Improving HFMG Ambulatory Care Reliability Update on Organizational Performance AMGA 2013 Institute for Quality Leadership COO Council Presented by: Thomas S. Nantais Chief Operating Officer Henry Ford Medical Group Chair-AMGA COO Council Who Is HFMG? A 40-specialty academic Medical Group practicing in 34 HFMG Medical Centers in SE Michigan Employing 1,300 Senior Staff Physicians & Researchers along with 3,500 non-physician providers and support staff HFMG generates $750M in net revenue ($1.6B in gross billings), which represents about 33% of total HFHS provider revenues 70% of the business in traditional fee-for-service, with the other 30% being global capitated (120,000 HMO members) Physicians generate 2.1M clinic visits annually 2 1
4 Strategies to Improving Ambulatory Reliability 1. Improve HFMG Ambulatory care reliability for preventive care and chronic disease 2. Achieve high P4P reimbursement rates 3. Successful participation in the Michigan Primary Care Transformation (MiPCT) Project 4. Successful participation in the Organized Systems of Care (OSC) Initiative 5. Quality-based Incentive Compensation INITIATIVE # 1: Diabetes and Prevention Bundles IMPROVE HFMG AMBULATORY CARE RELIABILITY FOR PREVENTIVE CARE AND CHRONIC DISEASE 2
2013 Diabetes Care Bundle Regional Diabetes Bundle Scores(%) July 2013 Bundle Measure (target = 25%) 2 A1c tests Northern Southern Detroit 72% 70% 65% A1c < 8% 74% * Above HEDIS 90 th percentile 69% * At HEDIS 90 th percentile 63% BP < 140/90 LDL test annually 72% 70% 59% 87% 87% 79% LDL < 100 58% * Above HEDIS 90 th percentile 56%* Above HEDIS 90 th percentile 44% 5 out of 5 29% 25% 15% 3
Regional Diabetes Bundle Scores(%) July 2013 Bundle Measure (target = 25%) Northern Southern Detroit BP < 140/90 72% 70% 59% Regional Diabetes Bundle Scores(%) July 2013 Bundle Measure (target = 25%) 2 A1c tests A1c < 8% BP < 140/90 LDL test annually LDL < 100 5 out of 5 Northern Southern Detroit 72% 70% 65% 74% 69% 63% 72% 70% 59% 87% 87% 79% 58% 56% 44% 29% 25% 15% 4
2013 Preventive Care Bundle Regional Preventive Bundle Scores(%) July 2013 Bundle Measure (target =62%) Northern Southern Detroit Mammogram 77%* At HEDIS 90 th percentile 72% 70% Chlamydia screening 76% Above HEDIS 90 th percentile 72% Above HEDIS 90 th percentile 75% Above HEDIS 90 th percentile Colonoscopy 82%* Above HEDIS 90 th percentile 81%* Above HEDIS 90 th percentile 79%* Above HEDIS 90 th percentile Overall Prevention Bundle Score 67% 63% 62% 5
2013 Preventive Care Bundle STRATEGY # 2: Physician Group Incentive Program ACHIEVE HIGH PAY FOR PERFORMANCE REIMBURSEMENT RATES 6
BCBSM Physician Group Incentive Program (PGIP) The Patient Centered Medical Home (PCMH) designation program focuses on chronic disease initiatives and supports and rewards the transformation of processes and systems of care. *10% bump up on E&M visits The formal designation process has 2 components: 1. 50%- Site Visits to confirm capabilities (standards) are in place 2. 50%-Overall Quality Score Achievement Quality score (includes 21 measures), Prevention, Generic Dispensing, Low tech Imaging use vs. High tech imaging use, & Primary Care Sensitive ED Use rates. 2013 Site Visits for Patient Centered Medical Home 3 Sites reviewed Detroit Main Campus (K-15/New Center One) Novi Harbortown Visits went well 120 capabilities reviewed (40 at each site) and fully in place Opportunities identified Update policy on how we follow-up on tests and procedures to reflect Epic Develop process for tracking no shows to ensure follow-up Increase population management beyond diabetes and prevention Increase use of self-reported data with MyChart 7
STRATEGY # 3: Michigan Primary Care Demonstration Project SUCCESSFUL PARTICIPATION IN MICHIGAN PRIMARY CARE (MIPCT) CMS DEMONSTRATION PROJECT Michigan Primary Care Transformation (MiPCT)- CMS Demonstration Project 3 year initiative, focused on achieving the triple aim to improve health in the state, make care more affordable, and strengthen the patient-care team relationship To be in MiPCT, you must be PGIP Designated Project priorities include care coordination, improved access to care with attention to population management, and building on patient registry IT infrastructure 8
Phases of MiPCT Phase 1 Access & Extended Hours Patient Registry Case Managers Hired and Trained Developing Transitions of Care Model Phase 2 Additional Patient Registry Infrastructure and Reporting Reducing Primary Care Sensitive ED Avoidable Visits Reducing avoidable readmissions for chronic disease Building collaborative network in medical neighborhood * 2013 had added metrics; new educational requirements for all sites with additional participation in state meetings MiPCT Achievements To Date 30% same day appointments at all 25 HFMG Primary Care Sites 12 Extended hours per week beyond the traditional 9-5, to accommodate patient demand 24 Nurse case managers integrated across 21 MiPCT-eligible sites with focus on care transitions added to complex disease management model Transitions of care follow-up appointment with PCP occurs within 7-14 days for patients at risk. Outreach calls are made within 48 hours of discharge to all patients. Project funding from Medicare, Medicaid Blue Cross, Blue Care Network totals $3.8M for 2013 (Jan-July): Includes $2.5M revenue for care coordination and practice transformation, and $1.3M incentives. 9
MiPCT Utilization and Outcome Metrics Metric Population Description Rate MiPCT ranking ED Utilization ED Utilization (2011-2012) Ranking of 36 participating organizations at 6 month mark Overall HFMG MiPCT rate snapshot taken at 6 months Overall HFMG MiPCT rate at 12 months #1 in the State 9.08% decrease 1.36% decrease MiPCT ranking Inpatient hospitalizations ED utilization Ranking of 36 participating organizations at 12 month mark MiPCT Case Managed Patients only* who completed CM program MiPCT Case Managed Patients only* who completed CM program #4 in the State 26% decrease 32% decrease HFMG Primary Care Transformation Access Action Plan 1) Each clinic maintains 30% Same Day Access (SDA) 2) Maintain weekend coverage at current Weekend Care sites with the attempt to move to a totally volunteer/contingent model by 12/31/13 3) After Hours Care totally in place at Ford Rd. by 10/1/13 (weekday 5-8pm, weekend/holiday 10am-2pm) 4) Start Same Day Access clinic at Fairlane by 11/15/13 (M-F, 8am-4pm) 10
HFMG Primary Care Transformation Access Action Plan, continued 5) Hire additional adult providers at Taylor, Livonia, Canton 6) Track ED visits in each clinic (CM or RN) and contact patient day after ED visit. 7) Nurse on-call in place by 10/1/13- MiPCT incentive used to fund this. Provider of Choice Superior Patient Engagement Employer of choice by physicians Strategy # 4: SUCCESSFUL PARTICIPATION IN ORGANIZED SYSTEMS OF CARE (OSC) INITIATIVE 11
What is an OSC? A community of caregivers consisting of primary care practices, specialists, hospitals and other providers working together to improve quality and keep costs down by measuring performance, setting goals, tracking progress, and coordinating care across the continuum for the primary-care-attributed patient population. Why are we Participating? Leverage our system's movement to value-based care & be the #1 Provider for Population Management by 2015. Participation will drive us to improve upon how we approach multiple quality initiatives and thereby decrease fragmentation, promoted coordination of system resources and expertise across specialties to comanage populations of patients Receive incentives for Specialists, as well as for phased implementation consistent with our Helios plan in 2013 (Received $366,000 Jan-July 2013) Goal- Integrated Care Utilization Management Providers Incentives & Compensation Transitions of Care Quality outcomes reports Electronic Health Record Access & Service Call Center Outreach Disease Management Hospitalist Service Care Management Practice Transformation Referral Management 12
OSC Eligible Specialties for 2014 Allergy Oncology** Cardiology** Chiropractic Critical Care Emergency Medicine* Endocrine Gastroenterology* Infectious Disease Neonatal Care Neurology Nephrology* OB/GYN* Orthopedics* Otolaryngology Pain Management Physical Medicine Podiatry Psychiatry Psychology Pulmonology Rheumatology Sports Medicine Urology * participating since 2013 ** participating since 2012 Strategy # 5: QUALITY BASED INCENTIVE COMPENSATION MODELS 13
HFMG Quality Incentive Model The purpose of model is to improve quality and utilization scores by facilitating patientcentered, team-based care; rewarding the performance of those who directly impact patient care Plan funding is derived from dollars received from the Physician Group Incentive Plan (PGIP) 27 HFMG Quality Incentive Model This funding is dependent upon performance in a variety of quality performance measures The goal of the plan is to target key measures/bundles that will improve the health of patients 28 14
HFMG Quality Incentive Model The plan is targeted to focus on three areas: Quality: 45% Utilization: 45% Process: 10% 29 HFMG Quality Incentive Model Quality: Focus of Family Practice and IM: 1) Preventative Care Bundles 20% 2) Chronic Care (Diabetes) Bundle 25% Focus of Pediatrics: 1) Well-Child Visits 45% 30 15
HFMG Quality Incentive Model Utilization: Focus of Family Practice and IM: 1) High-Tech Radiology 20% 2) Non-emergent ED Utilization 25% Focus of Pediatrics: 1) Non-emergent ED Utilization 45% 31 HFMG Quality Incentive Model Process: Focus of All Areas: Use of standard process put in place by Primary Care leadership 32 16
HFMG Quality Incentive Model Funding: Plan will pay eligible participants from a pool equal to 2/3 of the total payments received from the PGIP program Eligible participants include primary care MDs, APCs and related support staff 33 HFMG Quality Incentive Model Payouts: Payouts are promulgated on the achievement of targeted goals in each performance area Targets will be derived as improvement above a baseline goal and payouts are all or nothing 34 17
HFMG Quality Incentive Model Schedule: PGIP implemented 1/1/2011 Plan evaluation period is semi-annual Payouts occur every six months Plan currently being assessed 35 Questions? 18