Manitoba‟s
Physician Integrated Network
CHSRF Picking Up the Pace Conference
November, 2010
What is PIN?
 A primary care renewal initiative that engages
fee-for-service primary care group practices.
(13 group practices, 130 physicians, 150,000
patients)
 Provides participating group practices the
opportunity to implement practice changes that, in
turn, support comprehensive continuous care
 Supports Manitoba‟s vision for Primary Care:
“Primary Care is the foundation of the health
system and quality primary care will be accessible
to all Manitobans.”
INFORMATION
ACCESS
WORK-LIFE
PIN Objectives
QUALITY
Quality Indicators
 The PIN objective of Quality Care is supported by
six indicator clusters (which include 27 quality
process indicators).
 Indictor clusters are:
Prevention
Diabetes Management
Asthma Management
Congestive Heart Failure Management
Hypertension Management
Coronary Artery Disease Management
 Indicators are derived from CIHI‟s Primary Care
Indicators and align with clinical guidelines.
Quality Based Funding
 PIN provides quality based incentive funding (QBIF)
to participating PIN group practices.
 QBIF compensation is tied to:
 number of “core patients” (incenting continuity of care)
and,
 indicator achievement (incenting quality of care).
 QBIF payments:
 are to the group, not individual providers;
 are in addition fee-for-service physician payments;
 are one catalyst for practice and system change; and
 provide physician groups the means of hiring other
providers.
QBIF Methodology
 While the amount of QBIF funding available to a
group is based on the number of “core patients”,
actual compensation is determined based on:
 Percentage achievement on quality indicators.
 “Clustering” of achievement for chronic disease
indicators within a cluster.
 The QBIF Compensation Scale; compensation is
lower than % achievement in the lower ranges,
and higher than % achievement in the higher
ranges.
QBIF Compensation Scale
Achievement
Clinic
%%Achievement
bybyClinic
Available
QBIFFunding
Funding
%%ofofAvailable
QBIF
Provided
ToTo
BeBeProvided
19.99%
0 0– –19.99%
0%
0%
29.99%
2020– –29.99%
10%
10%
39.99%
3030– –39.99%
20%
20%
49.99%
4040– –49.99%
40%
40%
79.99%
5050– –79.99%
Samepercentage
percentageasas
Same
percentage
achievement.
percentage
achievement.
84.99%
8080– –84.99%
90%
90%
85%- 100%
- 100%
85%
100%
100%
QBIF – a Clinician‟s Perspective
Opportunities:
• Direct encouragement of complying with the indicators.
• Flexible approach, allowing clinics to determine and
invest in the supports they need.
Challenges:
• Are all items actually really worth the same amount of
funding – e.g. BMI measurement vs. FOBT counselling
• How many QBIF items can be added, and who decides
which to add and which to remove and when?
Results
A Phase 1 Evaluation found that:
 Progress had been made in improving access to
and use of information, and in demonstrating quality
care.
 Further progress is needed to improve access to
primary care and to improve the work life of
providers.
 Stakeholders were optimistic about greater progress
towards PIN objectives as they move past the initial
stages of implementation.
Select Indicators
On the Horizon
1. Further refinement of quality-based funding
approach.
How to support „improvement‟ as well as
„maintenance‟ of quality.
How to best support quality care for patients with
complex needs / co-morbidities.
2. Piloting Patient Enrollment/Registration
Necessary to confirm “core patients” as required to
support quality measurement and quality based
incentive funding.
On the Horizon
3. Extending Quality Measurement to New Domains
Depression Screening and Follow-up
Access to Primary Care / ? Include Patient Surveys
4. Ongoing Evaluation, Including:
Phase 2 Evaluation
- Data analysis
- Pre and Post surveys (PCAT)
Benefits Evaluation
- System impacts
Economic Evaluation
- Economic impacts of clinical
processes
QUESTIONS/COMMENTS?
www.manitoba.ca/health/phc/pin