The Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration AcademyHealth June 2016 Donald Nichols, PhD www.rti.org RTI International is a registered trademark and a trade name of Research Triangle Institute.
Acknowledgement and Disclaimer This project was funded by the Centers for Medicare & Medicaid Services under contract no. HHSM-500-2010-00021I. The statements contained in this presentation are solely those of the authors and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. RTI assumes responsibility for the accuracy and completeness of the information contained in this report.
Overview of MAPCP Demonstration Medicare participated in 8 state-led multi-payer PCMH initiatives, along with Medicaid and commercial payers – NY, RI, VT, NC, MN, ME, MI, PA MAPCP Demonstrations began in 2011 through 2012 Initially a 3 year demonstration – Extended until the end of 2016 in some states: NY, RI, VT, ME, and MI – Evaluation goes through December 2014 Expected State and Practice Patient Payer Outputs Inputs Outcomes • Financial support (e.g., • Enhance practice • Cost savings payments to practices infrastructure (e.g., • Efficient utilization and supports) health IT, staffing) • High quality of care • Technical support (e.g., • Provide advanced and patient learning collaboratives, primary care services experiences coaching) (e.g., care • Claims data (e.g., data coordination) and performance reports)
MAPCP Participation Attributed Attributed All- Participating Medicare payer State Practices Participants Participants New York 37 27,707 100,033 Rhode Island 16 12,631 59,251 Vermont 125 78,881 271,282 North Carolina 40 33,154 81,925 Minnesota 208 159,460 1,050,003 Maine 70 59,548 140,082 Michigan 312 299,897 1,175,586 Pennsylvania 44 41,640 153,597 852 712,918 3,031,759
Evaluation Design Mixed methods evaluation – Difference-in-differences – Comparative case study – Qualitative comparison analysis Qualitative data sources – Annual site visits – Medicare and Medicaid beneficiary focus groups (late 2014) Quantitative data sources – Medicare fee-for-service (FFS) beneficiary enrollment and claims data – Medicaid enrollment and claims/encounter data – Medicare beneficiary survey (mid 2014) – Practice transformation survey (early 2015)
Results Transformation accomplishments – Integration of care management/coordination activities and staff was focus of transformation process – Expansion of patient access It took states longer than expected to operationalize initiatives, thus they felt 3 years was not enough time to reduce cost or improve health outcomes – Saved Medicare a combined $323 million through the second year of the demonstration – NY, ME, and MI reduced hospital admissions – MI and MN reduced 30-day unplanned readmissions – ME was only state to reduce ER visits not leading to hospitalization Importance of multi-payer aspect of demonstration – Greater payer participation provided greater momentum – Sustainability and scalability depended on practices’ receiving payment for a critical mass of patients
More Information Donald Nichols Susan Haber Project Director Deputy Project Director dnichols@rti.org shaber@rti.org Melissa Romaire Deputy Project Director mromaire@rti.org
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