Michigan Primary Care   TransformationDemonstration Project   September 5, 2012
Agenda   Pay for Performance   Care Manager   Environmental Scan   MiPCT Metrics Committee   Behavior Health Represen...
Pay for Performance:          Six Month Metrics – eRegistry1)   Practice has electronic registry2)   Registry has interfac...
Pay for Performance:          Six Month Metrics - eRegistry7.   Used to flag gaps in care8.   Patient demographics9.   Reg...
Pay for Performance:          Six Month Metrics - eRegistry   0 points for entire metric if no eRegistry   1 point each ...
Pay for Performance:         Six Month Metrics - Access   Extended access:    • 30% same day appointment (10 points)   A...
Pay for Performance:         Six Month Metrics - Care Manager   Number of Moderate Care Managers hired/    contracted by ...
Pay for Performance:         Six Month Metrics - Care Manager   Number of Complex Care Managers hired/    contracted by p...
Pay for Performance:          Year One   Clinical Quality diabetes, hypertension, BP    (140/90), Asthma   ACSC hospital...
Pay for Performance:          Points   Notification of hospitalizations   5 points   Primary care sensitive ED visits   ...
Care Managers   Each practice has a Hybrid Care Manager assigned    and actively engaged   Dietitian, Certified Diabetes...
PDCM CodesCODE                            SERVICEG9001    Initial assessmentG9002    Individual face-to-face visit (per en...
General Conditions of Payment   For billed services to be payable, the services must be    delivered and billed under the...
Registration for CCM Workshop   Moderate Care Manager web based enhanced    training begins September 10 at 11:30am      ...
Learning Collaborative   Focus on behavior health integration   Recruitment for family medicine, internal    medicine an...
Questions            16
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MiPCT Webinar 09/3/2012

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MiPCT Webinar 09/3/2012

  1. 1. Michigan Primary Care TransformationDemonstration Project September 5, 2012
  2. 2. Agenda Pay for Performance Care Manager Environmental Scan MiPCT Metrics Committee Behavior Health Representation 2
  3. 3. Pay for Performance: Six Month Metrics – eRegistry1) Practice has electronic registry2) Registry has interface capability3) Incorporates evidence-based care guidelines4) Identifies individual attributed practitioner5) Information available and used by the practice unit team at the point of care6) Used to generate communications to patients regarding gaps in care 3
  4. 4. Pay for Performance: Six Month Metrics - eRegistry7. Used to flag gaps in care8. Patient demographics9. Registry identifies and tracks care for patients with at least 2 of the following: diabetes asthma cardiovascular disease pediatric obesity 4
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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) 11
  12. 12. PDCM CodesCODE SERVICEG9001 Initial assessmentG9002 Individual face-to-face visit (per encounter)98961 Group visit (2-4 patients) 30 minutes98962 Group visit (5-8 patients) 30 minutes98966 Telephone discussion 5-10 minutes98967 Telephone discussion 11-20 minutes98968 Telephone discussion 21+ minutes 12
  13. 13. 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
  14. 14. Registration for CCM Workshop Moderate Care Manager web based enhanced training begins September 10 at 11:30am 14
  15. 15. Learning Collaborative Focus on behavior health integration Recruitment for family medicine, internal medicine and geriatric medicine practice teams 15
  16. 16. Questions 16
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