The Michigan Primary Care Consortium MPCC Member Orientation. March 5, 2010.
Post on 18-Jan-2018
217 Views
Preview:
DESCRIPTION
Transcript
The Michigan Primary Care Consortium
MPCC Member Orientation.
March 5, 2010
The Primary Care Crisis
3
National MD Experience
Number of Residents 2000 to 2005
*Combined Primary Care/Specialty Residents, e.g. FM/ER, are Counted as a .5 FTE, all FM & IM Emphasis and Track Interns are Included in these Numbers as well as MDs who participate in SCS programs. Traditional interns are not included.
2000 2001 2002 2003 2004 20050
200
400
600
800
Primary Care
Non-Primary Care
Primary Care 367.5 318.5 281.5 289.5 261.5 276
Non-Primary Care 499.5 493.5 530.5 593.5 629.5 703
4
Michigan DO Experience
Ideal: 50% Primary Care Physicians (Pew Commission Report on Health Care Workforce)
Michigan: 35% Primary Care Physicians, of which 43% plan to retire or stop practicing
within ten years (MDCH Survey of Physicians 2008)
5
Michigan’s Primary Care Status
• $150,000 - $200,000 Debt• Three Years GME @ $40-45,000/Year
Take Your Choice!Starting Salaries:Family Practice $120,000 - $150, 000Internal Medicine $120,000 - $175,000Pediatrics $110,000 - $125,000Orthopedic Surgery $250,000 - $400,000Cardiology $250,000 - $400,000 (Medical Opportunities in Michigan 2006 Data)
6
Medical School Perspective
Year Inflation Medicaid Medicare
BCBSM
2005 3.39 -2% (-4% for 6 months)
1.5% 2%
2004 2.68 0 1.5% 2%2003 2.27 0 1.4% 2%2002 1.59 11%* -4.8% 2%2001 2.83 0 5.0% 2%2000 3.38 0 5.5% 1.5%1999 2.19 0 2.3% 1.6% (2% for 8
months)
1998 1.55 0 2.3% .8%1997 2.34 0 .6% 2.4%1996 2.93 0 .8% 2%Totals 25.1% 9% 16.1% 18.3%*Medicaid HMOs received an 11% increase for physician services.
The amount that flowed to physicians is unknown. 7
How does Michigan’s reimbursement compare to inflation?
FIN
Per Capita Health Care Expenditures
8
Primary Care Score vs. Health Care Expenditures,
1997
More Primary Care Physicians / 100,000
• Lower Cost
• Higher Quality
(2003 Medicare Data on “General Practitioners”)
9
Primary Care is the Foundation of the Health
Care System
Community safety
Education
Family & social support
Employment
Built environment
Environmental quality
Income
Unsafe sex
Alcohol use
Diet & exercise
Tobacco use
Access to care
Quality of care
Physical environment(10%)
Social & economic factors(40%)
Health behaviors(30%)
Clinical care(20%)
Health Factors
Programs and Policies
Health OutcomesMortality (length of life): 50%
Morbidity (quality of life): 50%
County Health Rankings model © 2010 UWPHI
The Michigan Primary Care Consortium: A Brief History
12
World Health Org: Acute vs. Chronic Care
“Health care systems [throughout the world] evolved around the concept of infectious disease, and they perform best when addressing patients’ episodic and urgent concerns. However, the acute care paradigm is no longer adequate for the changing health problems in today’s world.
Both high- and low-income countries spend billions of dollars on unnecessary hospital admissions, expensive technologies, and the collection of useless clinical information.
As long as the acute care model dominates health care systems, health care expenditures will continue to escalate, but improvements in the population’s health status will not.”
World Health Organization. Innovative care for chronic conditions: building blocks for action: global report. (Geneva: WHO; 2002.)
13
Changing Needs
1900 – 1950 Infectious disease 1950 – 2000 Acute, episodic care 2000 – 2050 Chronic care
Gerald Anderson, PhD – Johns Hopkins UniversityGerald Anderson, PhD – Johns Hopkins University
How do we create new systems to meet today's healthcare needs?
Health Care Spending Fact: In 2007, the U.S. spent $2.2 trillion
— or more than 16% of its Gross Domestic Product — on health care. We spend more than any other country, yet our health system continually underperforms and lags behind less advanced countries.
14
15
Broken Health Care System
Rising costs of health care Rising rates of uninsured, underinsured Flat or worsening health status
indicators Significant health disparities Unimpressive quality indicators Rising dissatisfaction by all Aging population greater demands
on health care system
16
Primary Care System in Crisis
Fragmented, uncoordinated patient care Inconsistent delivery of evidence-based care,
especially preventive and chronic care Misaligned reimbursement system Increasing expectations by payers and
purchasers impacting providers’ quality of life
Shrinking primary care workforce (i.e., physicians, NP’s, PA’s, others)
Will primary care survive?
The Michigan Primary Care Consortium
BACKGROUNDIn 2005-06, 134 Michigan professionals developed strategic recommendations to resolve key primary care system barriersFive barriers to effective primary care: Under-use of community resources Under-use of patient registries, other HIT Under-use of evidence-based guidelines Inappropriate reimbursement system Practices not designed to deliver effective chronic care
17
18
Informed,ActivatedPatient
ProductiveInteractions
Prepared,ProactivePractice Team
Improved Outcomes
DeliverySystemDesign
DecisionSupport
ClinicalInformation
Systems
Self-Management
Support
Health SystemResources and Policies
Community Health Care Organization
Chronic Care Model
Outcomes
19
The Mission of the MPCC The MPCC is a collaborative
partnership of organizations concerned about the survival of primary care
The MPCC was created to improve preventive and chronic care
The MPCC is committed to aligning existing QI initiatives, addressing gaps, and engaging in problem-solving
Michigan Primary Care Consortium
The MPCC spent its early years: Convening organizations concerned about the
rising incidence of preventable health conditions, spiraling health care costs, and the survival of primary care
Gathering information on huge challenges like inadequate reimbursement for primary care services and looming workforce shortages
Building consensus on the actions needed
20
Strategies to Solve Michigan’s Primary Care Crisis (2008)
Transform practices to Patient-Centered Medical Homes (PCMH)
Increase reimbursement for Primary Care Professionals in PCMH practices
Rebuild the supply of MDs/DO’s, NP’s, and PA’s working in Primary Care
Activate consumers regarding self-care 21
MI Primary Care Consortium MPCC: Current Status
22
23
Professional & Trade Associations (15)
Insurers and Payers (11) Health Systems and Centers (7) Physician Organizations (26) Businesses (10) Regional QI Initiatives (4) Public Health Organizations (5) Academia (14) Consumer Organizations (4) Others (7) as of March 2010
MPCC Membership: >100
24
25
MPCC Committees Steering/Board of Directors and Executive –
Chair, Janet Olszewski, MDCH Priorities – Chair, Kim Sibilsky, MPCA Communications – Chair, Rebecca Blake, MSMS Governance – Chair, Dennis Paradis, IHCS -
MSU Funding – Chair, Lody Zwarensteyn, AFH Strategic Planning – Chair, Larry Wagenknecht,
MPA
Michigan Primary Care Consortium
26
Since 2008, MPCC activities have focused on• Redesign of primary care practices to be patient-
centered and efficient, and Patient-Centered Medical Homes
• Utilization of health information technology to improve safety and quality of care
• Processes to ensure that evidence-based preventive and chronic disease care are the norm
• Overhauling the way that primary care is reimbursed
• Making good use of community health resources• Helping consumers become actively engaged
members of their health care team• Rebuilding the primary care workforce
27
Patient-Centered Medical Home
PCMH is an approach to providing comprehensive, team-based primary care for children, youth, adults and seniors based on the Chronic Care Model
PCMH is a health care setting that facilitates partnerships between patients and their personal physicians and health teams and, when appropriate, the patient’s family or caregivers
A PCMH makes effective use of community resources and supports to assist patients and families become activated and achieve their health goals
28
Michigan Primary Care Consortium
Improving Performance in Practice” (IPIP) Program
29
“Improving Performance in Practice” Program
The American Board of Medical Specialties created IPIP to support new physician recertification requirements
7 states were provided with program materials and support; Michigan was 3rd state selected
A grant, funded by Robert Wood Johnson Foundation provided 2 years of seed money to states, with states adding additional funds
30
Michigan IPIP: A Unique Partnership with Industry
Michigan enrolled 35 practices in a year-long learning collaborative.
Practices are charged with implementing the change package and working toward PCMH
Each practice is coached by one or more volunteer quality improvement engineers from industry who had received an orientation to healthcare
The final Outcomes Congress will be March 24-25, 2010
31
Key IPIP Interventions
1. Use a Patient Registry2. Initiate Team Care3. Implement Planned Visits4. Provide Self-Management Support5. Work toward Creation of a PCMH
32
Michigan Primary Care ConsortiumMPCC Non-Profit Status Unanimous approval by MPCC
Leadership IRS Form 1023 process: awaiting
final internal approval Submission Planned before end of
March 2010 Why non-profit status?
33
Michigan Primary Care Consortium
MPCC Funding Efforts No more fiscal support from the
State of Michigan for infrastructure No fiscal support for implementation
of priorities other than in-kind
Long term sustainability?
34
Michigan Primary Care Consortium
Priorities
Michigan Primary Care Consortium
35
2009 White Paper SeriesPrimary Care is in Crisis
Part 1: Primary Care is in CrisisPart 2: Transform Primary Care Practice and PaymentPart 3: Activate Consumers of Primary
Care Part 4: Rebuild the Primary Care
Workforce
36
White Paper Recommendations
The white papers contained over 51 recommendations. Of these, 12 were identified as most important.
30 objectives for achieving the important recommendations were identified
Action Groups were formed to create implementation plans for the objectives
37
MPCC Action Groups Created Implementation Plans for
30 Objectives Objectives and plans were further ranked and categorized:
9 were Top Priority Plans to be achieved by end of 2010
11 were Logical “Next Steps” to be implemented when top priority plans are implemented
10 were deemed beyond MPCC’s current capacity to implement, but could be implemented if a member organization agreed to sponsor and staff them
MPCC Action Planning Groups
1. Practice Transformation Leads: Ernie Yoder, MD, St John Health System and Larry Abramson, DO, POH
2. Consumer Engagement and Empowerment Lead: Stacey Hettiger, MSMS
3. Rebuilding the Primary Care Workforce Lead: TBD
38
Top Priority Objectives
FOCUS AREA 1: PRIMARY CARE PRACTICE TRANSFORMATION Promote Health Information Technology (HIT) Create PCMH Toolkit Spread PCMH throughout Michigan Prepare Providers to Teach Self-Management Assessing Need/Demand for Community
Resources Determine the Cost of Creating a PCMH
39
Practice Transformation Activities
A HIT Handbook will help practices prepare for, purchase and implement EHR systems
A PCMH Toolkit is available that includes web-accessible resources to assist practices meet BCBSM’s PGIP and NCQA’s PCMH requirements
PCMH Spread Group will be surveying physician organizations to: Determine their capacity to support their
practices working toward PCMH recognition Identify whether / how MPCC might assist 40
Practice Transformation Activities (cont.)
Self-management support resources for practices are being assembled. The workgroup is identifying strategies to make these accessible to practices
Consideration of what community resources are needed in communities to address medical and social determinants of health, and how to identify, use and align different resource databases, including 2-1-1
41
Top Priority Objectives
FOCUS AREA 2: CONSUMER ENGAGEMENT AND
ACTIVATION
Teach Self-Management to Consumers Teach Health Literacy in the Michigan
Model for Comprehensive School Health Education
42
Top Priority Objectives
FOCUS AREA 3: REBUILD PRIMARY CARE WORKFORCE
Create a Workforce State Plan Convene a Strategic Partnership
Conference with HRSA
43
Top Priority Objective FOCUS AREA 4: PAYMENT REFORMAccomplishments - All-Payer Agreements on:
1. Michigan definition of PCMH2. Components of PCMH to incent in 2010 using common metrics: a) Expanded Accessb) Use of Registry c) Use of E-Prescribing
3. Discussion on measures for 2011 is underway
44
In summary: MPCC is helping the primary care community
to:Redesign primary care practices to be patient-centered and efficient
Improve safety and quality of care by using health information technology
Make evidence-based care the norm
Overhaul the way that primary care is reimbursed
Help consumers become active engaged members of their health care team Ensure there are sufficient primary care providers
The Michigan Primary Care Consortium
Message
Comprehensive, coordinated, whole-person care that is adequately reimbursed should be available in every primary care setting in Michigan.
46
47
Michigan Primary Care Consortium
For more information about the MPCC: www.MIPCC.org
PCCstaff@MIPCC.org (517) 241-7353
top related