The Michigan Primary Care Transformation (MiPCT) Project

PO Open Forum WebinarJuly 29, 2014

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Post-Demonstration MiPCT

• Proposed Components Maintained via Payer Support: – Care Management Funding– Central Administration, including

• Support Services, Policy Analysis, Communication, Multipayer Coordination and Governance

• Data and Reporting• Training and Education

• Recruitment of Additional Payers

• Practice Growth Over Time: Manage practice participation growth over time to reach State goals

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1/1/12 1/1/15

Ongoing “MiPCT V.2”

Original Demonstration Period Potential CMS Year Extension

Payer UpdatesPriority Health

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• Continue to pay G and CPT codes for CM– No member liability (even if member has an HSA)– CM billing to be adjudicated and paid real time (no longer batched

retrospectively)– For all lines of business, with potential exception of Medicaid Priority

which is still in determination– Also for specialty providers (e.g. oncology, cardiology)

• Will pay new CMS Chronic Care code for non-face-to-face care coordination (level to be finalized but expected to be about $42PMPM)– Coordination with G and CPT codes in development – Potential for this to be an alternative to CPT code non-face-to-face

reimbursement

Payer UpdatesPriority Health, cont.

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• In addition, related incentives at two levels:

– $3.25 PMPM to practices who attest to having a CM in the office• Practice must provide CM to a minimum of 2% of Priority Health patients• CM does not have to be employed by the practice • Practice must submit examples of care plans

– $1 PMPM if practice has PCMH (but no onsite Care Manager)

• Priority will continue streamlined MiPCT administrative funding for MiPCT support services to practices and POs

Payer UpdatesMedicaid

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• $7.50 PMPM equivalent to continue for 2015– Not dependent on demonstration period extension by CMS– Differential rates for forward years in exploration

• Aged Blind and Disabled (ABD) population• Temporary Assistance to Needy Families (TANF) and Healthy Michigan

populations

Other Updates

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• In-Person PO Leader Visioning Session in fall

• 2015 Care Management revenue modeling in development

• Comments on CMS proposed language for monthly chronic care management code due to dbechel@umich.edu by August 2

• CMS decision on demonstration period extension still in process

• Applications for practices who want to participate in patient and family advisor training are due Aug 1 (provides four Practice Learning Credits)

Questions and Discussion

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