The Michigan Primary Care Consortium and its Initiative

1
The Michigan Primary Care Consortium and its
Initiative

• Carol Callaghan, MPH
• Division of Chronic Disease and Injury Control
• Michigan Dept of Community Health

2
Acknowledgements

• David Walsworth, MD, FAAFP MSU
• Ernie Yoder, MD, PhD, FACP St. John Health
  System
• Ed Wagner, MD, MPH, FACP MacColl Institute for
  Healthcare Innovation and
• The many wise and passionate individuals who
  represent the member organizations on the
  Michigan Primary Care Consortium

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Outline of Presentation

• Broken Health Care System and Primary Care in
  Crisis
• Michigan Primary Care Consortium
• Purpose
• Initial Focus
• Current Priorities
• Recommendations for Action

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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

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Primary Care System in Crisis

• Fragmented, uncoordinated patient care
• Inconsistent delivery of evidence-based care
• Misaligned reimbursement system
• Increasing expectations/demands from payers,
  purchasers
• Shrinking primary care workforce

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Why Is Primary Care Important?
Better health outcomes Lower costs Greater equity
in health
Source Barbara Starfield, October 2006
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Changing Needs

• 1900 1950 Infectious disease
• 1950 2000 Acute, episodic care
• 2000 2050 Chronic care
• Gerald Anderson, PhD Johns Hopkins University

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MI Primary Care Consortium

• BACKGROUND
• In 2005-06, 134 Michigan professionals developed
  strategic recommendations to resolve key primary
  care system barriers
• Five 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 well designed to deliver chronic
  care

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MI Primary Care Consortium

• MISSION
• The Michigan Primary Care Consortium is a
  collaborative public/private partnership created
  to improve the system of delivery of prevention
  and chronic disease services and other conditions
  in primary care settings throughout the state, by
  aligning existing quality improvement
  initiatives, addressing gaps, and engaging in
  problem-solving strategies to assure a
  patient-centered medical home for everyone.

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MI Primary Care Consortium

• VISION
• Through collaboration involving primary care,
  public health and other key stakeholders, major
  system level barriers are resolved and every MI
  resident has a patient-centered medical home that
  is consistently providing evidence-based
  preventive and chronic disease care. Changes to
  sustain quality care have been embedded into
  primary care practices across the state.

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MI Primary Care Consortium

• GUIDING PRINCIPLES
• The purpose of the MPCC is to resolve system
  barriers that affect primary care.
• Primary care services delivered to MI residents
  should routinely incorporate high quality and
  culturally sensitive preventive and chronic
  disease management services.
• Collaboration is essential to restore primary
  care as the base or lynchpin of the healthcare
  system.
• The MPCC supports and encourages transformation
  at all levels of the healthcare system - at the
  practice, community, region, statewide and
  national levels.

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MPCC Membership

• Professional and Trade Associations
• MI Association of Health Plans
• MI Chap. American Academy of Pediatrics
• MI Chap. American College of Physicians
• MI Academy of Family Physicians
• MI Academy of Physician Assistants
• MI Association of Osteopathic Family Physicians

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MPCC Membership

• Professional and Trade Associations (continued)
• MI Council of Nurse Practitioners
• MI Osteopathic Association
• MI Pharmacists Association
• MI Primary Care Association
• MI State Medical Society

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MPCC Membership

• Insurers
• Aetna
• Blue Cross Blue Shield of Michigan
• Health Systems/Health Plans
• Blue Care Network
• Genesys Health System
• Henry Ford Health System
• University of Michigan Health System

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MPCC Membership

• Businesses
• Automotive Industry Action Group
• Chrysler LLC
• Ford Motor Co
• General Motors
• Glaxo-Smith-Kline
• Pfizer
• Pyper Products, Inc.

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MPCC Membership

• Regional Quality Improvement Initiatives
• Alliance for Health, Grand Rapids
• Greater Detroit Area Health Council
• Public Health
• Detroit Department of Health and Wellness
  Promotion
• Michigan Association for Local Public Health
• Michigan Department of Community Health

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MPCC Membership

• Academic Programs
• Wayne State University, Cancer Institute
• Michigan State University, Institute of Health
  Care Studies
• Other
• Integrated Health Associates
• Medical Network One
• Michigan Consumer Health Care Coalition
• Michigan Council for Maternal Child Health
• Michigan Peer Review Organization

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MI Primary Care Consortium

• 2006 MPCC created to coordinate implementation
  of strategic plans
• 2007 MPCC identified need to align with
  activities underway in MI and nation to address
  the system barriers
• 2008 MPCC voted to focus its energies on
  supporting the Patient-Centered Medical Home

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Patient Centered Medical Home

• PCMH is an approach to providing comprehensive
  primary care for children, youth and adults.
• The PCMH is a health care setting that
  facilitates partnerships between individual
  patients and their personal physicians, and when
  appropriate, the patients family.
• The AAP, AAFP, ACP, and AOA, representing
  approximately 333,000 physicians, have developed
  joint principles to describe the characteristics
  of the PCMH.

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2007 Joint Principles for PCMH

• Personal physician
• Physician-directed medical practice
• Whole person orientation
• Care is coordinated and/or integrated
• Quality and safety
• Enhanced access to care
• Payment that supports a PCMH

• Jointly approved by
• American Academy of Family Physicians
• American Academy of Pediatrics
• American College of Physicians
• American Osteopathic Association

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Chronic Care Model
Health System
Community
Health Care Organization
Resources and Policies
ClinicalInformationSystems
DeliverySystem Design
Self-Management Support
Decision Support
Prepared, Proactive Practice Team
Informed, Activated Patient
Productive Interactions
Outcomes
Improved Outcomes
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The PCMH is based on evidence of successful
models for improving care

• The PCMH is based on studies that show the value
  of care coordinated by a personal physician using
  systems-based approaches
• Patient-centered primary care has been
  implemented successfully in
• other nations that have better overall quality
  scores and lower costs
• in the U.S in health care systems like the VA
• Within the U.S., states that rely more on primary
  care have better quality, lower overall Medicare
  costs and lower utilization
• Effective care coordination in the ambulatory
  setting can reduce hospital admissions and
  re-admissions for chronic diseases (such as
  diabetes, CHF)

Starfield, presentation to Commonwealth Fund
Roundtable on Primary Care, October
2006 Commonwealth Fund, Chartbook on Medicare,
2006 Dartmouth Atlas, Fall, 2006
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NCQA Practice Connections Patient Centered
Medical Home Certification
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NCQA Practice Connections Patient-Centered
Medical Home Certification
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PCMH Practices

• Organize the delivery of team-based care for all
  patients, according to the Chronic Care Model
• Use evidence-based medicine and clinical decision
  support tools
• Coordinate care in partnership with patients and
  families
• Provide enhanced and convenient access to care
• Identify and measure key quality indicators
• Use secure health information technology to
  promote quality and safety
• Participate in programs that provide feedback on
  performance and accept accountability for process
  improvement and health outcomes

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OPPORTUNITY

• Improved provider satisfaction
• Reimbursement based on value provided primary
  caregivers compensated for service provided
• Improved practice margins due to efficiencies
  and new revenue streams
• Team approach allows primary care physicians to
  be more effective

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OPPORTUNITY

• Healthier patients equal
• Better quality of life
• More productive workforce (less absenteeism,
  fewer injuries, etc.)
• Slower rate of increase in health care spending
  and lower costs over time
• Reduced burden on Medicaid, insurers, employers,
  and health care providers
• Healthier economy

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MPCC Priority Projects for 08/09

• Obtain multi-stakeholder consensus on a Michigan
  definition and metrics for the Patient-Centered
  Medical Home
• Promote primary care payment reform
• Develop educational materials on PCMH for
  consumers, health care professionals, and policy
  makers
• Address primary care workforce issues
• Support and evaluate Improving Performance in
  Practice project

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Improving Performance in Practice Project

• American Board of Medical Specialties
• Created IPIP to support new physician
  recertification requirements
• States were provided with program materials and
  support
• Funded by RWJF, grant provides 2 years of seed
  money to states

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States Participating in IPIP

• 2006 North Carolina, Colorado
• 2007 Michigan, Pennsylvania
• 2008 Minnesota, Wisconsin,
• Washington

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Improving Performance in Practice Project

• Objective Improve chronic disease
• care in primary care practices
• Chronic disease learning collaborative -
  Quarterly 2-day learning sessions
• - Monthly phone calls
• - Focus adult diabetes and/or pediatric asthma
• On-site coaching

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IPIP in Michigan

• Michigans IPIP features a unique collaboration
  involving industry
• MPCC is the programs sponsor
• AIAG is the fiduciary agent
• On-site coaches are volunteers who are
  industry-trained quality improvement engineers

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Key IPIP Interventions

• Use a Patient Registry
• Initiate Team Care
• Implement Planned Visits
• Provide Self-Management Support
• Work toward Creation of PCMH

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Clinical Outcome Measures
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RECOMMENDATIONS
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RECOMMENDATIONPhysician Leaders are needed!

• Promote concept of informed, activated patients
  and proactive practice teams
• Advocate for and teach efficient design of
  practices
• Promote need for continuous quality
  improvement and accountability for outcomes
  (clinical, satisfaction, cost, function)
• Promote IPIP as opportunity for practice
  transformation

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RECOMMENDATIONPhysician Leaders are needed!

• Develop community supports, including healthy
  public policy, supportive environments,
  community action
• Develop physician and team skills to empower
  patients and activate them for self- management
• Develop physician skills for leading and
  coordinating team care
• Develop methods to document the added value of a
  PCMH
• Develop models and strategies to spread PCMH
  across Michigan

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Systemness as a Community Property

• Community entity provides
• Leadership and integration via coalition
• Performance measurement
• Financial incentives
• Models of change
• Programs for learning and dissemination
• Shared infrastructure
• Guidelines
• IT software and support
• Care management
• Consumer education

Health Systems in a Community
Widespread Practice Change
Improved Community Outcomes
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FINAL RECOMMENDATION

• Become involved in the MPCC as the
  representative of a new member organization or
  on work-groups such as PCMH evaluation,
  promotion of patient registries, community
  resource identification, public policy
  development, primary care workforce, consumer
  engagement, community improvement networks, etc.
• Work with us to move primary care in Michigan to
  a bright future and better health for all our
  citizens!

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Michigan Primary Care Consortium

• For more information
• www.MIPCC.org
• If you wish to become involved with the MPCC,
  contact
• CallaghanC_at_michigan.gov