Michigan Primary Care Transformation

Demonstration Project

September 5, 2012

Agenda

Pay for Performance

Care Manager

Environmental Scan

MiPCT Metrics Committee

Behavior Health Representation

2

Pay for Performance: Six Month Metrics – eRegistry

1) Practice has electronic registry

2) Registry has interface capability

3) Incorporates evidence-based care guidelines

4) Identifies individual attributed practitioner

5) Information available and used by the practice

unit team at the point of care

6) Used to generate communications to patients

regarding gaps in care

3

Pay for Performance: Six Month Metrics - eRegistry

7. Used to flag gaps in care

8. Patient demographics

9. Registry identifies and tracks care for patients

with at least 2 of the following:

diabetes

asthma

cardiovascular disease

pediatric obesity

4

Pay for Performance: Six Month Metrics - eRegistry

0 points for entire metric if no eRegistry

1 point each for numbers 1-8

Up to 2 points for number 9

5

Pay for Performance: Six Month Metrics - Access

Extended access:

• 30% same day appointment (10 points)

Appointments outside regular hours:

• 8 hours/week (10 points)

6

Pay for Performance: Six Month Metrics - Care Manager

Number of Moderate Care Managers hired/

contracted by practices and/or PO

• 10 points

Number of Moderate Care Managers within PO

that have completed the required training

• 10 points

7

Pay for Performance: Six Month Metrics - Care Manager

Number of Complex Care Managers hired/

contracted by practices and/or PO

• 10 points

Number of Complex Care Managers within PO that

have completed the required training

• 10 points

8

Pay for Performance: Year One

Clinical Quality diabetes, hypertension, BP

(140/90), Asthma

ACSC hospitalization metric for 18 years and older

Asthma self management plans 5-64 years

Adolescent well child visits replaced with

adolescent immunization measure

CHF measures removed

Additional points added for Family Medicine

9

Pay for Performance: Points

Notification of hospitalizations 5 points

Primary care sensitive ED visits 30 points

(NY algorithm)

ACSC hospitalizations 10 points

Readmissions 5 points

Clinical metrics 50 points

10

Care Managers

Each practice has a Hybrid Care Manager assigned

and actively engaged

Dietitian, Certified Diabetes Educator, Behavior

Health Specialist, Health Coach, Health Educator,

Certified Asthma Educator, Pharmacist (as

needed)

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PDCM Codes

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CODE SERVICE

G9001 Initial assessment

G9002 Individual face-to-face visit (per encounter)

98961 Group visit (2-4 patients) 30 minutes

98962 Group visit (5-8 patients) 30 minutes

98966 Telephone discussion 5-10 minutes

98967 Telephone discussion 11-20 minutes

98968 Telephone discussion 21+ minutes

General Conditions of Payment

For billed services to be payable, the services must be delivered and billed under the auspices of a practice or practice-affiliated PO approved by BCBSM for PDCM reimbursement.

• Based on patient need

• Ordered by a physician, PA or CNP within the approved practice

• Performed by the appropriate qualified, non-physician health care professional employed or contracted with the approved practice or PO

13

Registration for CCM Workshop

Moderate Care Manager web based enhanced

training begins September 10 at 11:30am

14

Learning Collaborative

Focus on behavior health integration

Recruitment for family medicine, internal

medicine and geriatric medicine practice teams

15

Questions

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