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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

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



                                                                         6
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

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MiPCT Webinar 10/31/2012

  • 1. Michigan Primary Care Transformation Demonstration Project October 31, 2012
  • 2. Agenda  Context and Overview  Payer Updates • BCBSM • BCN • Medicaid • Medicare 2
  • 3. 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
  • 4. 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
  • 5. 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
  • 6. PDCM Codes and Fees 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 6
  • 7. 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
  • 8. 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
  • 9. 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
  • 10. 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
  • 11. 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
  • 12. Documenting Success Stories  Robert Wood Johnson video submission for possible full length story  Interviews by national research organization  Interviews by CMS representatives 12
  • 13. 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