PRACTICE FLASH. Important Dates: MiPCT Physician Leadership Training Program Survey

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1 PRACTICE FLASH Michigan Primary Care Transformation Volume 3 - Issue 4 - April 27, 2015 We can do this together - we can make care better...one patient at a time. MiPCT Physician Leadership Training Program Survey Parking is available onsite at the NCRC structure for a fee of $5 cash. Each of our practices and physician organizations have been actively engaged in transformation over the past several years. These sweeping changes require sustained engagement from our staff and physician leaders. Physician leaders are successful when we are embedded into our practice teams and work as facilitators in the transformation process. This requires ongoing professional development for us to be successful. MiPCT is committing to assist our physician leaders in developing the knowledge, skills and attitudes to be effective transformative leaders in their organizations. The session is open to both current billing and coding collaborative participants and those who have not yet participated in the collaborative but are interested. Billers, coders, Care Managers, practice managers and PO representatives are encouraged to attend. The session will Important Dates: CONTINUED ON PAGE 3 DUE DATES: 4/30 MiPCT Q1 REPORT DEADLINE 5/1 Registration deadline for may 12 in-person halfday biling & coding session 5/6 deadline for new practice nominations We are in the early stages of program development and would like to get your input on what would be most helpful for you at this time. We are asking physician leaders both formal (have an FTE and job description as physician leader) and informal (no FTE but actively involved at office practice level or within the physician organization to implement change/ transformation) to complete this survey. We appreciate your time, input and advice. Please Take the Survey Here: May 12 In-Person Half-Day Billing & Coding Session: Registration is Open A half-day intensive MiPCT Billing and Coding Collaborative will be held in Ann Arbor on May 12 from 8:00 AM-noon in the Dining Hall of the North Campus Research Center (NCRC), Building 18, at 2800 Plymouth Road. (This is the same location as last year s MiPCT Ann Arbor Summit). MiPCT care manager TRAININGS: 5/4 MiPCT may CCM Training begins (may 4-7) 5/15 MiPCT Pediatric webinar: Parent/professional partnerships: the benefits of family engagement; presenters: jane pilditch and kristen hawkins, parent coordinators with Michigan family to family health information center project and parents of children with special healthcare needs (10-11AM) 6/8 MiPCT JUNE CCM Training begins (JUNE 8-11) 7/6 MiPCT JULY CCM Training begins (JULY 6-9) MiPCT events: 5/12 MiPCT In-Person Billing Learning Collaborative, um ncrc dining hall, ann arbor (8AM) 9/ MiPCT Pediatric CONFERENCE - (Ann Arbor) at um-ncrc, (full day) 9/16 MiPCT REGIONAL ANNUAL SUMMIT - WEST (Grand Rapids) at Frederik Meijer Gardens (8 AM) 10/20 MiPCT REGIONAL ANNUAL SUMMIT - north (thompsonville) at crystal mountain resort (11 AM) 10/29 MiPCT REGIONAL ANNUAL SUMMIT - southeast (ann arbor) at um - ncrc, bldg. 18 dining hall (8 AM)

2 physicians corner: The Four Habits Model Kevin Taylor MD With so many new care options available retail clinics, virtual visits, and new physician practices patient loyalty isn t a guarantee or even the norm any longer. So how can PCPs attract and keep patients in an era of consumer choice? The Advisory Board Company recently published a research briefing on, What drives consumer loyalty to primary care physician 1. They surveyed 1843 patients who had a primary care physician visit in the last 12 months. I would like to focus on one of the insights from this survey today. skills they were learning consistently. That resulted in the Four Habits Model 3. The Four Habits Model is based on a high-quality conversation and a collaborative partnership. Just one simple lesson of the model, Stein says, is reminding clinicians of the importance to talk to patients in their own terms, not in our medical jargon. The result, Stein says, is the quality of diagnosis goes up, which impacts first-time right treatment, which impacts health outcomes, and also helps to deepen the trust between patient and physician. Another result is patients feel seen and heard. The Four Habits Model A little trust, patience, and respect go a long way. Out of the 27 factors evaluated, four correlate with a patient s self-professed likelihood to stay with, follow to a new location, and recommend their PCP. HABIT Invest in the Beginning Elicit the Patient s Perspective Skills Create rapport quickly; Elicit patient s concerns; Plan the visit with the patient. Ask for patient s ideas; Elicit specific requests; Explore the impact on the patient s life. 1. Trust PCP to make right diagnosis and recommend appropriate treatment. 2. The PCP respects me. 3. The PCP explains possible causes of illness and helps me stay healthy in the future. 4. The staff are patient and helpful. These factors are all related to interpersonal interactions between the patient and the physician or staff. How can we promote this trust, patience and respect in our interactions with our patients? In 1990, Terry Stein 2, an Internal Medicine physician at Kaiser Permanente in Northern California, led the effort to create a workshop that offered physicians training and tools to specifically deal with patients who were angry or wanted tests or treatments the physician felt were not in their patient s best interest. It struck a chord. Over the next few years Stein and her colleagues crafted a practical approach to help physicians use the Demonstrate Empathy Invest in the End Be open to patient s emotions; Make at least one empathetic statement; Convey empathy non-verbally; Be aware of your own reactions. Deliver diagnostic information; Provide education; Involve patient in making decisions; Complete the visit. Much like this Kaiser program, MiPCT is planning to provide training and skill development initiatives for our physician leaders. Our goal is to empower our physician leaders to transform their practices into robust primary care medical homes. To assist in this planning process we have distributed a survey to all PO and practice leaders to complete (SEE ARTICLE ON PAGE 1 OF THIS PUBLICATION). We hope to provide programs like the Four Habits Model that will help to create loyal patients to our practices. 1 The Advisory Board Company. Marketing and Planning Leadership Council. What Drives Consumer Loyalty to a Primary Care Physician? 12 Insights from the Primary Care Physician Consumer Loyalty Survey Getting the Most out of the Clinical Encounter:The Four Habits Model. Richard M. Frankel, PhD, Terry Stein, MD 1996, 1999, 2003 The Permanente Medical Group, Inc. Physician Education & Development Revised April 2003 in partnership with the Kaiser Permanente Institute for Culturally Competent Care

3 focus on solution-finding, process mapping and review of some new billing and coding resources. We are pleased to say that representatives from all participating MiPCT commercial payers (BCBSM, BCN and Priority Health) have graciously agreed to attend as well. Following the session, slides and material will be posted on the website (under the resource tab), but because of the interactive nature remote dial in will not be available. Attendance requires registration before the deadline of May 1, 2015 at: MSMS Session on Opioids MSMS is hosting some interesting training on safe opioid use for extended release and long acting varieties. As it is relevant to several Clinical Focus Areas, including our palliative care initiatives, we wanted to share the following information and details: Title: ER/LA Opioid REMS: Achieving Safe Use While Improving Care Dates and Locations: > May 2, pm: Amway Grand Plaza - Grand Rapids > May 14, am-12:15 pm: The Henry - Dearborn > June 10, am-12 pm: Crowne Plaza - Novi All sessions are free but advance registration is required. Register at: Tiger Teams Update: Introductory Webinar Wednesday April 29! The MiPCT Clinical Subcommittee is forming Tiger Teams to identify ways MiPCT can support PO leaders in top clinical focus areas during 2015 and The focus areas are: 1. Addressing social determinants of health 2. Using registries and data to support population health 3. Integrating behavioral health 4. Integrating palliative care and end of life care, and 5. Appropriateness of Care. Please send your suggestions for ways MiPCT might support your PO in these areas to Dana Watt wattd@michigan.gov. There will be an introductory webinar for Tiger Team volunteers on Wednesday, April 29, 2015 at 2:00 p.m. Registration can be completed at: Nominations Now Being Accepted for Additional MiPCT Practices PO leaders are invited to submit nominations for ten (10) MiPCT practice openings. Nominations will be accepted until May 6, 2015, and may be submitted at In order to be considered, the following requirements must be met by the nominated practice: Affiliated with an existing MiPCT PO Acceptable PCMH designation Available care management staffing (NOTE: The practice must have care management services available to patients, and the practice s PO must meet a minimum 80% of a 2-care manager per 5000 MiPCT member ratio). Demonstration of compliance on key PCMH capabilities, including: > Registry use > Access to 24-hour clinical decision maker > After-hours access for patients > 30% open-access/same-day scheduling The practice replacement policy was published in the January 26, 2015 edition of the FLASH, and can be found on Only complete nominations submitted by May 6, 2015 will be considered.

4 From the MI Department of Community Health & Human Services* Your Public Health Partner co-founded by the American Cancer Society and the Centers for Disease Control and Prevention, is rallying organizations to embrace this shared goal. Has your organization taken the 80% by 2018 pledge? Colorectal Cancer Screening News Free Continuing Education Courses & the 80% by 2018 Campaign Did you know that colorectal cancer is the second leading cause of cancer death in the US? Yet it is one of the most preventable of cancers. What tools do you have at your disposal to make sure patients are screened and know their risk? Continuing Education The CDC s Division of Cancer Prevention and Control recently announced two new CDC-sponsored continuing education (CE) courses for health care providers. Screening for Colorectal Cancer (CRC): Optimizing Quality is offered in two separate versions. One is intended for primary care providers and the other for clinicians who perform colonoscopies. CE credits are available for physicians, nurses, and other health professionals without charge. These courses provide guidance and tools for clinicians on optimal ways to implement screening to help ensure that patients receive maximum benefit. The courses were developed by nationally recognized experts in CRC screening, including primary care clinicians, gastroenterologists, and leaders in public health programs and research. The courses can be accessed at The 80% by 2018 Campaign 80% by 2018 is a National Colorectal Cancer Roundtable initiative in which more than 250 local and national organizations have committed to eliminating colorectal cancer as a major public health problem and are working toward the shared goal of 80% of adults aged 50 and older being regularly screened for colorectal cancer by The National Colorectal Cancer Roundtable, an organization For tools and resources related to the 80 by 2018 campaign, including an informative guide for primary care providers, visit the Colorectal Cancer Roundtable campaign website at There is also a video for the campaign, featuring television personality Katie Couric, in which she lends her support to the 80% by 2018 campaign and notes the success and momentum of this national initiative. In the three-minute video, Couric issues a call-to-action to providers and public health professionals to ensure that all eligible adults have access to affordable CRC screening options, and urges them to address health equity issues so that all people benefit from this important cancer screening. Take a moment to view this important video at your next provider or all-practice meeting. It is available on YouTube at: *Effective April 10, 2015, the state departments of Community Health and Human Services merged to form the Michigan Department of Health and Human Services. More information about the merger is available at From the MI Department of Community Health & Human Services* Your Public Health Partner Diabetes Self-Management Education Programs and Patient Centered Medical Home (PCMH) Did you know there is a way to assist patients in your practice with their diabetes self-management and enhance your practice s Patient Centered Medical Home (PCMH) capabilities? Diabetes self-management education (DSME) is a critical element of care for all people with diabetes

5 (PWD) and those at risk for developing the disease. Referring patients to structured health education programs such as group classes, and maintaining a current resource list of community service areas that are of importance to the patient population (including services offered outside the practice) is referenced in Standard 4, Care Management and Support, of the 2014 NCQA PCMH Standards Referring patients to one of the approximately 90 MDHHScertified DSME programs in Michigan can be a part of the integrated plan of care that providers and care managers coordinate for patients with diabetes within your PCMH practice. The BCBSM Physician Group Incentive Program Patient-Centered Medical Home-Neighbor Domains of Function Interpretive Guidelines state: Referrals to hospital-based diabetes educators that take place in the context of an overall coordinated, integrated care plan and include bilateral communication between the diabetes educator care management team, with individualized feedback provided to the care team following the diabetes education sessions. Diabetes educator and care team collaborate to ensure that referred patients receive needed services, and that patients understand that they should follow-up with PCMH practice regarding questions and concerns, contribute to meeting the requirements for capability 4.2. Standard 10.2 mentions the need for the PCMH practice to include self-management training programs that are available in the community as part of their community resource database. To assist you with that database and your patients with their self-management education and support, a list of MDCH certified DSME programs can be found at *Effective April 10, 2015, the state departments of Community Health and Human Services merged to form the Michigan Department of Health and Human Services. More information about the merger is available at 30-Month Incentive Update The 30 Month Incentive scores will be posted to the MDC dashboard this week. POs will receive an from the MiPCT Demo mailbox alerting them to the score availability and will have one week to review the scores and report any concerns. This was a competitive incentive period, with many POs improving on one of more of the utilization metrics. Please note that for the registry metrics (worth 15 out of 100 points), a data submission threshold of 50% applies to each metric. This means that POs must submit registry/ehr numerator data for 50% or more of the metric s eligible population in order to receive points for that metric. Only three POs met the 50% threshold for all seven registry metrics, so we encourage POs to work with their practices to improve registry use. If you have any concerns about your PO s scores, please submit them to the MiPCT Demo mailbox mipctdemo@michigan.gov by the deadline. SAVE THE DATES! MiPCT Regional Annual Summits As previously announced, the dates and venues for the 2015 MiPCT Regional Annual Summits are: Summit West - Grand Rapids, MI Wednesday, September 16, 2015 Frederik Meijer Gardens and Sculpture Park 8AM to Noon General Session open to all; afternoon care management training Summit North - Thompsonville, MI Tuesday, October 20, 2015 Crystal Mountain Resort & Conference Center 11 AM to Noon Project Leadership Briefing, followed by afternoon care management training Summit Southeast - Ann Arbor, MI Thursday, October 29, 2015 University of Michigan NCRC 8AM to Noon General Session open to all; afternoon care management training

6 Michigan Care Management Resource Center Approved Self-Management Support Training Programs Update For information about MiCMRC approved self-management programs please see the document titled Care Management Resource Center Approved Self-Management Support Training Programs at This document includes details for each MiCMRC approved self-management program: location, objectives, modality, resources, course date/criteria to schedule, trainer qualifications, certification/ces, and cost. MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. For questions please submit to: micmrc-requests@med.umich.edu MiPCT Complex Care Management Course The 2015 MiPCT Complex Care Management (CCM) course is provided in a blended learning activity format. The MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs). Completion of the MiPCT CCM course occurs over a 4-day period. The course consists of: Day 1 Live Webinar MiPCT CCM course introduction (1 hour) Day 2 Self-study modules and post-tests to be completed prior to Days 3 and 4 in-person training (total expected time to complete the self-study and post-tests is six hours) Day 3 and Day 4 In-person training days. (Full day sessions) Register for the May 4-7, 2015, MiPCT CM course at the following site: Upcoming 2015 MiPCT CCM course dates: May 4-7, Introductory Webinar May 4, Total six hour self-study modules and post-tests, May 4-5, In-person training May 6-7, June Introductory Webinar June 8, Total six hour self-study modules and post-tests, June 8-9, In-person training June 10-11, July 6-9, Introductory Webinar July 6, Total six hour self-study modules and post-tests, July 6-7, In-person training July 8-9, Please submit questions regarding the MiPCT CCM course to: micmrc-requests@med.umich.edu. Care Manager Monthly - Update for April 2015 Please see the Care Manager Monthly Update, attached to this issue of the Practice FLASH for April, Stories of Your Care Management Success Monica Brunetti, RN, QMHP, CCM, CCP, Hybrid Care Manager, Holt Family Practice, McLaren PHO Laura, a 61 year old female with BCN insurance, was referred to care management services in person by Dr. Lessard following her office visit. The rationale for referral was poorly controlled diabetes, obesity, hypertension, hyperlipidemia, and depression. On the date of Monica s initial visit with Laura, the patient s A1C was 8.7, which was a noted elevation from her previous office visit and her weight

7 was now 260 pounds, and her triglycerides were 197. Laura had established her own self-management goals with her provider at the time of her office visit. Her selfmanagement goal was to lose weight; one-two pounds a week over the next three months. Her plan included making changes in her diet to include portion control, lowering her carbohydrate intake, and getting routine exercise by walking daily. Her long term self-management goal was to lower her A1C to 7.0 or below over the next four to six months. In support of this patient meeting her self-management goals, Monica conducted monthly follow-up calls to reassess her engagement in making changes that were supportive of meeting her goals, and if not, to re-evaluate the barriers she was facing in following her own action plan. Over the course of several months, there were times that Laura acknowledged that she often made these commitments at her office visits but would stop trying over time. She then stated, Knowing that you are going to call has really kept me on track and motivates me to keep working on my goals. At a follow-up visit, Laura had lost twelve pounds and lowered her A1C to 8.0. At her most recent office visit, her weight was 240 pounds with a total weight loss of 20 pounds since engaging in care management services. She lowered her A1C to 7.1, and her triglycerides were down to 150. At this appointment, Laura stated, I can t believe how much this all has helped my mood. I feel great. I feel young and full of energy again. All of this was obtained through dietary changes and maintaining a regular schedule of exercise. Laura has established new goals for herself and is eager to demonstrate her commitment to her own wellness at her next follow up appointment. NEXT ISSUE DATES: Next MiPCT P.O. FLASH Issue: May 11, 2015 Next MiPCT Practice FLASH Issue: May 11, 2015