This document outlines metrics and requirements for a pay for performance program for primary care practices in Michigan. It discusses six month metrics related to electronic health records, access to care, and care management. It also outlines one year clinical quality metrics and points allocation. The document provides information on care manager roles and responsibilities, codes for chronic care management services, and conditions for payment. It announces an upcoming training and a learning collaborative focused on behavioral health integration.
2. Agenda
Pay for Performance
Care Manager
Environmental Scan
MiPCT Metrics Committee
Behavior Health Representation
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3. 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
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4. 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
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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
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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)
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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
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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
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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
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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
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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)
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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
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14. Registration for CCM Workshop
Moderate Care Manager web based enhanced
training begins September 10 at 11:30am
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15. Learning Collaborative
Focus on behavior health integration
Recruitment for family medicine, internal
medicine and geriatric medicine practice teams
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