MPCC History

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THE MICHIGAN PRIMARY CARE INITIATIVE: PAST, PRESENT AND FUTURE

BACKGROUND

Poor Health Outcomes.The US has historically had worse health status among its citizens than other countries that spend substantially less per capita for health care.  One reason for this disparity is that the US focuses on the treatment of illness while other countries invest more heavily in primary care services to prevent and manage illness so that fewer high-priced tertiary care treatments are required.

Public Health Roots. The initiative that gave rise to the Michigan Primary Care Consortium originated with the Michigan Department of Community Health (MDCH). The MDCH recognized that there was an impending crisis in primary care, a crisis that government alone could not solve. To lessen the ever increasing burden on government caused by a fragmented and inefficient primary care system, the MDCH convened public and private organizations that could potentially take actions to improve the health of Michigan citizens, lower the cost of health care, and reconfigure health care delivery and financing systems.  The goal was to convene these Michigan stakeholders to address system level barriers to enable Michigan residents to benefit from high quality primary care services.

PAST: 2006-2008

In December 2006, the Michigan Primary Care Consortium (MPCC) formally began its work as a collaborative public/private partnership.  Its mission was to improve the system of delivery of prevention services and the management of chronic disease in primary care settings by aligning quality improvement initiatives, addressing gaps in health care, and engaging in problem-solving strategies. (See Mission and Vision)

Initially, the MPCC infrastructure and many of its activities were financed by the State of Michigan. Additional support came from in-kind and charitable contributions. The MPCC developed plans and processes for change using the intellectual capital of the diverse experts who comprise its membership.

The MPCC spent its first years sorting through the issues that challenge the primary care health system and broadening the consortium to facilitate the work.  The three primary activities included:

  1. Convening organizations concerned with the survival of primary care, the rising incidence of preventable health conditions, and spiraling health care costs;
  2. Identifying huge system barriers to improved primary care in Michigan such as looming workforce shortages and misaligned reimbursements for primary care services; and
  3. Building consensus on the actions needed.  

By the end of 2008, MPCC had four primary accomplishments:

  1. An exhaustive review of the best national and international research and analysis on the crisis in primary care and promising solutions. The review was summarized in a four-part White Paer series:  Primary Care is in Crisis.  This publication lays out the research base for the context and framework for MPCC activities. (See the MPCC White Paper Series )
  2. Agreement that changes were needed in reimbursing primary care in Michigan. that increased reimbursement for primary care functions should be based on compliance with a Michigan definition for the Patient-Centered Medical Home (PCMH).  The same insurers reached consensus on such a Michigan definition.  Consensus was achieved among all major Michigan-based insurers
  3. A major quality improvement project, Improving Performance in Practice (IPIP).   IPIP worked directly with 35 primary care practices across Michigan, supplying coaching from industry-trained quality engineers. In addition, each practice participated in quarterly Learning Collaborative sessions to gain skills in implementing the Chronic Care Model and creating Patient-Centered Medical Homes.
  4. A website for communication. (See www.mipcc.org.)

PRESENT WORK: 2009 THROUGH EARLY 2010

In 2009, the MPCC began to see the culmination of the previous three years of careful hard work.  MPCC accomplishments for 2009 and early 2010 can be summarized under eight headings:

  1. Action Plans Finalized. In July 2009, seventy volunteer members of the MPCC, working together in highly-focused topic groups, took the White Papers to the next level by finalizing action plans to implement 35 priority objectives, addressing the issues listed below that impact on the delivery of primary health care services:
    • Rebuilding the shrinking primary care workforce.
    • Reforming the payment system for primary care practitioners.
    • Re-engineering primary care practices to improve efficiency and effectiveness.
    • Promoting use of secure electronic health information technology to improve safety and quality care.
    • Incorporating decision-support tools into practices to assure that evidence-based care is the norm.
    • Engaging and incentivizing consumers to become active participants in their own health care.
  2. Implementation of Action Plans Begun In August 2009, the 35 objectives were re-ranked, presented to and approved by the MPCC Steering Committee.  Nine top priority objectives emerged for achievement by end of 2010.  Volunteers and resources were identified for nine implementation groups.  In fall 2009, implementation of those nine priority objectives began.  Three workgroups – Practice Transformation, Workforce, and Community Resources – are meeting regularly and sub-groups formed where necessary.  The nine MPCC Priority Objectives for 2010 focus on:
    • Promoting the effective and efficient use of Health Information Technology.
    • Defining the cost of creating Patient-Centered Medical Homes and seeking funding sources available to Michigan practices.
    • Systematically working to spread adoption of the Patient-Centered Medical Home model throughout Michigan in all primary care delivery settings.
    • Creating and disseminating tools to assist primary care practices to initiate their transformations to Patient-Centered Medical Homes.
    • Facilitating providers in their efforts to engage consumers in self-management to improve wellness and manage their chronic conditions.
    • Defining evidence-based services and resources that should be available in communities throughout Michigan to support consumers manage their health. 
    • Communicating to the public evidence-based strategies to engage consumers in self-management to improve wellness and manage chronic conditions.
    • Creating a plan to incorporate health literacy principles into high school modules of the Michigan Model for Comprehensive School Health.
    • Creating a state plan to serve as a blueprint to enable Michigan to have a competent and an adequate supply of Primary Care Health Professionals.
  3. Funding Plans Developed.  The State of Michigan covered the start-up costs for the MPCC for several years, primarily using funds generated by a tobacco tax in the Healthy Michigan Fund. But with the state’s fiscal crisis, the MPCC was one of many valuable programs that saw an end to State support in 2009.  To sustain MPCC operations at the current average level of $400,000 per year, the MPCC Funding Committee has launched an intensive fundraising campaign.  The short-term plan to raise funds through the next year hinges on contributions from MPCC member organizations.  Each of the MPCC’s 100 member organizations has been asked to contribute or raise $5,000 to support the MPCC.  In addition, selected business and corporations have been targeted for funding solicitations.  For longer term sustainability, MPCC will continue to seek donations, but will also respond to public and private funding announcements that may offer funding to support activities consistent with the MPCC mission, and will investigate other potential financial streams of revenue as appropriate.

    To attract funding sources that are legally bound to give to non-profit organizations only, MPCC governance agreed that seeking non-profit status was appropriate and necessary for financial viability.  On October 19, 2009, the MPCC Steering Committee concurred unanimously.  Shortly thereafter, the task of completing the IRS Form 1023 began.  MPCC became incorporated on December 8, 2009 in the State of Michigan.

  4. All-Payer Group Progress. Convened by the MPCC, the group of Michiganorganizations that pay for health care continued to meet throughout 2009.  Consensus was achieved on the three best initial metrics to objectively determine adoption of the Patient-Centered Medical Home by a primary care practice.  Primary care professionals consider this consensus to be crucial to minimize additional administrative burdens faced by practices. Such consensus is also a critical precursor to increasing reimbursement rates for primary care practices meeting quality and efficiency standards.
  5. Website Upgraded.  The MPCC website has been redesigned to be more user-friendly. 
  6. Tool Completed. The toolkit “Getting Started with Patient Centered Medical Homes” was completed for use by primary care practices that want to begin the transformation process.
  7. MPCC Membership Expanded.  During 2009, membership in the MPCC almost doubled (more than 100 organizations are members as of February, 2010.)  New members continue to join MPCC ranks with enthusiasm and expertise to share in the many varied activities that form the substance of its workgroups and committees.
  8. Federal Initiatives Supported. MPCC staff and members helped to plan a strategic partnership session sponsored by the U.S. Health Research and Services Administration (HRSA) to clarify needs and identify potential solutions regarding the shrinking primary care workforce.  Since then, the MPCC has engaged in additional strategic planning to harness the diverse interests and capacity for influence represented by participants at that meeting.  HRSA has expressed interest in sponsoring a follow-up meeting in 2010 to build additional support for rebuilding the workforce in Michigan. 

FUTURE: PLANS FOR 2010 AND BEYOND

MPCC has become an indispensable part of the movement to preserve and improve primary health care in Michigan. The MPCC has a critical role in assuring that the momentum for change is sustained.  In 2010 and beyond, MPCC will continue to implement the action plans developed to date.  It will seek funding to maintain the momentum.  And it will continue to play roles in four major arenas:

  1. Convener: In its role as a convening entity, the MPCC will continue to bring together organizations with knowledge and resources to develop understanding about and help to solve the multiple and inter-related challenges facing the primary care community in Michigan.  The MPCC will continue to assure that all parties concerned that primary care both survives and thrives will have a place at the table.
  2. Rapid Responder:  The next few months will be critical as the waves of national health care funding and reform initiatives emerge.  Because so many influential partners already are working together through the MPCC, Michigan will be able to respond quickly to opportunities and challenges that arise with changes in federal health laws.  The MPCC also will be able to help respond to challenges to Michigan’s health status from the state’s budget deficit.   
  3. Communicator:  MPCC members communicate to the public and to health professionals, promoting materials that reflect the current understanding of and efforts to address the crisis in primary care. Communication vehicles include the MPCC website, presentations in diverse forums and publications, presentations to partner organizations, new-member orientations, and meetings of the MPCC Steering Committee and Executive Committee.
  4. Coordinator:  In its coordinating role, the MPCC will continue to staff and otherwise support planning and problem-solving groups, implementation groups addressing priority objectives, interest groups (e.g., Payer Group) focusing on specific challenges facing primary care providers, and groups created to respond to funding and other opportunities to enable Michigan organizations and providers transform primary care practices and create Patient-Centered Medical Homes for all Michigan residents.

While many volunteers from member organizations throughout the health care/service community have begun to implement these plans, the MPCC continues to seek participation from others who can lend their ideas, skills and experiences to help resolve the issues salient to rebuilding the primary health care system.

In 2010, the MPCC believes the promise of health care improvement and the beginnings of cost control will be realized in Michigan.  While many agendas exist, the collective agreement is that the health status of Michigan residents is fundamental and its importance is without dispute.  The MPCC can be characterized as a fulcrum from which many thoughts and actions generate and are effectively channeled.