Michigan Primary Care Transformation

Demonstration Project

April 17, 2013 Webinar

Congratulations!

Anchor Bay Clinic

• Karl Emerick, DO

• Kevin Klein, DO

• Raquela LePera, DO

• Thomas Mianecki, DO

• Debra Moses, DO

• Irene Scott, Office Manager

• Angie Siegmon, RN, Care Manager

2

Upcoming URAC Audits

Hampton Medical

• Bruce Johnson, DO

• Susan Tam, DO

Country Creek Family Physicians

• Al Juocys, DO

• Shailaja Rastogi, MD

Douglas Hames, MD

3

Upcoming URAC Audits

Rosa Parks Geriatrics

Ron Williamson, MD

4

URAC Deadline Extended

URAC has given a green light for deadline

extension

5

Care Manager Training

Moderate Care Manager Training

Complex Care Manager Training

6

Liability Insurance

All MNO care managers carry full liability coverage

$1,000,000/$3,000,000

7

Liability Coverage

Letter from carrier

Letter from MNO endorsing malpractice carrier

Average annual premium $7,000

Approximate 20-30% savings

Dinner meeting on Wednesday, May 22, 2013

from 6:00-7:30pm ay APCC

8

Liability Coverage

“Reserve” Plan only available to MNO primary

care physicians in wave one

URAC PCMH accreditation

Annual team training including risk training

Quality scores at 70%

9

iExaminer

Project lead

One iExaminer/MiPCT office

Training tool

Appropriate ophthalmoscope

10

Diabetes Pilot Project

Project lead

Poor enrollment

Outreach

Assistance

11

Shared Visits

Hampton Medical

Anchor Bay Clinic

12

Financial Incentives

Year one distribution

Care manager funding

1st Quarter 2013 report

13

Billing and Coding Seminars

Throughout May, regional meetings will be held

throughout the state, facilitated by BCBSM, BCN,

and Medicare Advantage

G and CPT care management codes

14

Billing and Coding Seminars

Sessions will be approximately three hours long

(morning or afternoon)

Billers, coders, care managers, PO representatives,

and others involved in the coding and billing

process should attend

15

Sequestration

President Obama signed an order that imposes

across-the-board Federal spending reductions (also

known as sequestration) for Federal payments

effective as of April 2013.

If Congress does not take action to avert this,

monthly payments to practices and POs will be

reduced by 2% beginning April 1, 2013 and this will

continue until there is resolution about the Federal

budget and Federal deficit.

16

Metrics Year Three

You’ve referred patient out…what next?

Behavioral health metrics supplied by Dr. Zeman

Committee meets to review all process and clinical

outcome proposed metrics

17

Physician Engagament

Highly engaged

Moderately engaged

Minimally engaged

Totally disengagement

18

Open Discussion

19

QUESTIONS?

20