MiPCT Evaluation Overview & Update

1. MiPCTEvaluation Overview & Update MiPCT Retreat February 27th, 2014

2. Objectives • How is MiPCT being evaluated? • Metrics: cost, utilization, and quality • MiPCT patients compared to other patients • Snapshot of Results to Date • Care Manager Activity Trends (from PO quarterly report) • 2013 Care Manager Surveys • Future Surveys and Timeline

3. Two evaluations • Research Triangle Institute (RTI) = National evaluator • Michigan Public Health Institute (MPHI)=Michigan evaluator

4. How will RTI (and CMS) determine success? What would have happened in Michigan without the MAPCP demonstration?

5. RTI Measures Cost Utilization All-cause hospitalizations ACSC hospitalizations (PQI) All-cause ED visits % ED visits that do not lead to hospitalization Discharges from short-term general, rehabilitation, and SNF with (billed) clinical follow-up within 14 days Rate of 30-day unplanned readmissions (CMS definition developed by the Yale New Haven Health Services Corporation) • Average PMPM • Measured as Medicare payments • By risk group • By dual eligible status • Cost buckets • Other inpatient • Emergency room • Hospital outpatient • Primary care services • Specialist services • Laboratory • Imaging • Home health • Other

6. RTI Measures: Quality Metrics Diabetes care: • LDL-C screening • HbA1c testing • Retinal eye examination • Medical attention for nephropathy • All 4 diabetes tests • None of the 4 diabetes tests Ischemic Vascular Disease: • Total lipid panel test Patient experience survey

7. To be considered a success: Outcomes of MiPCT beneficiaries must improve at a greater rate than comparison beneficiaries

8. Total Average PMPM Payments Demo start

9. Total Average PMPM Payments Demo start

10. How is MiPCT being evaluated in Michigan? Multi-payer evaluation conducted by MPHI Each payer might do additional evaluation

11. Cost Measures National Evaluation MiPCT Evaluation Average PMPM Standardized costs estimated based on service use All payers Dashboards By risk group By chronic conditions By payer Cost buckets (in development) ED: total and ACSC Hospitalization: Total and ACSC Other • Average PMPM • Medicare Payments • Total • Demo payments excluded • By risk group • By dual eligible status • Cost buckets • Other inpatient • Emergency room • Hospital outpatient • Primary care services • Specialist services • Laboratory • Imaging • Home health • Other

12. Utilization measures National Evaluation MiPCT Evaluation All-cause hospitalizations ACSC hospitalizations (PQI) All-cause ED visits ‘Potentially preventable’ ED according NY algorithm Non-emergent Primary care treatable Preventable/avoidable All cause readmissions (HEDIS) • All-cause hospitalizations • ACSC hospitalizations (PQI) • All-cause ED visits • % ED visits that do not lead to hospitalization • Discharges from short-term general, rehabilitation, and SNF with (billed) clinical follow-up within 14 days • Rate of 30-day unplanned readmissions (CMS definition developed by the Yale New Haven Health Services Corporation)

13. Quality Metrics National Evaluation MiPCT Evaluation Diabetes Asthma Hypertension Cardiovascular Obesity Adult preventive care Child preventive care Childhood lead screening (Medicaid) (available: www.mipctdemo.org) Patient experience survey Diabetes care: • LDL-C screening • HbA1c testing • Retinal eye examination • Medical attention for nephropathy • All 4 diabetes tests • None of the 4 diabetes tests Ischemic Vascular Disease: • Total lipid panel test Patient experience survey

14. Core Michigan Evaluation Questions • What are the quantifiable improvements to practice infrastructure, processes, and capacity made by practices as a result of the MiPCT program? • To what extent is practice transformation in these areas (as measured within the MiPCT infrastructure requirements and the 4 functional tiers) associated with benefits for cost, utilization, quality, and patient experience? • How do MiPCT patient outcomes compare to patients in non-MiPCT PCMH and non-PCMH settings?

15. Both evaluations utilize comparison groups 1) Patients of other PCMH practices 2) Patients of other practices that are not PCMH

16. How can we know if we are having an impact now? • Payers are pulling comparison data right now • Final results ~ 2015 • In the meantime: • Monitor trends – use the MDC dashboard • Compare to benchmarks • Look at progress on ‘near term’ outcomes • Practice change • Care management implementation