Physician Group Incentive Program Program Updates

Transcription

1 Physician Group Incentive Program Program Updates September 14, 2012 Tom Leyden, MBA Director, Value Partnerships

2 PGIP Program Growth THANK YOU! PO efforts to continuously grow physician engagement in program is working Currently there are approximately 16,400 network physicians in the PGIP program, up 89.5 % from two years prior During this same time period, specialist participation has increased by 253% (from 3,058 to 10,795) Still adding PCPs: 192 new-to-pgip PCPs in the last 6 months. Finally, with regards to overall PGIP penetration: # of eligible doctors (MD/DO/DC/DPM/PSY) in network: 30,915 # of physicians in PGIP (Summer 2012): 16, % physician penetration/network participation in the program

3 Opportunities for Continued Growth in Specialty Participation Comprehensive care is about inclusion of all providers touching the patient If it is a paid benefit, costs associated with care of attributed members are reflected in the PO s Cost Trend PMPM calculation Decrease chances for duplicated service and improves knowledge of patient s whole health status Our understanding is that some POs do not currently allow non-md/dos to join their PO and participate in PGIP. Working with MSMS to learn more about how PO s organizational structure affects participation among non-md/do care providers

4 Opportunities for Continued Growth in Specialty Participation At present we have less than optimal participation among Chiropractors and Psychologists. Having said that we do routinely see increases in specialist participation over multiple cycles, and our expectation is that this will hold true for both specialties. Latest updates: Summer 2012 PGIP (New Physician List) 6-mo % Change in PGIP Participation Book of Business (PPO/TRUST and Trad) Winter 2012 PGIP Summer 2012 % of BOB Chiropractors % 2,330 3% Psychologists (FLP) n/a 1,902 7% Psychiatrists % 1,175 24%

5 PCMH Program Growth BCBSM s PCMH program maintains its status as the largest program of its kind in the nation As of 2012 PCMH Designation, BCBSM s PCMH program consists of: 995 designated practices 3,029 designated physicians 1.08 M attributed BCBSM members 13 POs have 75% or more of their PCPs receiving PCMH designation/uplifts Highest percentage of PCPs receiving uplift: Advantage Health with 97.5% 3 other POs with over 90% of their PCPs PCMH-designated 5 POs have 25% or less of their PCPs receiving PCMH designation/uplifts

6 Formal Recognition of Michigan s PCMH Efforts BCBSM/BCN full page ads in MSMS Michigan Medicine and MOA TRIAD. Ads will run in Fall 2012 Advertisement thanks Michigan physician community for incredible improvements seen across Michigan highlighting many of the advances of the PCMH designated physicians Ads also invite physicians who are not in PGIP to join and provides them with contact information

7 3,307 PCPs 33% Partnering with Engaged PCPs on Physician Practice Transformation PCP Participation in PGIP* Network PCPs participating in PGIP Network PCPs not participating in PGIP 6,773 PCPs 67% Number of PCMH Designated and Non-Designated PGIP Participating PCPs in 2012** 3,756 PCPs 55% 2012 Estimated Reward Pool ~ $100 Million 3,017 PCPs 45% 1,770 PCPs 59% 2012 PCMH Designated PCPs 2012 PGIP Non- Designated PCPs Number of PCMH Designated PCPs Receiving 10% and 20% Uplifts 1,246 PCPs 41% PCMH Designated PCPs Receiving 20% Uplift PCMH Designated PCPs Receiving 10% Uplift *Based on Winter 2011 Physician List Update **2012 BCBSM PCMH Designation results finalized 6/18/12 Estimated spend for PCMH uplifts = $35 million

8 PCMH Capabilities In Place Among those practices that were designated as PCMH in 2012: 100% of PCMH designated practice units maintain up-to-date patient contact details Over 99% of PCMH designated practice units have the following capabilities in place: o All test tracking steps documented in the patient s medical record o Patients informed about abnormal test results o Medication review and management provided at every visit for all patients with chronic conditions o Directory listing specialists to whom patients are referred o Staff training about Patient Centered-Medical Home/Chronic Care model and practice transformation concepts o 24-hour access to a clinical decision-maker o Tobacco use assessment tools and smoking cessation advice provided 8

9 PCMH: Geographic Growth Geographic representation of PCMH designated practices continues to expand across the state o PCMH designated practices now in 66 counties, up from 57 in 2011 (16% increase) Now In: Antrim, Hillsdale, Huron, Ionia, Lake, Lapeer, Mason, Midland, Osceola, Roscommon o Increasing number of PCMH designated practices in urban and rural communities

10 Geographic Dispersion of PCMH Designated Practices in

11 Geographic Dispersion of PCMH Designated Practices in PCMH Designated PGIP Practice Units (n=994) First year of designation *Sites with identical zip codes appear as one star

12 Location of 2012 PCMH Designated Practices Relative to Highly Populated Counties 2010 Population Estimate Data Source: 2010 Census Data *Sites with identical zip codes appear as one star ** 16 designated PUs could not be matched to an existing zip code

13 Location of 2012 PCMH Designated Practices Relative to Counties with High Physician Densities Number of Office-Based MDs Data Source: 2008 HRSA Area Resource File *Sites with identical zip codes appear as one star ** 16 designated PUs could not be matched to an existing zip code

14 PCMH in the News and Peer Reviewed Literature Much media exposure, both nationally and across Michigan recognizing the efforts of the 995 practices/3,000+pcps in obtaining PCMH designation. Local media is recognizing the efforts of their local practitioners BCBSM authors (David Share, MD, MPH and Margaret Mason, MHSA) authored Michigan s Physician Group Incentive Program Offers A Regional Model For Incremental Fee For Value Payment Reform which was published in the September issue of Health Affairs. The article details the strong work of the Michigan provider community CONGRATS DAVID AND MARGARET! THANK YOU TO THE MICHIGAN PROVIDER COMMUNITY!

15 Breaking News! BCBSA National Recognition of Value Partnerships Programs Annually, through the Best of Blue Clinical Distinction Award Program, BCBSA recognizes the achievements of the Blue plans that take a leadership role in making health care safe; improving quality, accessibility, affordability, and outcomes; and engaging providers, consumers, and communities. Award applications are judged by the Harvard Medical School, Department of Health Care Policy and representatives of key medical societies following a rigorous, protocol-driven, criteria-based process Recognition - Best of Blue (BoB) Clinical Distinction Awards 30 submissions, BCBSM received 2 of 5 BoB awards presented earlier this week Reimbursement Transformation: From Fee-for-Service to Fee-for-Value BCBSM Cardiovascular Consortium for Percutaneous Coronary Intervention (BMC2-PCI) 2010 and 2011 Recognition - Best of Blue Clinical Distinction Awards Premier Blue Works award was awarded to MBSC and MSQC Premier Blue Works award was awarded to BCBSM for its PCMH program THANK YOU FOR YOUR CONTINUED COLLABORATION!

16 Development Updates

17 Specialist Fee Uplifts Upcoming Events October 4 (1 pm to 2 pm) Webinar explaining how POs will officially nominate eligible practice units October 22 PU nominations process begins on the PO Collaboration site November 30 PU nominations process ends December 7 (11:30 am to 12:30 pm) PGIP Quarterly Meeting, Specialist Uplifts presentation by CEB on uplift metrics and weights January (date TBD) 2013 Specialist Uplift recipients announced to POs February Specialist Uplifts commence

18 Specialist Uplift Nomination Webinar October 4, 1 pm-2 pm Registration is required to ensure that every PO has at least one representative! Please refer to the Uplifts page announcements on the PO Collaboration site or the September 5th for registration instructions Webinar will provide instructions on how to nominate member and principal partner PUs on the PO Collaboration site

19 Nomination Reminders May receive principal partners that were not on the preliminary list and principal partners that appeared on the preliminary list may disappear! Nomination Criteria Each PO s nomination criteria is available on the Uplift page of the PO Collaboration Site POs are encouraged to review criteria of other POs, especially those that are principal partners of your member PUs Nomination criteria should be made available to member and principal partner PUs Nomination Selection If the PO(s) of your principal partner PUs have not contacted you, reach out to them Please recall that POs may not discriminate based on PO membership, or IT infrastructure (such as selection of a registry)

20 Supplemental Information Process The mechanism for receiving Supplemental Information (SI) was piloted with three Physician Organizations to test the mechanics of the file exchange Henry Ford Medical Group Huron Valley Physician Association Oakland Southfield Physicians The pilot was helpful in identifying further development needed to refine the SI process We are currently working to ensure that SI received through this mechanism will be reflected in EBCR dashboards and datasets The pilot will be completed in September/October

21 Supplemental Information Process Scope Overview The intent of the Supplemental Information mechanism is to provide PO s the opportunity to submit claim-like information not captured in the BCBSM system The mechanism is a file exchange (batch feed) process and will mirror the Blue Care Network process already used by some POs

22 Advanced Care Planning 2013 Advanced Care Planning (ACP) Initiative will be open to POs who did not previously participate in 2012 POs that previously participated in 2012 will be offered the opportunity to participate in the ACP Initiative: Phase 2 Advanced Care Planning is now included as a capability in PCMH under 4.16: Individual Care Management

23 Initiative Selection We will begin to post 2013 program offerings in late October on the PO Collaboration site an update on the 2013 initiative selection process will be coming in late September An enhancement to selection this year is the creation of Executive Summaries Offering POs a more condensed and specific overview of each initiative to assist in the selection process

24 Initiative Plan Executive Summary Each PGIP Initiative Plan will include an executive summary comprised of the following elements: Overview of PGIP Initiative goals and objectives Incentive design Results Discussion Summary of changes for upcoming program year Initiative Plans will still be the primary source for detailed information surrounding Initiatives

25 PGIP Quarterly Meeting September 14, 2012 OSC, CKD, e-prescribing, PCMH, Women s Health, and PDCM Updates Margaret H. Mason, MHSA Value Partnerships

26 Organized Systems of Care Updates 39 OSCs are being invited to sign contracts to join PGIP What does this mean? That these OSCs can participate in the OSC initiatives and (as with PCMH Initiatives) earn incentives for implementing capabilities Does not mean the OSC is designated or recognized by BCBSM in any way regarding performance These are nascent OSCs, just beginning the journey OSC Core Workgroup will continue to meet and further develop the OSC program 26

27 Organized Systems of Care Updates Baseline OSC Strategic Plans due September 14 (today) Still need plans from 13 OSCs OSC Start-Up payments will be made in December Must submit strategic plan and DCT to be eligible for start-up payments Start-up payments may be made in two installments, depending on the status and progress of the OSC 27

28 Organized Systems of Care Updates OSC Data Collection Tool (DCT) and OSC Physician List update processes begin in September and will be due in October OSCs will have opportunity to update DCTs before spring OSC incentive payments, which will be based on implemented capabilities Second annual OSC Dashboard and Population Insights reports will be distributed in November (based on new/updated OSC physicians lists) 28

29 Organized Systems of Care Reminders Please remember: the cost benchmark analysis conducted to determine which PO s/sub-po s/osc s PCMH-designated practices are eligible for the additional 10% fee increase is not an OSC designation program The cost benchmark analysis does not review any other aspects of OSC performance, and does not in any way constitute a BCBSM endorsement of an OSC as highperforming 29

30 Chronic Kidney Disease Updates Pay-for-reporting based on POs capability to report: CKD BCBSM Patient datasets CKD Performance Measures (all-patient, all-payer) First CKD dashboard was recently distributed (based on CKD BCBSM patient datasets) Reminder: CKD Performance Measures should be reported via the PGIP Progress Reports PO input is welcome regarding updates to the CKD Performance Measures 30

31 E-Prescribing Initiative Phasing in new incentive payment methodology Phase 1 Single payment rather than four installments (July 2012) Phase 2 e-rx incentive payments will be adjusted based on actual erx claims submission rate (as of 3 months after SRD) (July 2013) For more information, attend the session and demo on E- Prescribing Controlled Substance and demo at 1:45 this afternoon 31

32 Women s Health Updates The uplift for obstetricians and gynecologists is currently in development. We have obtained feedback on possible metrics from PGIPparticipating Ob-Gyn physicians, and are working to refine them. Twelve metrics are being considered The uplift will go into effect in February 2013, consistent with other specialist uplifts 32

33 PCMH Updates Newly revised PCMH-N Interpretive Guidelines now available on the PO Collaboration Site Includes expanded information on the role of specialists and how to implement the capabilities within specialist practice units New capabilities under Individual Care Management for Advanced Planning, Survivorship Plans, and Palliative Care For the SRD this winter, mixed practices (with both PCPs and specialists) will be given opportunity to report separately on PCP and specialist PCMH implementation activity, if applicable 33

34 MiPCT/Provider Delivered Care Management Webinars were held on 7/24 and 7/26 to discuss the patient list in more detail. Thanks for participating! A recording of the webinar is now available on the MiPCT website ( Other resources now available on the MiPCT website include data dictionaries for the monthly member list, a Frequently Asked Questions Document, and billing guidelines Special BCBSM/BCN PDCM session today 11:30-1:30 to address patient engagement, billing questions, and more 34

35 BCBSM PGIP Quarterly Meeting September 14, 2012 Program Updates Field Team Donna Saxton, MHA, MPH, FACHE, CPHQ Manager, Field Team, Value Partnerships

36 Updates From the Field Practice Designation Certificates are in the classroom across the hall from the registration table Please remember to pick them up Upcoming Celebration: Novi September 20, 2012

37 Updates From the Field Current Field Staff: Southeast/Mid Michigan Scott Johnson Joni Krapes Marie Kaledas Patrice Gray Western/Northern Michigan Shaun Raleigh Manager Shawn Irwin - Grand Rapids Erin Redman - Portage Pat Bramer Traverse City

38 Updates From the Field PCMH Site Visits: Completed two weeks of calibration training in August Thank you to all of the Physician Organization and Practice Units who have assisted us in this process Sparrow MSU Jackson NPO

39 Marketing Materials for PCMH: Updates From the Field A toolkit loaded with sample materials is available on the PCMH Designation Results tab, at: A news release template for local press or publications An announcement template for patient newsletters A PCMH designation flier A letter template for patients A PCMH flier designed for physician office waiting rooms Informational handout is available on the table near registration Please don t hesitate to reach out if you have questions or need additional guidance.

40 Updates From the Field

41 Updates From the Field Winter 2012 SRD: Will be distributed on November 8 th. SRDs will be due back to BCBSM on December 5 th. Reminder that the Winter SRD will be used for 2013 PCMH Designation (nominations, site visits). Please join us at 1:45 in the Auditorium for a preview of upcoming changes to the SRD process in 2013, as well as a review of submitting accurate data with your Winter 2012 SRD.

42 Updates From the Field OSC Orientation Site Visits: 39 OSC site visits to conduct Visits will begin week of September 10, 2012 Will conclude October 31, 2012 Special thanks to everyone for their flexibility in scheduling Agendas have been embedded in the calendar invites that were distributed

43 Updates From the Field New PO Orientation: October 25 and 26, 2012 Designed for POs and PO staff that are new to their role or new to PGIP BCBSM Conference Center in S. Lyon, MI Agenda will cover various topics related to PGIP We will also solicit questions from attendees prior to the program You can view the draft agenda by clicking on the calendar item in the PO Collaboration site

44 Updates From the Field MD Datacor Pilot Evaluation Currently evaluating PO interest in pilot participation There will be criteria set for participation in the pilot Contract will be finalized in concert with pilot group selection Please contact me if you are interested

45 PGIP Quarterly Meeting Analytic Updates & Communications September 14, 2012 Amanda Harrier Department of Clinical Epidemiology & Biostatistics

46 Overview Enhancements to Quarterly Datasets Additional Reports Distributed on September 12 th Chronic Kidney Disease Report Evaluation & Management Report Professional Diagnosis Report Patient Safety Report Population Health Management Reporting (i.e. Population Insights Report) Symposium Evaluations Analytic Communications Links to Computer-based Learning Modules on PO Collaborative Site Quarterly Breakout Sessions

47 NEW! PGIP Reporting Dataset Schema allows for: Easy data transfer Lean data Adapt quickly to changes More levels of PGIP reporting Easier data navigation

48 Additional Reports (Distributed on September 12 th ) Chronic Kidney Disease Report Evaluation & Management Report Professional Claims Diagnosis Coding Report Patient Safety Report

49 Additional Reports: Chronic Kidney Disease Overview: Designed to provide information about the treatment and management of CKD patients at POs participating in the PGIP CKD Initiative. Provides information about these CKD patients and their care based on claims submitted during calendar year 2011 This report is based on BCBSM members who met two criteria: Attributed to a PGIP primary care physician Identified as having CKD based on patient-level data submitted to BCBSM by participating POs Note: The CKD report is applicable only for those POs that provided data for the CKD Initiative Patient-Level Dataset Exchange

50 Additional Reports: Evaluation & Management (E&M) Summary of professional claims (E&M only) Over a 12 month time period (April 2011 March 2012) Includes all PGIP PCPs Claims NOT limited to members with a care relationship Purpose: To aide practices in estimating the potential uplifts for: Physicians practicing within currently PCMH-designated practices Physicians whose practices have not yet been designated but are taking the steps needed to become PCMHdesignated

51 Additional Reports: Professional Claims Diagnosis Coding Informational report designed to increase awareness of the variation in professional diagnosis codes submitted on administrative claims for members across all lines of Blues business. Displays current high-level coding behaviors on submitted professional claims at the PO, sub-po, practice unit, and individual physician level This initial report is based on claims submitted: Over a six month time period (July Dec. 2011) For members across all lines of Blues business

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53 Additional Reports: Patient Safety Table 1. Equivalent Doses of Radiation for Radiological Imaging Examinations Compared to Chest X-Ray (msv) Imaging Modality Dose (milisievert) Equivalent to Chest X-ray Chest X-Ray Abdominal CT Scan Lower Extremity Arteriography Abdominal Radiograph Abdominal MRI 0 0 Abdominal Ultrasound 0 0 Report addresses questions: What is the problem and why is it increasing? What are others doing about the problem? How are radiation exposure levels estimated using BCBSM claims? What can BCBSM do about this problem? Estimation of cumulative radiation exposure for BCBSM members (Jan current) Supplements member-level estimates in the datasets

54 Population Health Management

55 58 Population Insights Report

56 Population Insights Symposia: Aligning hospital and physician incentives-population management approach Goal: Facilitate discussions on collaborative efforts in improving the overall delivery of care for the shared population Agenda: OSC Workgroup leaders explained the OSC concept and provided an open dialogue on how hospitals can become involved Reviewed PGIP analytics and reporting including attribution Conclude with a discussion on next steps in hospital-physician alignment Attendees: Hospital executives, PGIP PO leaders and medical society and association leaders Attendance: Approx. 271 attendees (Traverse City 34; Grand Rapids 74; Novi 114 and Frankenmuth 47) 59

57 Analytic Communications

58 Extended Analytic Learning Opportunities Q&A Breakout Session on the Population Insights Report Room U227 Ask Jack Analytic Q&A Stairwell-break area Breakout Session: PGIPReporting Dataset Updates & Best Practices Presenter: Jack Green Room U227

59 Extended Analytic Learning Opportunities Analytic Training Modules

60 Physician Group Incentive Program Looking Ahead to 2013 September 14, 2012 Tom Simmer, MD SVP and Chief Medical Officer Health Care Value

61 PGIP Achievements 2012 Selected Highlights PGIP Foundational Physician/PO Engagement Introduction of PCMH-N MiPCT/PDCM pilot expansion OSCs Opening of PGIP for all remaining Specialists Enhanced PCMH designation program Introduction of demonstration capabilities Renewed focus on Population Health Management Number of physicians in PGIP: 16,398 Development of consistent messaging in collaboration with MSMS/MOA Reward pool and payment vouchers further explained to POs New-to-PGIP PCP incentives Recruitment of PGIP leaders for the Healthcare Resource Stewardship Council 64

62 Our Vision A United Approach to Transformation BCBSM Leadership Value Partnerships CEB BCBSM Vision for PGIP Support for PCMH Model Other BCBSM Depts. Strengthen patient-provider partnership PCLC HRSC PO Feedback Physician Organization Vision for Healthcare Transformation Unified Strategic Vision Strengthening the Patients role in health Focus on Population Health Support for Data Integration Possible elements Health Policy Customers Advocacy group Stakeholder input to Healthcare Transformation Integration of services across providers Strengthen process management 65

63 We are Actively Addressing Challenges Faced by POs Number of POs who reported a barrier to Initiative Implementation (n=39 POs) Difficulty integrating information systems (e.g. EMR, registry, practice mgmt, etc.) at the PO level 97% Too many activities for practice units to focus efforts on Lack of provider or practice unit buy-in for selected initiatives Providers resistant to behavior change Inadequate financial or staffing resources within PO 82% 72% 64% 62% Patients resistant to behavior change Difficulty communicating information about PO goals and PGIP initiatives to practice units Difficulty incorporating changes into the PO workflow Difficulty prioritizing PGIP initiatives within PO Challenges developing goals and timelines for improvement activities at the PO level 31% 26% 23% 21% 18% 66 Inadequate training of PO staff Source: Spring 2011 PGIP Progress Report 5%

64 Initiative to Improve Reporting of Diagnoses New PGIP reports to measure performance in reporting diagnoses New initiative with collaboration between BCBSM provider relations area and provider billing staff 67

65 Evaluate MDdatacorp as a Clinical Data Integration Solution Structured similar to PDCM Pilot with implementation in 5 PO s based on PO willingness to participate. Future expansion based on PO experience BCBSM financial support to cover reasonable cost of implementation 68

66 Initiative to Improve PDCM Collaboration among PO s to improve the process of care for MIPCT-participating PO s and Primary Care Practices Enhance communication between physician and care manager Enhance flow of information between PO s and PDCM practices Improve care management effectiveness in improving care outcomes and costs 69

67 Provider Delivered Care Management - Oncology Oncology Care Management Objective is to implement a provider-based care management model to a cancer population Initial implementation model based on MIPCT model BCBSM process and payment similar to MIPCT model Program Goals Create a sustainable model for care management in Oncology Improve patient understanding and engagement care plan and treatment decisions Improve care outcomes and lower costs PCMH N Interpretive Guidelines Three new capabilities within the PCMH Individual Care Management domain to support program goals Advance Care Planning Survivorship Planning Palliative Care Needs Assessment PDCM Oncology Work Group First meeting scheduled for October 19 th, 8-11am, Lyon Meadows Suggested participants for the work group include oncologists, PCPs, nurse care managers POs interested in participating, contact Kim Harrison at kharrison@bcbsm.com 70

68 Purpose: catalyze establishment of a uniform approach to measurement of Patient Experience of Care across Michigan. OSCs will be encouraged to: Use a common survey tool/method that allows results to be comparable (e.g., CAHPS) Agree to participate in a collective approach that includes other community stakeholders (e.g., GDAHC, Alliance for Health) to achieve economies of scale (i.e., negotiating with vendors) and avoid surveying the same patients more than once Use survey finding to identify gaps in care throughout the OSC OSC participation will be voluntary. OSC Patient Experience of Care Timing: develop OSC Patient Experience of Care Initiative in 2013; implement in