Michigan Primary Care Transformation

Demonstration Project

October 31, 2012

Agenda

Context and Overview

Payer Updates

• BCBSM

• BCN

• Medicaid

• Medicare

2

Seeking Nomination

MiPCT is soliciting nominations for one slot for a

PO representative with financial expertise on the

Steering Committee.

The purpose of the Steering Committee is to

provide strategic direction to MiPCT Leadership

and monitor progress toward the goals and

objectives of MiPCT.

3

Care Management Reporting

The care management activity reporting

requirements have been finalized and will be

incorporated into the Quarterly Report beginning

in the first quarter of 2013.

Number of Care Manager face-to-face encounters

(by Care Manager, by practice, by primary payer)

4

Care Management Reporting

Number of Care Manager telephone or electronic

encounters by Care Manager, by practice, by

primary payer

Number of unique patients by Care Manager, by

practice, by primary payer

5

PDCM Codes and Fees

6

CODE SERVICE FEE*

G9001 Initial assessment $112.67

G9002 Individual face-to-face visit (per encounter) $56.34

98961 Group visit (2-4 patients) 30 minutes $14.08

98962 Group visit (5-8 patients) 30 minutes $10.47

98966 Telephone discussion 5-10 minutes $14.45

98967 Telephone discussion 11-20 minutes $27.81

98968 Telephone discussion 21+ minutes $41.17

*Net of Incentive amount

New MiPCT Files

MiPCT has sent the most recent data participating

practices and physicians, respectively.

NPs/PAs that serve as PCPs and bill separately

have been added to the file.

The same billing information needed for

physicians is needed for NPs/PAs.

To receive Medicaid payments, the NP/PA must be

the PCP of record for Medicaid managed care

members and must be enrolled in CHAMPS.

7

MDC Dashboard

The first MDC Dashboard is available for MNO and

the practices within it.

This release was constructed using 2010-2011

Medicare and Medicaid claims data and

September attribution lists.

8

MDC Baseline Data

This release provides baseline data for MNO and

each practice for Medicare and Medicaid (as it

reflects data January 2010 through December

2011).

More recent data will be integrated over time and

other payers will be added to aid in identifying

opportunities for improvement (and best

practice).

9

MDC Baseline Data

The next release of dashboards is scheduled for

January 2013 and will include BCBSM data.

Future dashboards will be released every two

months to provide data on your performance over

time.

10

Moderate Care Manager Program

Place: Physicians’ Training Center

26550 John R Madison Heights Mi 48071

Contact: Mike Mellor,

mmellor@transformcoach.org

Modality/schedule: Live, in-person

Course dates: November 6, 7, 14, 15. 8:30am-

4:30pm (Must all four days)

11

Documenting Success Stories

Robert Wood Johnson video submission for

possible full length story

Interviews by national research organization

Interviews by CMS representatives

12

Upcoming Events

Practice meeting to discuss Care Manager

integration

Billing and coding

Group assessment of current quality scores and

gap analysis

Learning Collaborative beginning December 5,

2012

Mini Learning Collaboratives

13