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MAPCP Demo: Participating States in 2014 Maine 70 practices 122,420 patients Michigan 358 practices 1,109,926 patients Minnesota **282 practices 1,013,545 patients New York 41 practices 99,019 patients North Carolina 47 practices 83,553 patients Pennsylvania ** 51 practices 163,670 patients Rhode Island 16 practices 57,676 patients Vermont123 practices 272,324 patients ____________________________________________ TOTAL 988 practices 2,922,151 patients ** no extension granted
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The Michigan Primary Care Transformation (MiPCT) Project
The Demonstration Extension:What It Means for MiPCT POsand Practices
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Two Year Extension Granted for MAPCP/MiPCT!
Here’s what we know…
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MAPCP Demo: Participating States in 2014
•Maine 70 practices 122,420 patients•Michigan 358 practices 1,109,926 patients•Minnesota ** 282 practices 1,013,545 patients•New York 41 practices 99,019 patients•North Carolina 47 practices 83,553 patients•Pennsylvania ** 51 practices 163,670 patients•Rhode Island 16 practices 57,676 patients•Vermont 123 practices 272,324 patients
____________________________________________•TOTAL 988 practices 2,922,151 patients ** no 2015-
16 extension granted
Michigan: Post-Demonstration MiPCT
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1/1/12 12/31/14
Post-Demo MiPCT
Original Demonstration Period
Two Year CMS Extension
12/31/16
GOAL: To sustain our gains (effective, efficient team-based care with embedded Care Managers) post-demonstration period
Outcomes of Discussion with CMS Project Officer on Demonstration Extension (9/29/14)
Q: Will the Medicare payments continue at $9.76 PMPM and be paid as they are currently (practice transformation directly to practices; care management and incentives to UMHS centrally for distribution to POs as appropriate)? A: Yes. Medicare will extend payment as is ($9.50 PMPM to POs/practices and .26 for admin). Sequestration will apply if so directed by Congress.
Q: Will the national evaluation period remain at 1/1/12-12/31/14 for Michigan, or will it now be extended until 12/31/16? A: The full national RTI evaluation will cover the 2012-14 time period. (Note though that the MPHI evaluation would however be for the entire five year period).
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Outcomes of Discussion with CMS Project Officer on Demonstration Extension (9/29/14), cont.
Q: Will Medicare permit increasing the number of Medicare beneficiaries? Practices? POs? A: Yes – up to the maximum permitted in the original demonstration agreement. (Note that addition of practices and/or POs would require discussion and consent of the other participating payers, however).
Q: Will CMS have the same expectations for state oversight of the project in years 4-5?A: Yes. (MDCH/PO/Practice/Commercial Payer agreements should continue, etc.).
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MiPCT 2015 Project Funding
• Medicare FFS payment will continue as $9.50 PMPM (with demo period extension) for MiPCT attributed members; and potentially $41.92 PBPM for engaged chronic non-MiPCT patients (but no “double-dipping” permitted)
• Medicaid: $7.50 PMPM continues through December 2016
• BCBSM: 5% E&M Uplift and G/CPT Codes, Existing incentives
• Priority Health: $3.25 PMPM Care Management Incentive and G/CPT Codes (including Medicare Advantage), Existing incentives
• BCBSM Medicare Advantage: G/CPT Codes (not part of MiPCT)
• BCN: Evaluation in process
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MiPCT 2015 Operational Issues To Be Addressed
• PO/Practice and Payer Agreements with MDCH
• Participation Requirements• Infrastructure Requirements • Care Manager Staffing Ratios• On-going Training (Care Managers, Practice teams)
• Documentation requirements for Care Management
• Possibility of adding new practices
• Implications for existing payers
• Recruitment of new payers
• Coordination with the State Innovation Model (SIM)
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Expanding the Reach of MiPCT: Adding New Payers
• Efforts underway to recruit additional payers
• PO Survey to identify most important additional payers
▫ PO partners will participate in outreach to plans
▫ Medicare Advantage plans
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PO 2015 Visioning Meeting
• Stakeholder participation in shaping the future▫ Clinical focus areas▫ Partnering with community resources
• One two-hour in-person session in Lansing
• Timing: Late October/November 2014
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MiPCT Key Messages Sustainability and Continuity
• We cannot lose focus on using the THREE (3) MONTHS left in the demonstration’s national evaluation period (ending DEC 31, 2014!) to produce continued and improved results for each payer on:
▫ Increased volume of MiPCT eligible patients receiving Care Management ▫ Reduced Avoidable ED and Inpatient Visits▫ Improved Clinical Metrics (especially diabetes)
• Your continued and focused efforts now on the key metrics above can pave the path to support the case for ongoing funding from participating payers
▫ Patient-Centered Medical Home model▫ Care Management
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www.mipctdemo.org
Questions/Discussion