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2. Presentation Outline. Origin of the MI Primary Care ConsortiumThe MPCC OrganizationCurrent Priorities and Plans of the MPCCThe Patient-Centered Medical HomeImproving Performance in Practice" (IPIP) ProgramVision for a Healthy Michigan. 3. Broken Health Care System. Rising costs of health ca
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1. The Michigan Primary Care Consortium and its Initiatives
March 2009
2. 2 Presentation Outline Origin of the MI Primary Care Consortium
The MPCC Organization
Current Priorities and Plans of the MPCC
The Patient-Centered Medical Home
Improving Performance in Practice (IPIP) Program
Vision for a Healthy Michigan
3. 3 Broken Health Care System Rising costs of health care
Rising rates of uninsured, underinsured
Flat or worsening health status indicators
Significant health disparities
Unimpressive quality indicators
Rising dissatisfaction
Aging population greater demands on health care system
4. 4 Primary Care System in Crisis Fragmented, uncoordinated patient care
Inconsistent delivery of evidence-based care, especially preventive and chronic care
Misaligned reimbursement system
Increasing expectations/demands by payers, purchasers
Shrinking primary care workforce (i.e., physicians, mid-level providers, others)
Survival of primary care is questioned
5. 5 Why Is Primary Care Important?
6. 6 MI Primary Care Consortium BACKGROUND
In 2005-06, 134 Michigan professionals developed strategic recommendations to resolve key primary care system barriers
Five barriers to effective primary care:
Under-use of community resources
Under-use of patient registries, other HIT
Under-use of evidence-based guidelines
Inappropriate reimbursement system
Practices not well designed to deliver chronic care
7. 7 MI Primary Care Consortium MISSION
The Michigan Primary Care Consortium is a collaborative public/private partnership created to improve the system of delivery of prevention and chronic disease services and other conditions in primary care settings throughout the state, by aligning existing quality improvement initiatives, addressing gaps, and engaging in problem-solving strategies to assure a patient-centered medical home for everyone.
2008
8. 8 Michigan Primary Care Consortium
The Organization
9. 9 MPCC Membership Professional & Trade Associations
Insurers and Payers
Health Systems
Businesses
Regional QI Initiatives
Public Health Organizations
Consumer Organizations
Others
10. 10 MPCC Membership:Diverse Stakeholders Professional/Trade Associations
American College of Physicians, MI Chapter
MI Academy of Family Physicians
MI Academy of Physician Assistants
MI Association for Local Public Health
MI Association of Health Plans
MI Association of Osteopathic Family Physicians
MI Chapter, American Academy of Pediatrics
MI Council of Nurse Practitioners
MI Health and Hospital Association
11. 11 MPCC Membership:Diverse Stakeholders Professional/Trade Associations (continued)
MI Osteopathic Association
MI Pharmacists Association
MI Primary Care Association
MI State Medical Society
Insurers
Aetna
Blue Cross Blue Shield of Michigan
Medicaid
12. 12 MPCC Membership:Diverse Stakeholders Health Systems
Genesys Health System
Henry Ford Health System
Karmanos Cancer Institute of Wayne State University
University of Michigan Health System
Consumer Organizations
MI Consumer Health Coalition
MI Council for Maternal and Child Health
13. 13 MPCC Membership:Diverse Stakeholders Regional Health Initiatives
Alliance for Health, Western MI
Detroit/Wayne County Health Authority
Greater Detroit Area Health Council
School & Community Health Alliance
Public Health Organizations
Detroit Dept of Health and Wellness Promotion
MI Department of Community Health
14. 14 MPCC Membership:Diverse Stakeholders Businesses
Automotive Industry Action Group
Chrysler LLC
Ford Motor Co.
General Motors, Inc.
GlaxoSmithKline Pharmaceuticals, Inc.
Merck & Company, Inc.
Pfizer, Inc.
Pyper Products, Inc.
15. 15 MPCC Membership:Diverse Stakeholders Others
Gratiot Family Practice
Integrated Health Associates
Medical Network One
MI Health Council
MI Peer Review Organization
MI State University Institute for Healthcare Studies
16. 16
17. 17 MPCC Committees Steering and Executive Chair, Janet Olszewski, MDCH
Priorities Chair, Kim Sibilsky, MPCA
Communications Chair, Rebecca Blake, MSMS
Governance Chair, Dennis Paradis, MOA
Funding Chair, Lody Zwarensteyn, AFH
Strategic Planning Chair, Larry Wagenknecht, MPA
18. 18 White Paper Work Groups Primary Care in Crisis Lead: Kevin Piggott, MD and Dennis Paradis, MOA
Consumer Engagement Lead: Stacey Hettiger, MSMS
Rebuilding Primary Care Workforce Teresa Wehrwein, MSN, PhD-MSU and Robert Burack, MD- WSU
Practice Transformation and Payment Reform Lead: Joseph Fortuna, MD-AIAG
19. 19 2009-2010 MPCC Action Groups Consumer Engagement and Empowerment Lead: Stacey Hettiger, MSMS
Rebuilding the Primary Care Workforce Lead: Robert Yellan, MPRO
Practice Transformation Lead: Ernie Yoder, MD (SJHS) and Larry Abramson, DO, POMC
Payment Reform Lead: TBD
20. 20 Other MPCC Work Groups Multi-Payer Group working on MI consensus on PCMH definition, metrics, recognition, payment
Task Group drafting PCMH Definition Lead:
Self-Management, Trissa Torres, MD, Genesys
Provider Language, Kim Sibilsky, MPCA
Payment Language, Paul Ponstein, MD, Priority Health
Task Group drafting PCMH Metrics Lead:
Ernie Yoder, MD, St. John Health System
Task Group working on collaboration between MPCC and
the MI Health Information Technology Commission
Primary Care Summit Planning Group
21. 21 Michigan Primary Care Consortium
Priorities for 2009-2010
22. 22 Michigan Primary Care Consortiums Priority Projects for 2009/2010 Increase transparency for consumers regarding health care quality and cost, improve self- management and empowerment, and increase health literacy.
Address primary care workforce shortages.
Implement transformation of primary care practices to create Patient-Centered Medical Homes that provide efficient and effective preventive and chronic care management.
Work toward payment reform concurrent with transformation.
Support and evaluate the MPCCs Improving Performance in Practice (IPIP) program.
23. 23 MPCC Recommendations to its Action Group 1. Consumer Empowerment focus on:
Transparency
Self Management
Health Literacy
24. 24 CONSUMER ENGAGEMENT Transparency The MPCC should support and encourage efforts to provide transparent information on health care costs, quality of services, and what insurance covers.
The MPCC should promote that payers provide eligibility and coverage information at point-of-service through a smart card or a web portal in order to reduce administrative logjams and paperwork, improve transparency, and help prevent fraud and abuse. (Information minimally should include the patients deductibles and co-pays, what their insurance policies cover, and what portion of the cost may be borne by the patient).
25. 25 CONSUMER ENGAGEMENT Self-Management The MPCC should urge medical schools and other health care professional training programs to develop and utilize educational programs that include patient self-management, motivational interviewing, and patient-centered primary health care in their curricula.
The MPCC should evaluate methods to engage patients in self-management (e.g., PAM, Motivational Interviewing), assess their feasibility for use by diverse primary care practices in Michigan, and communicate results to MI practices statewide.
26. 26 CONSUMER ENGAGEMENT Health Literacy The MPCC should encourage updates to the statewide Michigan Model for Comprehensive School Health Education to improve health literacy of Michigan youth (K-12).
27. 27 MPCC Recommendations to its Action Group 2. Primary Care Workforce focus on:
State Plan
Incentives for Expansion
Financial Help for Students
Mentoring New Practitioners
28. 28 PRIMARY CARE WORKFORCE State Plan The MPCC should support development of a State Plan based on analysis of workforce data to address the gap between projected workforce needs and the projected number of primary care workers (all disciplines) who will be employed in the State, paying special attention to geographically and economically underserved areas.
29. 29 PRIMARY CARE WORKFORCE Incentives for Expansion The MPCC should advocate for granting State funding preference to health professional schools that meet or exceed target numbers of graduating students in designated primary care specialties.
The MPCC should encourage endowments and capital campaigns to assist in expanding the numbers of medical, nurse practitioner and physician assistant students recruited from and trained in Michigan who choose to become primary care providers in Michigan.
30. 30 PRIMARY CARE WORKFORCE Financial Aid to Students The MPCC should advocate for academic institutions giving financial aid preference, including loans and scholarships, to medical residents and NP and PA students that commit to practice in primary care settings in Michigan with bonuses to those who choose to practice in rural and other underserved areas.
The MPCC should advocate for the expansion and wide communication of loan forgiveness programs and other incentives to professionals who agree to provide primary care services in designated underserved areas in Michigan.
31. 31 PRIMARY CARE WORKFORCE Mentoring New Practitioners The MPCC should encourage expansion of programs to reimburse providers who assume primary care mentoring roles.
32. 32 MPCC Recommendations to its Action Group 3. Primary Care Transformation focus on:
Convener Role for MPCC
Practice Transformation
Health Information Technology
33. 33 PRIMARY CARE TRANSFORMATION Convener Role The MPCC should assume the role of umbrella organization and champion for statewide primary care transformation and implementation of PCMH, including:
Convening stakeholders with interest in promoting integration of the principles of the PCMH into Michigan primary care practices
Developing a clear definition of the PCMH
Identifying meaningful metrics that can distinguish the PCMH from other practices
34. 34 PRIMARY CARE TRANSFORMATION Convener Role (continued) Identifying how PCMH practices will be recognized in Michigan
Promoting payment models that adequately support creation and sustainability of PCMH
Developing action plans for the MPCCs priorities that MPCC members can reasonably expect to execute
Conducting ongoing evaluation to identify which modifications increase value and should be promoted as greater experience with PCMH evolves
35. 35 PRIMARY CARE TRANSFORMATIONPractice Transformation The MPCC should support and promote assessment and analysis of practice culture and process flow in Michigan practices by qualified professionals skilled in the use of validated quality management systems and process-improvement tools. Objectives of process are:
Improvements in quality and patient safety
Improvements in patient care coordination
Reductions in waste
Improvements in patient, staff and provider satisfaction
Adoption and effective use of all relevant modalities of health information technology
36. 36 PRIMARY CARE TRANSFORMATIONHealth Information Technology
The MPCC should promote the effective use of patient/population registries and other useful health information technology in primary care practices.
37. 37 MPCC Recommendations to its Action Group 4. Payment Reform focus on:
Payment Policies for PCMH
Practice Infrastructure Support
38. 38 PAYMENT REFORM Payment Policies - PCMH The MPCC should review payment policies tested in Michigan and elsewhere and develop recommendations for change in Michigan payment policies that support the PCMH (e.g., increased direct payments through fee for service and primary care capitation models; supplemental incentives and/or payment models to sustain PCMH including, but not limited to, bundled arrangements and risk models).
39. 39 PAYMENT REFORMPractice Infrastructure Support The MPCC should encourage all potential private and public funding sources to invest in practice-level infrastructure for the PCMH. Initial direct funding is needed for:
Practice redesign
Information technology
Additional personnel to provide team care
Education and training for all providers to create and sustain a PCMH
40. 40 PAYMENT REFORMPractice Infrastructure Support (continued) The MPCC should advocate for financial arrangements that enable primary care practices to purchase and to staff important health information infrastructure including:
Population-Patient Registries
Electronic Medical Records
E-prescribing
Web portals for patients and providers
41. 41 World Health Org: Acute vs Chronic Care Health care systems [throughout the world] evolved around the concept of infectious disease, and they perform best when addressing patients episodic and urgent concerns. However, the acute care paradigm is no longer adequate for the changing health problems in todays world.
Both high- and low-income countries spend billions of dollars on unnecessary hospital admissions, expensive technologies, and the collection of useless clinical information.
As long as the acute care model dominates health care systems, health care expenditures will continue to escalate, but improvements in the populations health status will not.
World Health Organization. Innovative care for chronic conditions: building blocks for action: global report. (Geneva: WHO; 2002.)
42. 42
43. 43 The Patient-Centered Medical Home (PCMH) What is this?
Why has MPCC identified PCMH as THE SOLUTION to the Primary Care Crisis?
44. 44 Patient-Centered Medical Home PCMH is an approach to providing comprehensive primary care for children, youth, adults and seniors based on the Chronic Care Model
PCMH is a health care setting that facilitates partnerships between patients and their personal physicians and, when appropriate, the patients family or caregivers
A PCMH makes effective use of community resources and supports to assist patients and families become activated and achieve their health goals
45. 45 PCMH Practices Organize the delivery of team-based care for all patients, consistent with the Chronic Care Model
Use evidence-based medicine and clinical decision support tools
Use secure health information technology to promote quality and safety
Coordinate care in partnership with patients and families
Provide enhanced and convenient access to care
Identify and measure key quality indicators
Participate in programs that provide feedback to practices on performance and accept accountability for process improvement and for health outcomes
46. 46 PCMH IS AN OPPORTUNITY FOR Improving health of patients and their satisfaction with their care
Improving purchaser and payer satisfaction with outcomes of care
Improving reimbursement for primary care
Improving physician satisfaction with their choice to specialize in primary care
Improving recruitment of medical residents, NPs and PAs into primary care
Slowing the rise in health care spending
47. 47 2007 Joint Principles for PCMH Jointly approved by:
American Academy of Family Physicians
American Academy of Pediatrics
American College of Physicians
American Osteopathic Association Personal physician
Physician-directed medical practice
Whole person orientation
Care is coordinated and/or integrated
Quality and safety
Enhanced access to care
Payment that supports a PCMH
48. 48 PCMH Definition in Michigan Same as Joint Principles with footnotes to further define:
Patient-Centered
Personal Physician
Quality and Safety
Payment
49. 49 Patient-Centered MI Footnote This model of care recognizes the central role of patients and when appropriate their families, as stewards of their own health. In the Patient-Centered Medical Home, the team of health professionals guides and supports patients and their families to help them achieve their own health and wellness goals.
50. 50 Personal Physician - MI Footnote A personal physician may be of any specialty but to be considered a Patient-Centered Medical Home, the practice must meet all Patient-Centered Medical Home requirements. It shall be recognized that there may be situations in which a physician is not on-site and the patients relationship is with a certified nurse practitioner (NP) or physician assistant(PA) who provides the principalor predominant source of care for a patient.
51. 51 Personal Physician (continued) In those instances, the NP or PA provider, in collaboration with a physician, may perform the responsibilities of first contact, continuous and comprehensive care if he or she is otherwise qualified by education, training, or experience to perform the selected acts, tasks, or functions necessary where the acts, tasks, or functions fall within the certified nurse practitioners or the physician assistant's scope of practice.
52. 52 Quality and Safety MI Footnote Clinical outcomes, safety, resource utilization and clinical and administrative efficiency are consistent with Best Practices.
53. 53 Payment MI Footnote Transformational change in healthcare financial incentives should occur simultaneously with, proportionally to, and in alignment with Patient-Centered Medical Home adoption.
54. 54 NCQA Practice Connections Patient Centered Medical Home Certification
55. 55 BCBSMs Physician Group Incentive Program (PGIP) For Enhanced Payments as a Patient-Centered Medical Home:
Performance reporting
Patient-Provider agreement
Extended access
Individual care management
Test tracking and follow-up
Coordination of care
Preventive services
Specialist referral process
Linkage to community services
Self-management support
Patient registry
Patient portal
56. 56
57. 57 Systemness as a Community Property
58. 58 Michigan Primary Care Consortium Improving Performance in Practice (IPIP) Program
59. 59 Improving Performance in Practice Program American Board of Medical Specialties
Created IPIP to support new physician recertification requirements
7 states were provided with program materials and support; Michigan was 3rd state selected
Funded by RWJF, grant provides 2 years of seed money to states, with states adding additional funds
60. 60 Improving Performance in Practice Program in Michigan Objective:
Improve chronic disease management in primary care practices
Methodology:
Chronic disease Learning Collaborative
- 2-day learning sessions each quarter
- Monthly phone calls
- Focus: Adult Diabetes and/or Pediatric Asthma
On-site coaching from volunteers who are industry-trained process improvement engineers
61. 61 Key IPIP Interventions Use a Patient Registry
Initiate Team Care
Implement Planned Visits
Provide Self-Management Support
Work toward Creation of a PCMH
62. 62
63. 63 Improving Performance in Practice For more information about IPIP:
http://ipip.aiag.org
Rose Steiner rsteiner@aiag.org
State Director (248) 213-4656
64. 64 RECOMMENDATIONS for Action by MPCC and all Stakeholders
Help create informed, activated patients and families by supporting proactive teams in every primary care practice and in all community health settings
Promote IPIP Program to primary care practices as a transformation opportunity
Identify community resources that can help small practices create a PCMH for their patients
Create PCMHs in all primary care settings in public sector
Provide leadership in communities to spread PCMH via Wagners community model
Encourage PCMH practices to advocate for community supports: healthy public policy, community environments that encourage healthy lifestyles, community actions directed at social determinants of health
65. 65
66. 66 Michigan Primary Care Consortium For more information about the MPCC:
www.MIPCC.org
PCCstaff@MIPCC.org
(517) 241-7353