1 The Michigan Primary Care Transformation (MiPCT) Project: December PGIP Meeting Update MiPCT Team December 2, 2011
2 Agenda Introduction MiPCT Participation Care Management Update Funding Update MiPCT Next Quarter Timeline Invitational Launch Meeting Care Manager Practice Integration
MiPCT Participation Statistics January April (yes/tentative) Total POs 29 3 32 Practices 387 70 457 Providers 1,628 154 1,782 Patients 1,111,290 127,961 1,239,251
4 MiPCT Care Management Update Self Management Training programs MiPCT Implementation Guide Part 1 Complex Care Manager Training Update
5 Self Management and Moderate Risk Care Management (MCM) Training Programs A summary of Self Management and Moderate Risk Care Manager training programs training programs reviewed by MiPCT team Self Management training programs must be MiPCT approved required for all Care Managers
6 Self Management Training Program- MiPCT Criteria Self management support background Motivational Interviewing and/or Empowerment skills Individualized patient assessment Collaborative goal setting Problem solving Systematic follow up, support Minimum 6 hours didactic Opportunity for learner to practice new skills Post didactic - trainer facilitated webinar, conference call, face to face meetings to discuss case studies
Self Management and MCM Training Programs" posted: mipctdemo.org 7 Self Management and Moderate Risk Care Management (MCM) Training Programs MCM and self management training programs at a glance Programs vary: some are specific to self management training, a few address both MCM and self management training Program objectives/content Program contact Resources Modality Duration, location Trainer qualifications Certification, CEs Statewide or regional Cost
8 Self Management and Moderate Risk Care Management (MCM) Training Programs The self management and MCM training document will continue to expand MiPCT will continue to review and add training programs How you can help Contact mbeisel@umich.edu if you have an existing self management or MCM training program you would like reviewed or find another one that you are interested in pursuing
9 Self Management Resources Self Management resources summary document May be used as a supplement to a self management training program Ex. toolkits, videos, modules How you can help Please submit self management resources to mbeisel@umich.edu Self Management Resources posted: mipctdemo.org
10 MiPCT Implementation Guide Part I Background Overview of care management Successful components of care management Care Management Model and Staffing Four models: travel team, integrated, hybrid and central Description of models Pros and cons of each model Steps to identify a care management model that is a good fit Includes table with potential models to consider based on patient population, CCM & MCM FTE, and practice locations
11 MiPCT Implementation Guide Part I cont. Roles - Care Managers, Panel Management Hiring Care Managers Essential characteristics/skills for Care Manager Strong communication skills People skills Critical thinking skills Patient engagement and activation skills Negotiating and conflict resolution skills Motivated, self-directed Engagement of patients and providers Psychosocial aspects of chronic conditions Basic computer skills Ref: Geisinger Health Plan, The Medical Home Case Manager, April 2010
12 MiPCT Implementation Guide Part I cont. Operations Training CCMs, MCMs Integration of care manager into practice setting Team roles Identification of patients for care management MiPCT Implementation Guide Part I posted: mipctdemo.org
13 MiPCT Implementation Guide Part II planned topics G codes Geisinger specific CCM curriculum Care Management Software MiPCT Data reports, Patient Lists Team roles
14 Complex Care Manager (CCM) Training MiPCT will provide required training for CCMs Tentative - MiPCT partnership with Geisinger Expect plan to be finalized within 1-2 weeks Train the Trainer Model MiPCT Webinar 12/9 3-5 pm Update CCM training
15 MiPCT Training for Complex Care Managers (CCMs ) and Hybrid CMs CCMs and Hybrid Care Managers Mandatory completion of MiPCT CCM training MiPCT team provides standardized CCM training CCM training will take place in Michigan Time line -tentative CCM Master Trainers training occurs Jan/Feb 2012 Group 1 CCM - training occurs (ideally) Feb 2012 Plan rolling training for several months
16 Complex Care Manager (CCM) Training CCM train the trainer model 10 15 Master CCM Trainers Master Trainers Located Regionally Receive training directly from Geisinger Master Trainer role Preceptor for new MiPCT CCMs Patient caseload Cost Some salary subsidized by MiPCT
17 MiPCT Clinical Resources MiPCT clinical content temporary location - mipctdemo.org Michigan Care Management Resource Center website - live Jan 2012 micmrc.org will transition MiPCT clinical content from mipctdemo.org to the micmrc.org website - Jan 2012
18 Funding Update BCBSM off-cycle payment for portion of first three months funding will be sent next week (tentative date December 9) Purpose is to jump-start care management Balance of first quarter payments will be sent in January PGIP payment, represents $3 PMPM payment BCN will determine within the next week when they will start G-codes/CPT codes Understand that POs/PHOs/practices need ramp up time to begin G-code billing Committed to paying $3 PMPM until that time
19 MiPCT Timeline next 4 mos. Implementation Plan Part C Due December 8, 2011 MiPCT Webinar: Care Management software, CCM training MiPCT Webinar: Financial reporting and Performance Incentive metrics Post positions, interview, and hire Care Managers Plan training for MCM Care Managers: Select a MiPCT approved self management training program Review MCM general recommended training topics December 9, 2011 December 14, 2011 3-5 pm 3-5 pm In progress, continue (high priority) Schedule training programs for MCMs align with hiring dates MiPCT Invitational Launch Meeting March April 2012
20 Michigan Primary Care Transformation Project (MiPCT) Launch Invitational Meeting Supporting Your Success in Partnering with Patients to Improve Care Experience, Outcomes, and Value
21 Launch meeting Goal of Meeting To advance our practice unit s and organization s capabilities to implement the MiPCT program in their networks. Provide a motivational kick off to the program Create network opportunities and best practice sharing Develop the knowledge and skills necessary for success Multiple Meetings (2 or 3) Located in South, West, North Regions Who should attend 1 Representative from each practice, plus PO/PHO leads Dates: March-April 2012
22 One Day Program Key Note Speaker Motivational MiPCT Overview and Updates Skill Building Session Change management and practice transformation Breakout sessions Transitions in Care Medication Reconciliation Extended Access and Patient Awareness Patient Advisory Council Data Collaborative Update Care Management Resource Center: An In-depth Look Sharing our stories Our Practice s Best Practice for PCMH What Do We Do Well? Identifying Our Opportunities for Improvement
23 Care Manager Practice Integration
Care Management Models Travel Team Consists of MCM and CCMs that are responsible for a patient caseload at multiple practices Integrated Consists of MCMs and CCMs that are located on site at the practice Hybrid The role of the CCM and MCM is filled by one individual Central The Care Manager is located off-site and supports multiple practices Care Manager spends at least 50% FTE onsite at practice location The role of the CCM and MCM may be filled by one individual or may be separate individuals
We need to let them into the PCMH!!
Let them on the Team Care Management at the Practice Level
Integrating Care Management into Primary Care Care Management Resource Center Experience of the 5 pilot BCBSM PDCM physician organizations Henry Ford U of M Genesys Lakeshore Health Network Integrated Health Partners Participation in learning opportunities in 1 st to 2 nd quarter 2012
Questions and Discussion 28