meet or exceed target numbers of graduating students in target numbers of graduating students in designated primary care specialties. designated primary care specialties.

• The MPCC should encourage endowments The MPCC should encourage endowments and capital campaigns to assist in and capital campaigns to assist in expanding the numbers of medical, nurse expanding the numbers of medical, nurse practitioner and physician assistant practitioner and physician assistant students recruited from and trained in students recruited from and trained in Michigan who choose to become primary Michigan who choose to become primary care providers in Michigan.care providers in Michigan.

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PRIMARY CARE PRIMARY CARE WORKFORCEWORKFORCE Financial Aid to StudentsFinancial Aid to Students• The MPCC should advocate for academic The MPCC should advocate for academic

institutions giving financial aid preference, institutions giving financial aid preference, including loans and scholarships, to medical including loans and scholarships, to medical residents and NP and PA students that commit residents and NP and PA students that commit to practice in primary care settings in Michigan to practice in primary care settings in Michigan with bonuses to those who choose to practice with bonuses to those who choose to practice in rural and other underserved areas. in rural and other underserved areas.

• The MPCC should advocate for the expansion The MPCC should advocate for the expansion

and wide communication of loan forgiveness and wide communication of loan forgiveness programs and other incentives to professionals programs and other incentives to professionals who agree to provide primary care services in who agree to provide primary care services in designated underserved areas in Michigan.designated underserved areas in Michigan.

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PRIMARY CARE PRIMARY CARE WORKFORCEWORKFORCE Mentoring New PractitionersMentoring New Practitioners• The MPCC should encourage expansion of The MPCC should encourage expansion of

programs to reimburse providers who programs to reimburse providers who assume primary care mentoring roles.assume primary care mentoring roles.

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3.3. Primary Care Transformation Primary Care Transformation – – focus on:focus on:– Convener Role for MPCCConvener Role for MPCC– Practice TransformationPractice Transformation– Health Information TechnologyHealth Information Technology

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PRIMARY CARE PRIMARY CARE TRANSFORMATION TRANSFORMATION Convener Role Convener Role • The MPCC should assume the role of The MPCC should assume the role of

“umbrella” organization and “champion” “umbrella” organization and “champion” for statewide primary care transformation for statewide primary care transformation and implementation of PCMH, including:and implementation of PCMH, including:– Convening stakeholders with interest in Convening stakeholders with interest in

promoting integration of the principles of the promoting integration of the principles of the PCMH into Michigan primary care practicesPCMH into Michigan primary care practices

– Developing a clear definition of the PCMHDeveloping a clear definition of the PCMH– Identifying meaningful metrics that can Identifying meaningful metrics that can

distinguish the PCMH from other practicesdistinguish the PCMH from other practices

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PRIMARY CARE PRIMARY CARE TRANSFORMATION TRANSFORMATION Convener Role Convener Role (continued)(continued)

– Identifying how PCMH practices will be Identifying how PCMH practices will be recognized in Michiganrecognized in Michigan

– Promoting payment models that adequately Promoting payment models that adequately support creation and sustainability of PCMHsupport creation and sustainability of PCMH

– Developing action plans for the MPCC’s priorities Developing action plans for the MPCC’s priorities that MPCC members and other stakeholders can that MPCC members and other stakeholders can reasonably expect to executereasonably expect to execute

– Conducting ongoing evaluation to identify which Conducting ongoing evaluation to identify which modifications increase value and should be modifications increase value and should be promoted as greater experience with PCMH promoted as greater experience with PCMH evolves evolves

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PRIMARY CARE PRIMARY CARE TRANSFORMATIONTRANSFORMATIONPractice TransformationPractice Transformation• The MPCC should support and promote assessment The MPCC should support and promote assessment

and analysis of practice culture and process flow in and analysis of practice culture and process flow in Michigan practices by qualified professionals skilled Michigan practices by qualified professionals skilled in the use of validated quality management in the use of validated quality management systems and process-improvement tools. systems and process-improvement tools. Objectives of process are:Objectives of process are:– Improvements in quality and patient safetyImprovements in quality and patient safety– Improvements in patient care coordinationImprovements in patient care coordination– Reductions in wasteReductions in waste– Improvements in patient, staff and provider Improvements in patient, staff and provider

satisfactionsatisfaction– Adoption and effective use of all relevant modalities Adoption and effective use of all relevant modalities

of health information technologyof health information technology

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PRIMARY CARE PRIMARY CARE TRANSFORMATIONTRANSFORMATIONHealth Information TechnologyHealth Information Technology• The MPCC should promote the effective The MPCC should promote the effective

use of patient/population registries and use of patient/population registries and other useful health information other useful health information technology in primary care practices. technology in primary care practices.

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4.4. Payment Reform Payment Reform – focus on: – focus on:– Payment Policies for PCMHPayment Policies for PCMH– Practice Infrastructure SupportPractice Infrastructure Support

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PAYMENT REFORMPAYMENT REFORM Payment Policies - PCMHPayment Policies - PCMH• The MPCC should review payment policies The MPCC should review payment policies

tested in Michigan and elsewhere and tested in Michigan and elsewhere and develop recommendations for change in develop recommendations for change in Michigan payment policies that support the Michigan payment policies that support the PCMH (e.g., increased direct payments PCMH (e.g., increased direct payments through fee for service and primary care through fee for service and primary care capitation models; supplemental incentives capitation models; supplemental incentives and/or payment models to sustain PCMH and/or payment models to sustain PCMH including, but not limited to, bundled including, but not limited to, bundled arrangements and risk models).arrangements and risk models).

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PAYMENT REFORMPAYMENT REFORMPractice Infrastructure SupportPractice Infrastructure Support• The MPCC should encourage all potential The MPCC should encourage all potential

private and public funding sources to invest private and public funding sources to invest in practice-level infrastructure for the PCMH. in practice-level infrastructure for the PCMH. Initial direct funding is needed for: Initial direct funding is needed for: – Practice redesignPractice redesign– Information technology Information technology – Additional personnel to provide team careAdditional personnel to provide team care– Education and training for all providers to create Education and training for all providers to create

and sustain a PCMHand sustain a PCMH

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PAYMENT REFORMPAYMENT REFORMPractice Infrastructure Support Practice Infrastructure Support (continued)(continued)• The MPCC should advocate for financial The MPCC should advocate for financial

arrangements that enable primary care arrangements that enable primary care practices to purchase and to staff practices to purchase and to staff important health information infrastructure important health information infrastructure including:including:– Population-Patient Registries Population-Patient Registries – Electronic Medical RecordsElectronic Medical Records– E-prescribingE-prescribing– Web portals for patients and providers Web portals for patients and providers

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World Health Org: Acute vs Chronic CareWorld Health Org: Acute vs Chronic Care““Health care systems [throughout the world] evolved Health care systems [throughout the world] evolved around the concept of infectious disease, and they around the concept of infectious disease, and they perform best when addressing patients’ episodic and perform best when addressing patients’ episodic and urgent concerns. However,urgent concerns. However, the acute care paradigm the acute care paradigm is no longer adequate for the changing health is no longer adequate for the changing health problems in today’s world.problems in today’s world.

Both high- and low-incomeBoth high- and low-income countries spend billions of countries spend billions of dollars on unnecessary hospital admissions, dollars on unnecessary hospital admissions, expensive technologies, and the collection of expensive technologies, and the collection of useless clinical information. useless clinical information.

As long as the acute care model dominates health As long as the acute care model dominates health care systems, health care expenditures will care systems, health care expenditures will continue to escalate, but improvements in the continue to escalate, but improvements in the population’s health status will not.”population’s health status will not.”World Health Organization. Innovative care for chronic conditions: building blocks for World Health Organization. Innovative care for chronic conditions: building blocks for action: global report. (Geneva: WHO; 2002.)action: global report. (Geneva: WHO; 2002.)

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Informed,ActivatedPatient

ProductiveInteractions

Prepared,ProactivePractice Team

Improved Outcomes

DeliverySystemDesign

DecisionSupport

ClinicalInformation

Systems

Self-Management

Support

Health SystemResources and Policies

Community Health Care Organization

Chronic Care Model

Outcomes

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The Patient-Centered The Patient-Centered Medical Home (PCMH)Medical Home (PCMH)• What is this?What is this?• Why has MPCC identified PCMH as Why has MPCC identified PCMH as

THE SOLUTION to the Primary Care THE SOLUTION to the Primary Care CrisisCrisis

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Patient-Centered Medical Patient-Centered Medical HomeHome• PCMH is an approach to providing PCMH is an approach to providing

comprehensive primary care for children, comprehensive primary care for children, youth, adults and seniors based on the youth, adults and seniors based on the Chronic Care Model Chronic Care Model

• PCMH is a health care setting that facilitates PCMH is a health care setting that facilitates partnerships between patients and their partnerships between patients and their personal physicians and, when appropriate, personal physicians and, when appropriate, the patient’s family or caregiversthe patient’s family or caregivers

• A PCMH makes effective use of community A PCMH makes effective use of community resources and supports to assist patients and resources and supports to assist patients and families become activated and achieve their families become activated and achieve their health goalshealth goals

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PCMH Practices…PCMH Practices…• Organize the delivery of Organize the delivery of team-based careteam-based care for all for all

patients, consistent with the Chronic Care Modelpatients, consistent with the Chronic Care Model• Use Use evidence-based medicineevidence-based medicine and clinical decision and clinical decision

support toolssupport tools• Use secure Use secure health information technologyhealth information technology to to

promote quality and safety promote quality and safety • Coordinate care in Coordinate care in partnershippartnership with patients and with patients and

familiesfamilies• Provide enhanced and convenient Provide enhanced and convenient accessaccess to care to care• Identify andIdentify and measure measure key quality indicators key quality indicators• Participate in programs that provide Participate in programs that provide feedbackfeedback to to

practices on performance and practices on performance and accept accountability accept accountability for process improvement and for health outcomesfor process improvement and for health outcomes

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PCMH IS AN OPPORTUNITY FORPCMH IS AN OPPORTUNITY FOR• Improving health of patients and their Improving health of patients and their

satisfaction with their care satisfaction with their care • Improving purchaser and payer satisfaction Improving purchaser and payer satisfaction

with outcomes of carewith outcomes of care• Improving reimbursement for primary care Improving reimbursement for primary care • Improving physician satisfaction with their Improving physician satisfaction with their

choice to specialize in primary carechoice to specialize in primary care• Improving recruitment of medical residents, Improving recruitment of medical residents,

NP’s and PA’s into primary careNP’s and PA’s into primary care• Slowing the rise in health care spendingSlowing the rise in health care spending

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2007 Joint Principles for 2007 Joint Principles for PCMHPCMH

Jointly approved by:Jointly approved by:• American Academy American Academy

of Family Physiciansof Family Physicians• American Academy American Academy

of Pediatricsof Pediatrics• American College of American College of

PhysiciansPhysicians• American American

Osteopathic Osteopathic AssociationAssociation

• Personal physicianPersonal physician• Physician-directed Physician-directed

medical practicemedical practice• Whole person Whole person

orientationorientation• Care is coordinated Care is coordinated

and/or integratedand/or integrated• Quality and safetyQuality and safety• Enhanced access to careEnhanced access to care• Payment that supports a Payment that supports a

PCMHPCMH

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PCMH Definition in MichiganPCMH Definition in Michigan

• Same as Joint Principles with Same as Joint Principles with footnotes to further define:footnotes to further define:

• Patient-CenteredPatient-Centered• Personal PhysicianPersonal Physician• Quality and SafetyQuality and Safety• PaymentPayment

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Patient-Centered – MI Patient-Centered – MI FootnoteFootnote• This model of care recognizes the central This model of care recognizes the central

role of patients and – when appropriate – role of patients and – when appropriate – their families, as stewards of their own their families, as stewards of their own health. In the Patient-Centered Medical health. In the Patient-Centered Medical Home, the team of health professionals Home, the team of health professionals guides and supports patients and their guides and supports patients and their families to help them achieve their own families to help them achieve their own health and wellness goals. health and wellness goals.

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Personal Physician - MI Personal Physician - MI FootnoteFootnote• A personal physician may be of any specialty A personal physician may be of any specialty

but to be considered a Patient-Centered but to be considered a Patient-Centered Medical Home, the practice must meet all Medical Home, the practice must meet all Patient-Centered Medical Home requirements. Patient-Centered Medical Home requirements. It shall be recognized that there may be It shall be recognized that there may be situations in which a physician is not on-site situations in which a physician is not on-site and the patient’s relationship is with a and the patient’s relationship is with a certified nurse practitioner (NP) or physician certified nurse practitioner (NP) or physician assistant (PA) who provides the principal or assistant (PA) who provides the principal or predominant source of care for a patient. predominant source of care for a patient.

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Personal Physician Personal Physician (continued)(continued)

• In those instances, the NP or PA provider, in In those instances, the NP or PA provider, in collaboration with a physician, may perform collaboration with a physician, may perform thethe responsibilities of first contact, continuous responsibilities of first contact, continuous and comprehensive care if he or she is and comprehensive care if he or she is otherwise qualified by education, training, or otherwise qualified by education, training, or experience to perform the selected acts, experience to perform the selected acts, tasks, or functions necessary where the acts, tasks, or functions necessary where the acts, tasks, or functions fall within the certified tasks, or functions fall within the certified nurse practitioner’s or the physician nurse practitioner’s or the physician assistant'sassistant's scope of practice.scope of practice.

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Quality and Safety – MI Quality and Safety – MI FootnoteFootnote• Clinical outcomes, safety, resource Clinical outcomes, safety, resource

utilization and clinical and utilization and clinical and administrative efficiency are administrative efficiency are consistent with Best Practices. consistent with Best Practices.

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Payment – MI FootnotePayment – MI Footnote• Transformational change in Transformational change in

healthcare financial incentives should healthcare financial incentives should occur simultaneously with, occur simultaneously with, proportionally to, and in alignment proportionally to, and in alignment with Patient-Centered Medical Home with Patient-Centered Medical Home adoption. adoption.

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NCQA Practice Connections – Patient Centered Medical Home Certification

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BCBSM’s Physician Group BCBSM’s Physician Group Incentive Program (PGIP) Incentive Program (PGIP) For Enhanced Payments as a Patient-Centered Medical For Enhanced Payments as a Patient-Centered Medical Home:Home:

• Performance reporting Performance reporting • Patient-Provider agreement Patient-Provider agreement • Extended access Extended access • Individual care management Individual care management • Test tracking and follow-up Test tracking and follow-up • Coordination of care Coordination of care • Preventive services Preventive services • Specialist referral process Specialist referral process • Linkage to community services Linkage to community services • Self-management support Self-management support • Patient registry Patient registry • Patient portalPatient portal

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MICHIGAN PCMH METRICS Tiers 1-3

Data and Value

SourceAccess Comprehe

n-sivenessCoordinate

dContinuou

s

Patient / Family

Centeredness

Continuous Improveme

ntIntegration Linkage

Patients

Providers

Payers

Purchasers

Health System

Community

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“Systemness” as a Community Property

Improved Community Outcomes

Widespread Practice Change

Informed,ActivatedPatient

ProductiveInteractions

Prepared,ProactivePractice Team

Improved Outcomes

DeliverySystemDesign

DecisionSupport

ClinicalInformation

Systems

Self-Management

Support

Health SystemResources and Policies

Community Health Care Organization

Health Systems in a Community

Community entity provides:• Leadership and integration via coalition• Performance measurement • Financial incentives• Models of change• Programs for learning and dissemination• Shared infrastructure

1. Guidelines2. IT software and support3. Care management4. Consumer education

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““Improving Improving Performance in Performance in Practice” (IPIP) Practice” (IPIP)

ProgramProgram

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““Improving Performance in Improving Performance in Practice” ProgramPractice” Program

American Board of Medical American Board of Medical SpecialtiesSpecialties

• Created IPIP to support new physician Created IPIP to support new physician recertification requirementsrecertification requirements

• 7 states were provided with program materials 7 states were provided with program materials and support; Michigan was 3and support; Michigan was 3rdrd state selected state selected

• Funded by RWJF, grant provides 2 years of seed Funded by RWJF, grant provides 2 years of seed money to states, with states adding additional money to states, with states adding additional fundsfunds

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““Improving Performance in Improving Performance in Practice” Program in Practice” Program in MichiganMichigan

Objective:Objective: Improve chronic disease management in primary Improve chronic disease management in primary care practicescare practices

Methodology:Methodology:• Chronic disease Learning Collaborative Chronic disease Learning Collaborative

- 2-day learning sessions each quarter- 2-day learning sessions each quarter- Monthly phone calls- Monthly phone calls- Focus: Adult Diabetes and/or Pediatric Asthma- Focus: Adult Diabetes and/or Pediatric Asthma

• On-site coaching from volunteers who are On-site coaching from volunteers who are industry-trained process improvement engineersindustry-trained process improvement engineers

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Key IPIP InterventionsKey IPIP Interventions1.1. Use a Patient RegistryUse a Patient Registry2.2. Initiate Team CareInitiate Team Care3.3. Implement Planned VisitsImplement Planned Visits4.4. Provide Self-Management SupportProvide Self-Management Support5.5. Work toward Creation of a PCMHWork toward Creation of a PCMH

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IPIP Practice Sites,IPIP Practice Sites, 2008-092008-09

N=22

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Improving Performance in Improving Performance in PracticePractice

For more information about IPIP:For more information about IPIP:

http://ipip.aiag.orghttp://ipip.aiag.org

Rose Steiner Rose Steiner [email protected]@aiag.org State Director (248) 213-4656State Director (248) 213-4656

mailto:[email protected]

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RECOMMENDATIONS for Action RECOMMENDATIONS for Action by MPCC and all Stakeholdersby MPCC and all Stakeholders• Help create informed, activated patients and families by Help create informed, activated patients and families by

supporting proactive teams in every primary care supporting proactive teams in every primary care practice and in all community health settingspractice and in all community health settings

• Promote IPIP Program to primary care practices as a Promote IPIP Program to primary care practices as a transformation opportunitytransformation opportunity

• Identify community resources that can help small Identify community resources that can help small practices create a PCMH for their patients practices create a PCMH for their patients

• Create PCMHs in all primary care settings in public Create PCMHs in all primary care settings in public sector sector

• Provide leadership in communities to spread PCMH via Provide leadership in communities to spread PCMH via Wagner’s community modelWagner’s community model

• Encourage PCMH practices to advocate for community Encourage PCMH practices to advocate for community supports: healthy public policy, community supports: healthy public policy, community environments that encourage healthy lifestyles, environments that encourage healthy lifestyles, community actions directed at social determinants of community actions directed at social determinants of healthhealth

Michigan Steps Up!“Move More, Eat Better,

Don’t Smoke”* 20-year Statewide Social

Change Movement* State & Community

Coalitions for Environment & Policy Change Toward Wellness

* Roles for Business, Schools, Health Care, Faith Based & Community Organizations

* PH Fellowship Program for Workforce Replacement

* Minority Health Resource & Consultation Center

* Informing, Empowering Citizens

* Modeling Public Health Improvement for Citizens

“Michigan First” Proposal to CMS

“Access to Insurance for All” * Private Market Products * Medicaid 1115 Waiver * Subsidized Cost for those

<200% poverty* Unsubsidized Resource for

those >200% Poverty* Coverage for Prevention, Primary

Care, Pharmacy, Mental Health, Limited Hospital Services

* Encouraging Personal Responsibility

* Monitoring Safety, Quality * Informing Citizens* Modeling Prevention Benefits for

all Health Insurers

State & Local Public Health Programs“Public Health: For Michigan, For You”

* Immunizations * Smoke-Free Policies* WIC * Stroke Prev/Management* Health Promotion * Blood Pressure Control* School Health * Heart Disease Prevention* Obesity Prevention * Cancer Screening* Asthma Control * Diabetes Prev & Control* Osteoporosis Prev. * Kidney Disease Prev. * Fall Prevention * Health Disparity Reduction* Injury Prevention * End of Life/Palliative Care* Suicide Prevention * Etc.

VISION FOR A HEALTHY MICHIGAN

Healthy, Empowered Citizens

Healthy Communities

Healthy Michigan Economy

Michigan Primary Care Consortium “ A Patient-Centered Medical Home for All”

Removal of System Barriers to enable: * Use of Community Resources * Payment Reform that supports PCMH

* Use of Evidence-based Clinical Guidelines * Redesigned Practices for Efficient, Effective * Use of Patient Registries, other Info Technology Preventive and Chronic Care

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Michigan Primary Care ConsortiumMichigan Primary Care Consortium

For more information about the MPCC:For more information about the MPCC: www.MIPCC.orgwww.MIPCC.org

[email protected]@MIPCC.org (517) 241-7353(517) 241-7353

http://www.mipcc.org/

Documents

The Michigan Primary Care Consortium and its Initiatives