Blue Cross Blue Shield of Michigan. Organized Systems of Care

Transcription

1 Blue Cross Blue Shield of Michigan Organized Systems of Care 1

2 PGIP: Catalyzing Health System Transformation in Partnership with Providers PGIP Chronic Care Model PCMH Primary care transformation OSCs Organized Systems of Care Transform care processes to effectively manage chronic conditions Build registry and reporting capabilities to manage populations of patients Achieve savings in specified areas Reward physicians for improved performance and efficiency Share savings Build PCMH infrastructure Strengthen doctor-patient relationship Support PCPs and their team s ability to effectively manage care Coordinate care across the continuum for a defined patient population Establish linkages with community services Support establishment of systems of care that assume responsibility and accountability for managing a defined population of patients across all locations of care Expand PGIP to include specialists involved in chronic care Implement PCMH and quality/use initiatives Continue to increase number of initiatives Continue to add new specialties to PGIP Extend providerdelivered care management with links to BCBSM for customer reporting statewide 2

3 What is an Organized System of Care? BCBSM term used to describe a community of caregivers with a shared commitment to quality and cost-effective health care delivery for the primary care-attributed population of patients 3 3

4 What is an Organized System of Care? Care Partners Community Services Other Facilities Hospitals PCP- attributed patient population Requirements: Ability to identify patient population and key providers of care: PCMH Neighbors Other Specialists Major Specialists (Cardiology, Orthopedics, etc.) Measure performance: Provide feedback to providers Patient-Centered Medical Home Care Manager Primary Care Physicians Advanced primary care Integrated care processes 4 4

5 Organized System of Care: Vision Increase clinical integration among primary, specialty and facility-based care Strengthen the primary care foundation Decrease variation and fragmentation in care processes Improve care quality and health outcomes for patients 5 5

6 OSC Guiding Principles Organization exists to serve community Patient Centered Medical Home-based (primary care foundation) All patient systems and solutions (not payer -specific) Population defined by Primary Care Physician-attributed patients Clinical integration across provider groups Responsible for creating shared processes of care and information systems and accountability for cost and quality at population level Optimizing quality and efficiency at population level 6

7 Organized System of Care: Desired Outcomes High-performing health systems with responsibility and accountability for collectively managing a shared population of patients Coordinated health and social services support Improved management of complex patients Improved outcomes and efficiency Reduction in preventable ER visits & admissions Appropriate use of testing and referrals Prevention and early diagnosis Self-management support 7

8 How is an OSC different from an ACO? Goals conceptually aligned better care for individuals, better health for populations and slower cost growth Differences OSC focuses on before the fact responsibility/ infrastructure support; ACO focuses on after the fact accountability (contracts linking payments to population level performance) OSC ACO BCBSM and Physicians Organizations collaboratively develop program, determine how communities of caregivers are identified, defined and organized Requirements defined by CMS (section 3022 of the Affordable Care Act) 8 8

9 Organized Systems of Care: Development Collaboration with Physician Organizations Collaborative development of OSC concepts, initiatives and guidelines Core workgroup - 10 physician organization leaders representing a cross section of our provider community Review team - composed of representatives from over 25 physician organizations across Michigan 9

10 OSC Initiatives Supporting Infrastructure Development Integrated Registry July 2011 Promotes an integrated health information system Used to collect, track, use and store patient health information Allows all OSC providers to have the right information at the right time to effectively manage their patient population Integrated Performance Measures July 2011 OSC-level integrated performance metrics; used for measurement and reporting Enables providers to manage patient population at the OSC level Integrated Processes of Care March 2012 Clinical integration OSC level care processes that will enable the OSC community of caregivers to communicate, coordinate and collaborate 10

11 Organized Systems of Care BCBSM PGIP OSC 1 st open enrollment - July 2012 Result - 38 PGIP OSC-contracted organizations across Michigan for 2012/2013 program year PGIP-contracted OSCs are eligible to receive infrastructure development support from BCBSM PGIP through participation in the OSC Initiatives 11

12 OSC By County Ontonagon County: Upper Peninsula Health Group Grand Traverse County: Northern Michigan Health Network Oakland County: Accountable Healthcare Alliance, PC; DMC PHO, LLC; DMC Primary Care Physicians, P.C.; Genesys PHO, L.L.C.; Greater Washtenaw Area Care Partners; Henry Ford Medical Group Organized System of Care; McLaren Physician Hospital Organization; Michigan HealthLink; Physician Direct Connection, LLC; Michcare, LLC; OMS OSC; The Physician Alliance-Partners in Care; United Physicians Integrated Care Macomb County:; DMC PHO, LLC; DMC Primary Care Physicians, P.C.; Henry Ford Medical Group Organized System of Care; McLaren Physician Hospital Organization; Michigan HealthLink; Michcare, LLC; The Physician Alliance-Partners in Care; United Physicians Integrated Care Kent County: Advantage Health/Saint Mary's Care Network; Spectrum Health; Metro Health OSC; Physician Organization of Michigan; WMPN OSC Ottawa County: Advantage Health/Saint Mary's Care Network; Holland OSC; Lakeshore Health Network; Metro Health OSC; Physician Organization of Michigan; Spectrum Health; WMPN OSC Allegan County: Borgess Health; Holland OSC; Metro Health OSC; Physician Organization of Michigan Calhoun County: Borgess Health; Integrated Health Partners; Jackson Health Network Saginaw County: MidMichigan Collaborative Care Organization; Primary Care Partners Physician Network; Sparrow Physicians Health Network; St. Mary s of Michigan OSC; Michigan HealthLink Livingston County: Greater Washtenaw Area Care Partners; Michigan HealthLink; The Physician Alliance-Partners in Care Ingham County: Greater Washtenaw Area Care Partners; McLaren Physician Hospital Organization; Sparrow Medical Community; Sparrow Physicians Health Network; Jackson Health Network Eaton County: McLaren Physician Hospital Organization; Sparrow Medical Community; Sparrow Physicians Health Network; Integrated Health Partners Wayne County: Accountable Healthcare Alliance, PC; Organized System of Care; DMC PHO, LLC; DMC Primary Care Physicians, P.C.; Greater Washtenaw Area Care Partners; Henry Ford Medical Group Organized System of Care; Michigan HealthLink; Michcare, LLC; Oakwood Accountable Care Organization, LLC; OMS OSC; United Physicians Integrated Care; The Physician Alliance- Partners in Care Washtenaw County: Greater Washtenaw Area Care Partners; Henry Ford Medical Group Organized System of Care; Michigan HealthLink Lenawee OSC

13 CMS ACOs in Michigan ACO Pioneer or MSSP Start Date PGIP OSC 1 Greater Washtenaw Area Care Partners Pioneer ACO Jan 2012 Yes (GWACP) 2 Genesys Integrated Group Pioneer ACO Jan 2012 Yes 3 Michigan Pioneer ACO Pioneer ACO Jan 2012 Yes 4 Accountable Healthcare Alliance MSSP July 2012 Yes 5 Oakwood ACO MSSP July 2012 Yes 6 Southeast MI Accountable Care MSSP July 2012 no 7 ProMedica Physician Group MSSP July 2012 no 8 POM ACO MSSP Jan 2013 yes 9 Partners in Care (St. John Providence) MSSP Jan 2013 yes 13

14 Organized Systems of Care Hospitals BCBSM is aligning hospital and physician payment incentives by establishing common performance goals and fostering collaboration Hospital performance metrics will be the same as PGIP to facilitate information sharing and analysis across hospitals and their partner POs Build on PGIP initiatives to establish better clinical integration through OSCs 14

15 Other BCBSM Value Partnerships Initiatives that support population management/osc concepts Patient Centered Medical Home Neighbor program Provider Delivered Care Management (PDCM) and PDCM-oncology Specialist uplift process (includes fee uplifts for oncologists) 15

16 For More Information Robin Mitchell, BCBSM Value Partnerships, BCBSM Value Partnerships website Main PGIP section of BCBSM site: PCMH /OSC Initiatives: To subscribe to BCBSM s PGIP Matters enewsletter: