quarterly update (q3) - michigan · 2018. 10. 16. · quarterly update (q3) state innovation model...
TRANSCRIPT
Quarterly Update (Q3)STATE INNOVATION MODEL
PATIENT CENTERED MEDICAL HOME INIT IATIVE
10.04.2018
MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
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PCMH Initiative Team: MDHHS Team Members
Nell NewtonProject Manager
Laura Kilfoyle, MPASIM Care Delivery Coordinator
Katie Commey, MPHSIM Care Delivery Lead
Lyndsay TylerBusinessAnalyst
MI-SIM Care DeliveryGovernance Team
Kathy StifflerMedicaid Care Management and Quality Assurance, Deputy DirectorActing Medicaid Director
Brian Keisling Medicaid Operations and Actuarial Services, Bureau Administrator
Kim Hamilton Managed Care Plan, Division Director
Penny Rutledge Actuarial Division, Manager
Theresa Landfair Managed Care Plan Division,Specialist
Tom Curtis Quality Improvement and Program Development, Section Manager
PCMH Initiative Team: U of M Team Members
Diane MarriottDirector
Amanda First-Kallus, MHSAAnalyst
Veralyn KlinkAdministrator
Marie Beisel, Sr. Project Manager
Yi MaoAnalyst
Susan StephanSr. System Analyst
Scott JohnsonInt. Project Manager
Betty Rakowski, Curriculum Designer
Jessie ChenApplication Systems
Analyst / Programmer
Alice StanulisManager, Michigan Data
Collaborative
Marty KoslaSr. Business Systems
Analyst
Clinical Values Institute Michigan Data Collaborative MI Care Management Resource Center
Sarah Fraley, Int. Project Manager
Upcoming Events:October - December 2018
Date Type of Event Topic Registration Link
Nov 13 12:00 – 1:00
SIM PCMH Initiative Office Hours Supplemental
Tracking and Monitoring Codes
REGISTER HERE
Nov 1412:00 – 1:00
SIM PCMH Initiative Office Hours--November
Patient Engagement REGISTER HERE
Dec 1912:00 – 1:00
SIM PCMH Initiative Office Hours---December
PCMH Initiative Evaluation REGISTER HERE
Upcoming Events:2018 Regional Summits
Area Date Location
North October 10, 2018 Gaylord—Treetops
West October 23, 2018 Muskegon—Holiday Inn
Southeast November 8, 2018 Ann Arbor—Kensington Hotel
“Seamless Partnerships for Effective Patient Care”
Care Coordination Collaborative (CCC) Vision:Optimize the effective partnering of plans, practices, POs, community organizations and CHIRs (i.e., the multi-stakeholder partners) for the purpose of :
1. Addressing and closing patient/member/beneficiary social determinant health needs
2. Improving population overall health status, efficiency and effectiveness of care delivery
Care Coordination Collaborative (CCC) Series Overview: Where We Are
First Virtual Event held on 6/15/18◦ Distributed contact sheets for Medicaid Health Plan coordination◦ Focused on models of joint partner collaboration (plan/practice; practice/community
organization/plan; etc.)
Second Virtual Event on 9/24/18◦ Focus on overcoming challenges to coordination◦ Two successful SIM PCMH Initiative groups shared how they overcame challenges,
dealt with stretching resources and used creative options to help patients
Next in the Series: In-person event in Spring 2019
Next Year’s Planning Committee—if interested, indicate on the Q3 Progress Report
2018 Self-Management Training OptionsTo provide additional flexibility and convenience for SIM PCMH Initiative participants, three organizations are available for self-management training for Care Managers and Coordinators who have not been trained:◦ Integrated Health partners (IHP)◦ Michigan Center for Clinical Systems Improvement (MiCCSI)◦ Practice Transformation Institute (PTI)
If self-management training is completed through one of these vendors, the PCMH Initiative will cover the cost of the course. (Travel and any other related expenses are the responsibility of the attendee or their organization.)
Trainees must attest that they have not been previously been trained in self-management. (Those who completed self-management training with a MiCMRC-approved vendor with MiPCT or another initiative do not need to be retrained).
2018 Self-Management Training Options, cont.Class availability and the number of training slots may vary at each organization. If classes with a particular vendor are full, you will be put on a wait list or can explore availability at the other organizations.
The links for each organization are:◦ Integrated Health Partners (IHP) - based in Battle Creek
◦ http://www.integratedhealthpartners.net/events◦ To be placed on a wait list, contact: Emily Moe | [email protected] | Phone: 269-425-7138.
◦ Michigan Center for Clinical Systems Improvement (Mi-CCSI) - based in Grand Rapids◦ https://www.miccsi.org/training/upcoming-events/ ◦ To be placed on a wait list, contact: Amy Wales | [email protected] | Phone: 616-551-0795 ext. 11
◦ Practice Transformation Institute (PTI) - based in Southfield◦ http://www.transformcoach.org/care-manager-training/ ◦ To be placed on a wait list, contact: Yang Yang | [email protected] | Phone: 248-475-4839
For “At a Glance” information about each organization’s Self-Management training visit: http://micmrc.org/
MiCMRC Webinar Registration
Registration for MiCMRC webinars: http://micmrc.org/webinars
MiCMRC Longitudinal Learning Activities
Registration for MiCMRC learning activities: http://micmrc.org/
Date Title CE / Certificate Availability
Oct 312:00 – 3:00
Conversations for Michigan Physician Order Scope of Treatment (MI-POST)
CE: Nursing, Social Work, Commission for Case Manager Certification (CCMC) approved
Dec 12 2:00 – 3:00
Depression in Primary Care Certificate of Completion
Online E Learning Modules E-Learning Modules designed for on demand access to educational opportunities for CMs and CCs. Access via: http://micmrc.org/e-learning
NOTE: New module: “Patient and FamilyEngagement”
CE: Nursing, Social Work
Practice Support and Learning Opportunities: Monthly Newsletters
Distributed via GovDelivery & on our website!• To sign up for the distribution:
• Email us at [email protected], or • Sign up for MDHHS subscriptions: when managing your
“subscriptions” select State Innovation Model Patient Centered Medical Home Initiative”
Will be released late month for the following month (ex. February Newsletter will be released in late January)
Designed to have upcoming events, training information, topics of interest, participant highlights, suggested resources and other pertinent information
Suggestions always welcome, please email them to [email protected]
New Summit Page
Our Care Delivery website has a dedicated to our PCMH Initiative Regional Summits. View
supplemental documents and Nursing, Social Work, CCMC Continuing Education Credits information.
Register for all 3 summits on our website and find site-specific agendas on the new page.
Upcoming Compliance: Quarterly Progress Report (Q3) UpdatesDue: October 31, 2018Content:
1. Participant information (PO contacts, practice contacts, financial service contacts, MDC acknowledgers, Care Manager lead, MHP contracting information)
2. Participation requirements information, updates and attestation2.1 Core Primary Care (PCMH)
2.2 Care Management and Coordination
2.3 Health Information Technology and Exchange3. Participation Experience, Strengths and Challenges
Note:
Participant Key Contact should have received an email with report link and supplemental excel document on September 26, 2018. The PO will complete the report on behalf of all participating practices.
Upcoming Compliance:Semi-annual Practice Transformation Report
Due: December 21, 2018Content:
1. Clinical-Community Linkages (CCL), with the following sub-sections:
1.1 Assessing social determinants of health
1.2 Linkage methodology
1.3 Quality improvement activities
2. Population Health Management (New)
2.1 Ensuring engagement of clinical and administrative leadership
2.2 Empaneling patient population
2.3 Using feedback reports
Note:
Participant Key Contact will receive an email with report link and supplemental excel document in December, 2018. The PO will complete the report on behalf of all participating practices.
Upcoming Compliance:Clinical-Community Linkages2018 Tool Requirements
◦ Addition of the following requirements:
Family carePersonal/environmental safety (domestic violence)
◦ Changes due November 2018
◦ Tool will be submitted with the Practice Transformation Report due Dec 21
◦ Screening tool template was released in April
MDC Care Coordination ReprocessingPercentage of Patients with a Care Management Claim4Q17 (Oct-Dec), 1Q18 (Jan-Mar) and 2Q18 (April-June) reports will be reprocessed in December to incorporate additional claims:
◦ Medicaid Health Plan improvements in processing the Care Management and Coordination procedure codes
◦ Participating Organization changes to billing procedures to ensure zero-dollar claims◦ More claims run-out received from normal adjudication process◦ Claims paid through October 2018 are included
PCP Follow-Up After Inpatient Discharge report to be updated◦ Align with recent changes to Acute Admissions measures on dashboard◦ Limit to admissions for PCPs (excludes surgery for example)
MDC Dashboard InformationRelease 6◦ Available end of October◦ New measures including Ambulatory Care Sensitive Condition (ACSC) Admissions, Total Cost PMPM and
quality outcome measures reliant on QMI data◦ Measures listed in the Participation Guide◦ Reporting Period July 2017 – June 2018◦ Patients and provider attribution from June 2018
Reprocessing Plans◦ All measures will be re-run using the most current definitions the beginning of 2019◦ All releases will include all measures◦ Quarterly releases will be added for all of 2017◦ Trend line added
Q3 (July - September) 2018 Payment DetailsReminders: ◦ Care Management and Coordination PMPMs see 2018 Participation Guide. ◦ Payments will be made by each individual Medicaid Health Plan, the PCMH Initiative will send
a summary email with details of expected payments
Anticipated Payment Timeframe: MHPs should make payments to participants in November
Reminder: Please ensure practice and provider updates are submitted using the online Change Form.
SIM PCMH Initiative Evaluation ComponentsEvaluation Activity Purpose Target Audience Timeline Owner
Provider Survey (PO reps, PCPs, CM/CC, Office Managers)
Identify attitudes and experiences of health providers who participate in Clinical Community Linkages (CCLs) directly or indirectly
• PCMH Initiative Participantsidentified as members or partners of a CHIR
May – July, 2018 MSU
• PCMH Initiative Participants in CHIRs NOT identified as members or partners
Aug. 1-31, 2018 MPHI
• PCMH Initiative Participants outside of CHIRs
Aug. 1-31, 2018 MPHI
Patient Experience Survey
Identify experiences of patients who participate in CCLs
• Sample of patients from PCMH Initiative Participants
Fall, 2018 CHEAR
CCL DataPartnership(optional)
Connect individual-level CCL data (Social Determinant of Health screening and linkages) to Medicaid utilization and costs (claims data from MDC)
• Patients within PCMH Initiative participants selected to participate.
Oct. 2018, quarterly thereafter
MPHI
Time for Questions
Intent To Continue Participation
PCMH Initiative Year 3 PreviewWhat Lies Ahead?
SIM Care Delivery “Big Picture Goals”:
1. Champion models of care which engage patients using comprehensive, whole person-oriented, coordinated, accessible and high-quality services centered on an individual’s health and social well-being.
2. Support and create clear accountability for quantifiable improvements in the process and quality of care, as well as health outcome performance measures.
3. Create opportunities for Michigan primary care providers to participate in increasingly higher level Alternative Payment Methodologies.
2019 Participant Expectations:
• Very little or no change to most program requirements and associated language in participation agreement.
• Implementation of the Care Management Improvement Reserve (discussed in May 2018).
• Leveraging quality data to introduce Performance Incentive Program and support a more advanced payment model.
PCMH Initiative Year 3 Preview CM/CC Benchmarks
Note: The updated language does not reflect a change in performance measurement methodology or the required benchmark.
Please refer to the May 2018 SIM PCMH Office Hour Session on Care Management and Coordination Benchmarks for further detail on how participant performance will be measured.
Requirement 2018 2019
CM/CC Population Served U
PDAT
ED• Ensure at least 3% of attributed Practice patients
receive care management and coordination services, as measured quarterly (represented through billing MHPs using the Initiative’s tracking codes, outlined in the 2018 PCMH Initiative Participation Guide).
• Ensure at least 40% of attributed Practice patients receive a timely (within 14 days) follow-up visit with a Provider following a hospital inpatient stay, as measured quarterly.
Ensure at least 2.5% of patients within attributed population received care management and coordination services as measured on aggregated quarterly reports for service delivery periods of July 2018 – June 2019 (represented through billing MHPs using the Initiative’s tracking codes, outlined in the 2019 PCMH Initiative Participation Guide).
PCMH Initiative Year 3 PreviewPayment Model
Requirement 2018 2019
CareManagement & Coordination PMPM Rates N
O C
HAN
GE
PCMHs will receive care management and coordination payment to support embedded care coordination services as a PMPM rate of:
Adult : a. $3.00 for TANFb. $5.00 for HMPc. $7.00 for ABAD
Pediatric: a. $2.75 for TANFb. $7.00 for ABAD
Practice TransformationPMPM Rates U
PDAT
ED
1. PCMH Initiative Practices will receive practice transformation payment to support needed investment in practice infrastructure and capabilities at a PMPM rate of $1.25 for all Medicaid beneficiaries attributed to the Practice by the Initiative.
2. To receive the PMPM practice transformation payment, Practices must complete the required Practice Transformation Objectives within the timeframe specific in this Agreement (See also Appendix C), and report progress in a manner defined by the Initiative on a semi-annual basis.
3. Failure to report practice transformation progress, complete the required Practice Transformation Objective, will result in corrective action (see Section C of the Participation Agreement) up to and including payment sanction.
REMOVED
PCMH Initiative Year 3 PreviewPayment Model: Performance Incentive Program
UNDER DEVELOPMENT/FINAL APPROVAL
Participants that perform above the PCMH Initiative defined benchmark on a set of select quality and utilization measures will be eligible for a performance incentive payment
Current Assumptions: ◦ Payments will be retrospective ◦ Measurement/Payment planned quarterly◦ Will rely on MDC Quarterly Dashboard results
◦ Adult and Pediatric measure sets◦ Chronic Conditions Composite measure will be included
Dates of ServiceResults on MDC
PCMH PortalJan. – Mar. 2019 July 2019Apr. – Jun. 2019 Oct. 2019Jul. – Sept. 2019 Jan. 2020
Intent to Continue Participation Process
• The previous slides provided a preview to 2019 program changes, final requirements will be outlined and provided within the 2019 Participation Agreement.
• The Intent to Continue Participation “Application”: • Is required for all practices that wish to continue participation in 2019 • Is open to current participants only (not currently accepting new practices) • Can be completed by PO representatives on behalf of participating practice locations • FQHCs with multiple practice locations will complete a single “application”• Participant key contacts will be sent individualized excel templates to edit (as necessary)
and be asked to upload within the online “application”
• Key Dates: • “Application” open: October 22• “Application” closes: November 14
Sustainability
SustainabilityMoving Forward Together
Maintain, Sustain, Expand?• The service delivery model established in MiPCT and further refined through the support of the SIM
PCMH Initiative, is valuable to MDHHS and Medicaid Beneficiaries. • The need for provider delivered care management and coordination is not going away. • The need to address patients in a comprehensive, whole-person oriented manner, inclusive of their
social needs, is not going away.
What can SIM PCMH Initiative Participants Expect Going Forward? 1. There is no simple solution. 2. We are all in this together – POs and Providers will be engaged in the conversation.3. It will take coordination and collaboration between MDHHS, MHPs, POs, Providers…
Questions and Additional Resources
Thank you for joining us today!
www.michigan.gov/SIM
(SIM Comprehensive Summary; Newsletters; Operational Plan, CHIR info., PCMH, etc.)
