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Michigan Primary Care Transformation
Demonstration Project
November 14, 2012Webinar
MiPCT and Mid‐level Providers
NPs/PAs that serve as PCPs and bill separatelyhave 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.
2
Documented Success Stories
Robert Wood Johnson video submitted• Debby Kobayashi, LMSW• William Porter, RN
Interviews by national research organization completed• Monroe Medical Associates: Tedd March, MD• William Porter, RN
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Documented Success Stories
Care Managers were asked to provide a narrative of a patient/family success story
Six submissions from care managers
Awaiting pediatric success story
Narratives will be sent to MiPCT for publication in newsletter
4
Enhanced Eligibility Capability
Providers can currently check whether a patient has active BCBSM/BCN coverage using the Web‐DENIS or CAREN IVR system
Pending functionality in Web‐DENIS that will allow providers to check whether a patient is eligible for PDCM/MiPCT
The process will be finalized in the next few months
5
Pay for Performance
The data for six month incentive distribution has been secured
MiPCT is in process of rechecking each element to ensure accuracy
Data collaborative at U of M is providing the expertise to verify the data
6
Pay for Performance
If incomplete information is submitted by a PO follow up occurs
Incomplete information may be on a data element or is in conflict with care manager training completion
If this occurs, POs will receive their scores and will review them during a one‐week appraisal period
7
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
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Care Management Reporting
Number of Care Manager face‐to‐face encounters (by Care Manager, by practice, by primary payer)
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
Did referral to outside agency occur
9
Community Care Team Enhancements
Community Care Teams• Community Care Travel Team• Community Care Permanent Team
Bill Porter, RN: Community Care Clinical Lead
Erica Ross: Community Care Operations Lead
Dave Johnson, MSW: Behavior Health Consultant
Lori Zeman, PhD: Behavior Health Expert
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Community Care Team Enhancements
Bill Porter, RN: Community Care Clinical Lead
Monitor clinical activities at all practice sites
Oversee case reviews with practice team and care manager
Design quality improvement activities with practice team and care manager
Work with Erica Ross to determine appropriateness of care manager assignments
11
Community Care Team Enhancements
Erica Ross: Community Care Operations Lead
Monitor care manager assignments at practice sites
Working with Bill Porter and practice team to determine appropriateness of care manager assignments
Create and oversee satisfaction surveys and meet with practice teams and physicians to include them in pertinent assessments of care managers
Reviewing overall productivity statistics of care managers
12
Community Care Team Enhancements
Erica Ross: Community Care Operations Lead
MNO Care Managers assignments and schedule
Monitor care manager assignments at practice sites
Working with Bill Porter and practice team to determine appropriateness of care manager assignments
Create and oversee satisfaction surveys and meet with practice teams and physicians to include them in pertinent assessments of care managers
13
Community Care Team Enhancements
Erica Ross: Community Care Operations Lead
Review overall productivity statistics of care managers
Review statistics of care managers employed by practices
Review requests from practice units for additional assistance with various activities
14
Upcoming Event
MNO MiPCT practice meeting on December 12, 2012 at the Polish Cultural Center Discuss Care Manager integration• Current payments• Quarterly financial report• Billing and coding• Quality scores and all practice metric selection
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Upcoming Events
Mackinac Learning Collaborative IV• December 5, 2012• Kevin Taylor, MD and Lori Zeman, PhD co chair• Topic focused on integrated, collaborative or co‐located behavior health
• Currently behavior health specialists are integrated into several adult and pediatric practice
• Hoping 100% participation from MiPCT Teams
Mini Learning Collaboratives
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Thank You: Cluster Meetings
• Updates
• Discussions of new topics
• URAC
• Malpractice
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Open Discussion
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Happy Thanksgiving!
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