PGIP September 14, 2012 Quarterly Meeting-Morning Meeting … · 2019. 3. 15. · Business (PPO/TRUST and Trad) Summer 2012 % of BOB . Chiropractors 8 59 638% 2,330 3% Psychologists

Physician Group Incentive Program Program Updates

September 14, 2012

Tom Leyden, MBA Director, Value Partnerships

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): 16,398 – 53.04% physician penetration/network participation in the program

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

Opportunities for Continued Growth in Specialty Participation

Winter

2012 PGIP

Summer 2012 PGIP (New

Physician List)

6-mo % Change in

PGIP Participation

Book of Business

(PPO/TRUST and Trad)

Summer 2012 % of BOB

Chiropractors 8 59 638% 2,330 3% Psychologists (FLP) 0 135 n/a 1,902 7%

Psychiatrists 265 286 8% 1,175 24%

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:

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

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

Partnering with Engaged PCPs on Physician Practice Transformation

6,773 PCPs 67%

3,307 PCPs 33%

PCP Participation in PGIP*

Network PCPs participating in PGIP

Network PCPs not participating in PGIP

3,017 PCPs 45% 3,756 PCPs

55%

Number of PCMH Designated and Non-Designated PGIP Participating

PCPs in 2012** 2012 PCMH Designated PCPs

2012 PGIP Non-Designated PCPs

2012 Estimated Reward Pool ~ $100 Million

Estimated spend for 2012 PCMH uplifts = $35 million

*Based on Winter 2011 Physician List Update **2012 BCBSM PCMH Designation results finalized 6/18/12

1,246 PCPs 41%

1,770 PCPs 59%

Number of PCMH Designated PCPs Receiving 10% and 20% Uplifts

PCMH Designated PCPs Receiving 20% Uplift

PCMH Designated PCPs Receiving 10% Uplift

7

PCMH Capabilities In Place

8

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

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

Geographic Dispersion of PCMH Designated Practices in 2009

10

Geographic Dispersion of PCMH Designated Practices in 2009 - 2012

*Sites with identical zip codes appear as one star

2012 PCMH Designated PGIP Practice Units (n=994)

First year of designation

Location of 2012 PCMH Designated Practices Relative to Highly Populated Counties

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

2010 Population Estimate

Location of 2012 PCMH Designated Practices Relative to Counties with High Physician Densities

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

Number of Office-Based MDs

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!

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. 2012 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!

Development Updates

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 1 – 2013 Specialist Uplifts commence

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 email for registration instructions

• Webinar will provide instructions on how to nominate

member and principal partner PUs on the PO Collaboration site

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)

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

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

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

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

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

PGIP Quarterly Meeting September 14, 2012

OSC, CKD, e-Prescribing, PCMH,

Women’s Health, and PDCM Updates

Margaret H. Mason, MHSA Value Partnerships

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

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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

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

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 high-performing

29

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

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

Women’s Health Updates

• The uplift for obstetricians and gynecologists is currently in development.

• We have obtained feedback on possible metrics from PGIP-participating 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

PCMH Updates

• Newly revised 2012-2013 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

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

(http://mipctdemo.wordpress.com/)

• 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

Donna Saxton, MHA, MPH, FACHE, CPHQ Manager, Field Team, Value Partnerships

BCBSM PGIP Quarterly Meeting

September 14, 2012

Program Updates

Field Team

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

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

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

Updates From the Field

• Marketing Materials for PCMH: – A toolkit loaded with sample materials is available on the PCMH

Designation Results tab, at: http://sps-pgip/admin01/PCMH_Designation_Reports/Forms/AllItems.aspx

– 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.

Updates From the Field

Updates From the Field

• Winter 2012 SRD: • Will be distributed on November 8th. SRDs will be due back to BCBSM on

December 5th. • 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.

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

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

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

• [email protected] • 313.448.0969

PGIP Quarterly Meeting Analytic Updates & Communications

September 14, 2012

Amanda Harrier Department of Clinical Epidemiology & Biostatistics

Overview

• Enhancements to Quarterly Datasets • Additional Reports Distributed on September 12th

– 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

NEW! PGIP Reporting Dataset

Schema allows for: • Easy data transfer • Lean data • Adapt quickly to changes

• More levels of PGIP reporting • Easier data navigation

Additional Reports (Distributed on September 12th)

• Chronic Kidney Disease Report

• Evaluation & Management Report

• Professional Claims Diagnosis Coding Report

• Patient Safety Report

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

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 PCMH-designated

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

55

Additional Reports: Patient Safety 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. 2005 – current)

• Supplements member-level estimates in the datasets

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 0.14 1 Abdominal CT Scan 13.3 95 Lower Extremity Arteriography 12.4 88 Abdominal Radiograph 0.55 3.92 Abdominal MRI 0 0 Abdominal Ultrasound 0 0

Population Health Management

58

Population Insights Report

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

Analytic Communications

Extended Analytic Learning Opportunities

• Q&A Breakout Session on the Population Insights Report – 11:30am @ Room U227

• “Ask Jack” Analytic Q&A

– 11:30am @ Stairwell-break area

• Breakout Session:

PGIPReporting Dataset Updates & Best Practices – Presenter: Jack Green – 1:45pm @ Room U227

Extended Analytic Learning Opportunities – Analytic Training Modules

Physician Group Incentive Program Looking Ahead to 2013

September 14, 2012

Tom Simmer, MD SVP and Chief Medical Officer Health Care Value

PGIP Achievements 2012 – Selected Highlights

PGIP

Foundational

• 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

Physician/PO Engagement

• 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

PCLC

HRSC

PO Feedback

Physician Organization Vision for Healthcare

Transformation

BCBSM Leadership

Value Partnerships

CEB

Other BCBSM Depts.

BCBSM Vision for PGIP

Health Policy

Customers

Advocacy group

Stakeholder input to Healthcare

Transformation

Unified Strategic

Vision

Support for PCMH Model

Strengthening the Patients role

in health

Focus on Population

Health

Support for Data Integration

Our Vision – A United Approach to Transformation

Strengthen patient-provider

partnership

Integration of services across

providers

Possible elements

Strengthen process

management

65

We are Actively Addressing Challenges Faced by POs

97%

82%

72%

64%

62%

31%

26%

23%

21%

18%

5%

Difficulty integrating information systems (e.g. EMR, registry, practice mgmt, etc.) at the PO level

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

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

Inadequate training of PO staff

Number of POs who reported a barrier to Initiative Implementation (n=39 POs)

Source: Spring 2011 PGIP Progress Report 66

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

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

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

• 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

Oncology Care Management

• 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

Program Goals

• Three new capabilities within the PCMH Individual Care Management domain to support program goals • Advance Care Planning • Survivorship Planning • Palliative Care Needs Assessment

PCMH – N Interpretive Guidelines

• First meeting scheduled for October 19th, 8-11am, Lyon Meadows • Suggested participants for the work group include oncologists, PCPs,

nurse care managers • POs interested in participating, contact Kim Harrison at

[email protected]

PDCM – Oncology Work Group

Provider Delivered Care Management - Oncology

70

• 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. • Timing: develop OSC Patient Experience of Care Initiative in 2013;

implement in 2014.

OSC – Patient Experience of Care

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