2016 Practice FLASH

MiPCT Logo Final

Important information for our Practices is published in the MiPCT Practice FLASH in an effort to consolidate communications from MiPCT to our practices.   These publications are posted here for your easy reference.  A .pdf link appears on this page, followed by the text version of each issue.  For questions regarding the information in the FLASH, please email mipctdemo@michigan.gov.


December 12, 2016

Looking to 2017:  Closing out the MiPCT Demonstration and Transitioning to the Ongoing Programs

As the close of the demonstration period of the MiPCT comes to an end (on December 31, 2016), and the transition to ongoing programs (e.g., CPC+, SIM PCMH Initiative, etc.) begins on January 1, 2017, we wanted to thank everyone for their tremendously hard work during the demonstration.   We all worked hard and it paid off — Michigan’s performance led the nation in the CMS/RTI evaluation.  The close of the demonstration period brings with it some responsibilities and activities during 2017, however, that are important to remember.   Among them:

  • The 4Q 2016 PO Quarterly Report will be due on January 31, 2017.  Remember that 80% Care Manager Sufficiency ratio still applies.
  • The 54 and 60 month incentive scoring will be distributed for your review and then paid in 2017.   Information about these will be sent to your MiPCT PO leads as it is available.
  • MiPCT PHI may be retained through December 31, 2017, but effective January 1, 2018, CMS requires it to be destroyed.  Summary or limited data sets may be retained however.    We will work with the MDC on guidance and helpful resources to prepare for the January 2018 deadline and this will also be distributed to your PO leads throughout 2017 so that all are well-prepared.  An attestation of data destruction will also be sent along with timing later in 2017.
  • The mipct.org website will be retained throughout 2017 and refreshed as appropriate.   Resources will continue to be available on it and wrap up activity information will be included as well.  The website will also be refreshed to incorporate a high-level “go-to” tool to help POs and practices easily find summary, key information about the SIM PCMH Initiative and CPC+.

Rather than “goodbye”, we continue our journey together and will support each other as we move forward to make additional progress on primary care transformation and population health.


REMINDER: MiPCT Care Manager Summit 2016 Pre-Work

Recorded CE Webinars Close 12/31/16

For those of you who have not already taken advantage of the opportunity to earn up to 7 nursing or social work CE contact hours, the MiPCT Care Manager Summit 2016 Pre-Work recorded webinars will remain available until December 31, 2016. Four of the five webinars are approved for 1.5 CE contact hours and one is approved for 1.0 CE contact hour by both the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing, and by the Michigan Social Work Continuing Education Collaborative.

Please view the five recorded webinars prior to December 31, 2016. The links to the webinars will no longer be available after that date. The recorded webinars are posted on the http://www.mipct.org website on the 2016 Summit Prework Webinars page located under the 2016 MiPCT Annual Summits tab. Questions: micmrc-requests@med.umich.edu


MiCMRC CARE MANAGER WEBINARS

NEW 2017 MiCMRC CARE MANAGER EDUCATIONAL WEBINARS

Wednesday January 18th 2017 2-3pm

Title: Family Caregiver Health

Presenter: Donna Yadrich, MPA

To register for this webinar: http://micmrc.org/webinars


Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

For information about MiCMRC approved self-management programs please see the document titled “Care Management Resource Center Approved Self-Management Support Training Programs” at https://mipct.org/care-management-resource-center/ 

This document includes details for each MiCMRC approved self-management program: location, objectives, modality, resources, course date/criteria to schedule, trainer qualifications, certification/CEs, and cost.

MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. For questions please submit to: micmrc-requests@med.umich.edu


MiCMRC Complex Care Management Course Registration – 2017 Updates

New in 2017 The MiCMRC Complex Care Management (CCM) course:

  • Open to all care managers!
  • Has been updated to include new content!
  • No course fee!
  • Provides Social Work CE’s!

The MiCMRC Complex Care Management course is designed to prepare the healthcare professional for the role of Complex Care Manager. Course content is applicable to all Care Managers in the ambulatory care setting, working with complex patients. The MiCMRC Complex Care Management Course (CCM) curriculum provides the framework for the complex care management role, foundational elements of integration into the ambulatory care setting, and development of complex care management skills.

NEW FOR 2017: No fee for the MiCMRC CCM Course. Also, due to the numerous care management programs in 2017, CMRC is now requiring the PO leader, practice manager or attendee’s direct manager to register the care manager for the Complex Care Management Course. This will facilitate accuracy of completion of the course registration fields and access to longitudinal resources for your staff.

The training format for MiCMRC CCM course consists of: a one-hour introductory live webinar, two days for recorded webinar self-study (consists of approximately 6 hours’ self-study) and two days of in person classroom instruction.

**For High Intensity Care Model Managers (HICM) ONLY- New for 2017, HICM now integrates with the CCM course. HICM participants are required to complete the MiCMRC CCM course and two subsequent HICM self-study modules that provide the additional specific information for the HICM program.

 

NOTES:   If you have 15 or more non MiPCT Care Managers in your area and would like the MiCMRC team to provide a regional training at your location please submit your request to:   micmrc-requests@med.umich.edu

For questions please contact micmrc-requests@med.umich.edu

 

Upcoming course dates and course registration close dates:

January 23-26, 2017. Introductory Webinar January 23rd, 2017. Total six-hour self-study modules and post-tests January 23-24th, 2017. In person training January 25-26th, 2017. NOTE: Registration will be available on Thursday December 15th. Please visit micmrc.org for registration links.

January 30- February 2nd, 2017. Introductory Webinar January 30th, 2017. Total six-hour self-study modules and post-tests January 30– January 31st, 2017. In person training February 1-2rd, 2017. NOTE: Registration will be available on Thursday December 15th. Please visit micmrc.org for registration links.


 

 

 

Cereal City Pediatric and Moazami Practice: Patient Engagement is the Key

Situation: The practice uses multiple ways to engage our community, families and patients. Recently the practice started using Facebook to get information out to both current and potential families in the area on important health information, seasonal concerns, and news about the practice.

Strategy: The Website tag lineWelcome to Cereal City Pediatricswe’ll be there as they grow…. states “From very first newborn checkup in the hospital, to the unique health concerns of adolescents and every childhood illness in between, our caring providers have the expertise to help you safely navigate the sometimes confusing waters of children’s health care.” The website has also added many helpful pages: office hours, seasonal issues/concerns, is your Child Sick search, medication dosages, links to educational resources, scheduling, provider information, appointment guidance. The practices have access 6 days a week in the summer and 7 in the winter with extended office hours 7:30am – 6:30pm M-F and on Saturday and Sunday 7:30am – 12 noon. Patient hours are 8:00am – 6:00pm M-F with daily open slots for sick visits only from 4:30pm to 6:00pm M-F and on Saturday and Sunday 8 am to 11:30am to meet family needs. Patient/family can schedule a get acquainted visit to the practice. During their first visit,patient’s receive a Welcome to Cereal City practice folder which they are encouraged to bring to each visit. It contains:

  • Information about office practice, providers, office hours, making appointments
  • Calling the office after hours and weekends
  • Immunization schedule
  • Fever treatment
  • Feeding
  • Joining portal, how to create account
  • Information practice needs

Their patient portal is used by families to access visit information, stores copies of forms, medical summery of all visits, or records needed for school or sports. It provides frequently requested information such as medication dosingand facilitates communication between provider, CM and family.

One week before a planned 9mo, 18mo or 2yr well visit, families receive an age appropriate Ages and Stages Questionnaire to fill out and bring back with them to the visit. They are also able to access a SMART Healthy Behaviors Goal sheet with 5 questions help patient/families develop action plan based on their goals and needs. During the office visit, patients and family members are given educational materials specific to the visit type; this information is forwarded to patient portal for families to access after the visit as well.. Parents are educated on pros and cons of immunization. AIM Toolkit from the Alliance for Immunizations in Michigan is used in this process(aimtoolkit.org). If the patient has an urgent care, emergency room or hospital visit a TOC call is done (based on criteria) to follow up. The First question asked is “How are you and your child doing now?”

Triage nurses from the practice are on call nights and weekends to answer question and direct care. If a family visits the emergency room without calling the office first, an opportunity is taken to educate the family to call the office. Diane Thomas, office manager, stated “each contact with our families is an opportunity to support care from ‘first hello to last good bye’. Providing this level of care does not work unless everyone is on board. Everyone has a role and everyone touches the patient. Staff know what they do matters. Every visit is an opportunity to discuss and close care gaps.All staff have training and understand the process and roles to identify and close gaps in care. Catching gaps in care starts with the front desk staff, they generate a gap in care report from the registry, and health plan. They place flags and tasks in the EMR to alert staff of what is needed. They also place this information on a pink encounter form, which follows the patient/family through the visit from the hello to check out. They know why the patient and family are there.”

During any visit the MA checks pink encounter form, MICR and

EMR for HEDIS care gaps and closes according to protocols. The provider reinforces care, referrals and follow-up visits. At checkout, the next visit is scheduled from the pink encounter form. Education and materials are provided throughout the visit and attached to the portal. The office scanner makes sure referrals and reports are placed into chart. Amy Goff, care manager, focuses on both moderate and complex care management. She has an introduction letter for patients who may benefit from care management along with follow up contact letters for patients. She looks for every opportunity to help staff understand care for each patient and be part of cheering them on when they are meeting their goals.

Asthma patients receive a Red Folder with educational fliers and symptom log to help document symptom, track treatment and impact. There is consistent ongoing education and teach back patient demonstration on use of inhaler and spacers at each visit.

Dee Dailey, practice coach, is viewed as part of the team keeping them aware of data and assisting with opportunities for improvement. She presents at quarterly staff meetings a Quality Data Board with updated reports, raw data and specific cases for gaps not met. She helps staff see the impact of improvements and that what they do matters.

For more information on the great work Cereal City has been doing please contact Wendy Hanson @ wendy@cereal.pcc.com


 

From the MI Department of Health and Human Services – Your Public Health Partner

HIV Consultation Program

As a result of the Affordable Care Act and Medicaid expansion, more Michiganders have health coverage than ever before and are seeking out primary care services. As a result, health care professionals in primary care are more likely to encounter patients diagnosed with HIV (or at risk of contracting the virus), than ever before. According to the 2015 Annual Michigan HIV Surveillance Report, there are just over 15,000 individuals living with HIV in Michigan. Many providers may have questions about addressing the health care needs of such individuals. A new consultation program established by the Michigan Department of Health and Human Services, in partnership with Henry Ford Health System, can address questions and help support health care providers in caring for patients living with or at risk for HIV.

The Michigan HIV Consultation Program offers Michigan health care professionals information and guidance regarding:

  • HIV Occupational and Non-Occupational Post-Exposure Prophylaxis (PEP/nPEP)
  • HIV Pre-Exposure Prophylaxis (PrEP)
  • HIV Disease Management
  • HIV Drug Interactions
  • Perinatal HIV treatment

Non-urgent questions can be submitted to www.henryford.com/hiv-consult-program-request and will receive a response in 24-48 hours. For urgent questions, health care professionals should call the 24-hour consultation line at (313) 575-0332. Consultations are provided by a team of knowledgeable doctors and mid-level providers.

Please visit www.michigan.gov/hivstd for information about the State of Michigan’s activities related to prevention, control and surveillance of the human immunodeficiency virus (commonly called HIV), sexually transmitted diseases (also known as STDs), and viral hepatitis (types A, B and C).

You can always find more public health information and resources, including an order form for educational materials for use in primary care, at www.michigan.gov/primarycare.


Behind the Data                                          

By Michigan Data Collaborative

MDC’s Behind the Data section provides high-level information about the data for the MiPCT project in a Q & A format.

Q: Can you explain the purpose MDC’s ED Risk Adjusted Model and how it is calculated?

A: MDC used the following evidence based guideline from the National Committee for Quality Assurance (NCQA) to generate the ED Risk-Adjusted Model: “The National Committee for Quality Assurance investigated the appropriateness of developing this risk adjusted HEDIS measure by building on the existing, unadjusted measure: Ambulatory Care (AMB). Since 1993, the AMB measure has reported the unadjusted emergency department (ED) and outpatient services across health plan members of all ages.” (https://www.ncqa.org/Portals/0/PublicComment/HEDIS2016/4.%20Risk%20Adjusted%20Utilization.pdf)

NCQA test results reveal that risk adjustment is a desirable refinement and demonstrates that a risk adjustment strategy is both accurate and reliable. NCQA’s advisory panels agree that the results support the reliability of the risk adjustment model and that the measures can help identify opportunities for quality improvement.

MDC’s ED Risk Adjusted Model

MDC’s model for risk adjustment includes the relative health, payer, and demographic information of the patient population, allowing for better comparisons of ED use across Provider Organizations (POs). The model reports a risk-adjusted ratio of ED visits during the measurement year (observed) and the predicted probability of ED visits (expected). The model for ED risk adjustment uses Diagnostic Cost Groups developed by Verisk Health, Inc. to assign member level risk scores.

The following three rates are developed for the final evaluation:

  • PO Observed ED Rate – Uses the actual ED visits within the measurement period.
  • PO Expected ED Rate – Uses a two-step model to predict ED visits, which is based on the member’s age, risk score, gender, and payer.
  • The logistic regression estimates the probability of having zero ED visits.
  • The negative binomial regression estimates the probability of ED visits in the measurement year.
  • Overall Observed Rate – Combines all provider organization ED visits.

MDC’s ED Risk-Adjusted Formula

ED risk adjusted = ([PO observed ED rate] / [PO predicted ED rate]) * [overall observed rate]

The ED risk adjusted rate can then be used to compare against the utilization for other providers or MiPCT overall.

SIM / PCMH Initiative – Clinical Data Submission Update Reminder

As we posted in the October FLASH newsletters, POs and Practices continuing with SIM PCMH will send clinical data directly to MiHIN. The MiHIN/SIM team will provide direction regarding how to submit the clinical data in the near future.


 November 14, 2016

Final MACRA Rule Identifies BCBSM PGIP PCMH

The final rule for Medicare Access and CHIP Reauthorization Act (MACRA) was recently released by CMS.   It clarifies that regional PCMH programs that meet certain criteria, including BCBSM’s PGIP PCMH designation, qualify as an acceptable designation for MIPS PCMH credit.  Specifically, CMS relayed that:  “We also expand our definition of how CMS will recognize a MIPS eligible clinician or group as being a certified patient-centered medical home or comparable specialty practice to include certification from a national program, regional or state program, private payer or other body that administers patient-centered medical home accreditation.”   The final rule also identified BCBSM PGIP PCMH designation and the Oregon Patient-Centered Primary Care Home program as two examples of acceptable designation programs.


SIM PCMH Initiative Updates

In late October, MDHHS announced the practices eligible for SIM PCMH Initiative participation in 2017.  They are included as an attachment (Selected Practices.pdf).  The applying organization (practice or PO) for each eligible organization was sent a participation agreement to confirm their participation.  Data sharing and MiHIN legal onboarding documents followed.  The participation agreements were due to MDHHS last Friday (e.g.,  postmarked by November 11).    After signed agreements are tabulated, we will then ascertain those that are continuing MiPCT practices, those that are new to the SIM but applied via a PO, and those practices that applied independently.

MDHHS also released a set of G/CPT codes that are to be submitted for eligible Medicaid patients on and after January 1, 2017.  They are included as an attachment (2017 Care Management and Coordination Tracking Codes.pdf) and will also be covered on the November 15 Billing and Coding noon webinar.


Reporting of Incentive Distributions

Incentive payments from Medicare and Medicaid that were made to POs through the 42-month incentive payment (January 1, 2015-June 30, 2015) are posted on the web-based quarterly report, https://mipct.mihealth.org/. The Incentive Distribution reports are submitted in addition to the quarterly report, as data becomes available. The reports are accessed in a section below the list of quarterly reports on the Financial Reports page.

To complete each report:

  • Click on Edit to open each report to open the Incentive Distribution section.
  • Enter the amount and date payment was made to each practice.
  • As with the quarterly reports, anyone who has a user account may enter and save the data. However, the person who has the authority to submit the financial report will also be responsible for submitting the Distribution of Incentives.
  • The submitter will complete the steps below.
  • Select the checkbox at the end of the page to indicate the report is ready to submit. The Checkbox is only visible to Submitter.
  • Select the “Submit” button at the end of the page. The Status on the Financial Reports page changes from Draft to Submitted.

The Incentive Distributions can be completed anytime one is listed in Draft status. Please complete them at your earliest convenience.


BCBSM Pharmacy Resources Now Available for PDCM Practices

New pharmacy resources are available on the PGIP Collaboration site that MiPCT/PDCM care managers may find helpful when working with chronic condition patients.

Resources include an online toolkit published by the U.S. Department of Health and Human Services to educate providers and patients about safe pain management, called www.turnthetiderx.org; as well as the new Toolkits and Fliers section on the left side of the Pharmacy Initiative page, which includes information for physician organizations, patients and providers.

Topics include saving money by using generic drugs, the dangers of antibiotic overuse, engaging providers in Collaborative Quality Initiatives, and safely managing patients pain, among others.

To access this information and share it with MiPCT/PDCM care managers, visit the Pharmacy Initiative page on the collaboration site under “Initiatives/Projects/Workgroups.”


 Caregiver Stress: Supporting the Caregiver

The term family caregiver and/or informal care giver refers to an unpaid family member, friend, or neighbor who provides care to an individual suffering a chronic condition and needs assistance with various activities such as bathing, eating, dressing or taking medications. When caring for older adults or those with chronic disabilities of all ages, this “informal care” can be substantial in scope, intensity, and duration. Sometimes caregivers are referred to as secondary patients who also need attention and guidance.

A 2015 survey conducted by AARP regarding caregiving in the U.S. showed that approximately 43.5 million adults had provided unpaid care to an adult or child in a twelve-month period. In addition, 60% of caregivers were female, whereas males accounted for 40%. Furthermore, in 2013 it was estimated that caregivers in the U.S. provided 37 billion hours of unpaid care at an estimated cost of 470 billion dollars. On average an informal caregiver devotes 4.3 years to this work. In most cases the care being provided is that of activities of daily living (ADL) or instrumental activities of daily living (IADL). However, this does not always paint a clear picture of unforeseen challenges of providing assistance with such activities, i.e. patients who may have dementia, are resistant to care or have complex medication management.

Most family members feel unprepared to take on the caregiver role, with many having a lack of knowledge of how to deliver appropriate care and receive little guidance from health care professionals. Many are unaware of when community resources may be needed and therefore may not know how to access those resources. Caregivers are patients themselves, with many dealing with physical and mental health issues from their physically and emotionally demanding role as a caregiver. For example, elderly spouses who experience stressful caregiving situations have a 63%higher mortality rate. Caregivers have additional risk for fatigue and sleep disturbances, increased blood pressure, lower immune functioning and an increased risk for cardiovascular disease.

In addition to the increased health risks, caregivers have a difficult time balancing caregiving with other activities such as work or family leisure time, which can lead to increased distress from not being able to participate in those activities. More than half of adult children caring for a parent are employed. They report missed days, interruptions of their work, and reduced productivity. Moreover, those who are unemployed or have lower incomes may experience more distress due to fewer resources to meet the demands.

The Care Manager’s Role

Professional advocacy, can be instrumental in raising awareness of caregiver stress. The care manager plays an important role in supporting the caregiver at risk for physical and emotional harm. Interventions should serve two purposes. First, support the caregiver as a client. In this approach the caregiver is the primary recipient of the education and training which then benefits the patient. Second, utilizing interventions to help the caregiver increase competency and confidence, will lead to providing safe and effective care to the patient, indirectly reducing stress. Research has found that multicomponent interventions rather than single interventions like support groups or education greatly reduce burden.

In some cases, those caring for stroke survivors or patients with dementia found counseling to improve quality of life and reduce depression. Furthermore, many caregivers felt a reduction in burden or distress when receiving socially-supported phone calls that provided some respite from caregiving. Also, home visits and enhanced social support including assistance with respite/day care interventions reduced depression and increased well-being. In addition, a prescriptive program based on research on problem-solving and therapy was developed to empower family members to moderate caregiver stress through the Prepared Caregiver Model which is summarized in the acronym COPE (Creativity, Optimism, Planning, and Expert information). This model teaches caregivers how to design and carry out a plan that focuses on medical and psychosocial issues and are coordinated with care plans of health care professionals.

Caregivers require the knowledge, skills and judgement to carry out the needed tasks of caregiving and having those things help them feel more prepared to deliver care. When providing care one needs to take into account the following dimensions:

  • Nature of the task
  • Frequency of the tasks
  • Hours of care provided each day
  • Skills, knowledge and ability
  • Extent to which tasks can be routine, incorporate into daily schedules
  • Support of other family members.

At a minimum, care managers can recognize and respect a caregiver’s efforts, assess their needs, provide concrete instructions on the specific care they are giving and refer them to other community resources to provide on-going help. This assessment should take place in addition to the patient assessment. Listening skills and the ability to interpret body language and verbal communication are essential competencies when meeting with patients and their family members. Linking caregivers throughout the disease trajectory is critical because many times they are unaware of the support services available

Houts, P. S., Nezu, A. M., Nezu, C. M., & Bucher, J. A. (1996). The prepared family caregiver: a problem-solving approach to family caregiver education. Patient education and counseling, 27(1), 63-73.

Schulz, R. PhD, & Sherwood, P.R. PhD, RN, CNRN. (2008). Physical and mental health effects of family caregiving. American Journal of Nursing. 108(9 Suppl): 23-27.

Care Giving in the U.S. Final Report. (June 2015). AARP. Retrieved from http://www.caregiving.org/wp-content/uploads/2015/05/2015_CaregivingintheUS_Final-Report-June-4_WEB.pdf

Family Caregivers Provide Staggering $470 Billion in Unpaid Care According to AARP Study. (July 2015). Retrieved from http://www.aarp.org/about-aarp/press-center/info-07-2015/family-caregivers-provide-470-billion-in-unpaid-care-aarp-study.html

Reinhard SC, Given B, Petlick NH, et al. Supporting Family Caregivers in Providing Care. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 14. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK2665/


MiCMRC/MiPCT Complex Care Management Course

The MICMRC/MIPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiCMRC/MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiCMRC/MiPCT CCM Course occurs over a 4 day period. The course consists of:

  • Live Webinar on day 1 – introduction of MiCMRC/MiPCT CCM course
  • Self-study modules and post- tests which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • In person training days 3 and 4

Upcoming course dates and course registration close dates:

December 5-8 , 2016. Introductory Webinar December 5th , 2016. Total six hour self-study modules and post-tests December 5-6th, 2016. In-person training December 7-8th 2016. NOTE:   Registration for this course will close as of December 1st , 2016.

January 23-26, 2017. Introductory Webinar January 23rd, 2017. Total six hour self-study modules and post-tests January 23-24th, 2017. In person training January 25-25th, 2017. NOTE: Registration will be available soon. Please watch micmrc.org for registration links.

Register for all MiCMRC/MiPCT CCM Courses: Register Here

Please submit questions regarding the MiCMRC/MiPCT CCM course to: micmrc-requests@med.umich.edu.


REMINDER: MiPCT Care Manager Summit 2016 Pre-Work Recorded CE Webinars Close 12/31/16

For those of you who have not already taken advantage of the opportunity to earn up to 7 nursing or social work CE contact hours, the MiPCT Care Manager Summit 2016 Pre-Work recorded webinars will remain available until December 31, 2016. Four of the five webinars are approved for 1.5 CE contact hours and one is approved for 1.0 CE contact hour by both the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing, and by the Michigan Social Work Continuing Education Collaborative.

Please view the five recorded webinars prior to December 31, 2016. The links to the webinars will no longer be available after that date. The recorded webinars are posted on the http://www.mipct.org website on the 2016 Summit Prework Webinars page located under the 2016 MiPCT Annual Summits tab. Questions: micmrc-requests@med.umich.edu


Management Resource Center Approved Self-Management Support Training Programs – Update

For information about MiCMRC approved self-management programs please see the document titled “Care Management Resource Center Approved Self-Management Support Training Programs” at https://mipct.org/care-management-resource-center/ 

This document includes details for each MiCMRC approved self-management program: location, objectives, modality, resources, course date/criteria to schedule, trainer qualifications, certification/CEs, and cost.

MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. For questions please submit to: micmrc-requests@med.umich.edu


 2015 Summit Best Practice Winner Success Story

CHC Fort Gratiot Wins Most Improved Pediatric Practice

According to Deepa Nandamudi, LMSW/ACSW, Complex Care Manager for CHC Fort Gratiot, there are several factors that made a difference in their practice. First, they have a dedicated process and staff focuse on closing gaps in care. The office staff diligently follows up with parents by phone and via letters. Each visit, regardless of the reason for the visit is used as an opportunity to close gaps in care.

Additionally, ED calls are made to patients who visit the ED to remind them of extended access hours and arrange a follow-up visit, if appropriate.

They also utilize data to identify opportunities for improvement. Data analysis indicated that the most frequent driver of ED visits was constipation. Discussion with parents found that they didn’t know what to do when their child was in pain, or how to prevent constipation. The practice offered a group visit that included how to prevent constipation (e.g., with a high fiber diet that is appealing to kids), and offered information on what to do if constipation reoccurs. Care managers and physicians identified patients who could benefit from this group visit. The group visit was held at a convenient time for parents (from 5:30 to 7:30) and was a hit! As a result, group visits are now conducted for asthma, nutrition, and ADHD.

Another factor is that the care managers are centrally located but huddle once a week to discuss cases. Moreover, one care manager is a social worker and has good relationships with community mental health agencies and behavioral health resources. Community resources are monitored and published on their website and in a hardcopy binder. All employees are trained on community resources and there are good relationships with local agencies. The practice helps the agencies by documenting activity for funders, so that they can provide it to their funders as evidence of use.

There are a few hints that they would like to pass on to other practices. The whole team must know they play important roles and that others depend on them.

  • Connect your offices with community resources.
  • Define and document processes.
  • Create standard work and expectations.
  • Use your data to find out what your issues are.
  • Add a midlevel or increase your after-hours schedule if needed.

CHC Fort Gratiot hopes that the information provided here will benefit care managers, practice staff, and leadership throughout the state of Michigan as they work to provide quality care management for their patients.


Behind the Data  

By Michigan Data Collaborative

MDC’s Behind the Data section provides high-level information about the data for the MiPCT project in a Q & A format.

Q:  With the MiPCT project coming to a close at the end of 2016, what kind of reporting can we expect to see from MDC in 2017?

A:  MDC plans to release the following deliverables in 2017 to close out 2016 MiPCT reporting:

  • Dashboard Release 19.0, targeted for February 2017. This release will include:
  • Eligibility data through June 2016
  • Paid claims data through September 2016
  • Updated measurement period of July 1, 2015 through June 30, 2016
  • The 54 month incentives PDF files will be distributed, targeted for April/May 2017
  • Dashboard Release 20.0, targeted for July 2017. This release will include:
  • Eligibility data through December 2016
  • Paid claims data through March 2017
  • Updated measurement period of January 2016 through December 2016.
  • The 60 month incentives PDF files will be distributed, targeted for September/October 2017.

SIM PCMH/MiPCT Partnership – Clinical Data Submission Update

The plan for clinical data submission for SIM has changed since our last communication in the 10/10/16 PO FLASH. For the transition, SIM POs and Practices will send clinical data to MiHIN. The MiHIN/SIM team will provide direction regarding how to submit the clinical data in the near future.

If you have any questions, please contact MDC at MichiganDataCollaborative@med.umich.edu


 

The next edition of the:

  • MiPCT PO FLASH will be distributed on Monday December 11, 2016
  • MiPCT Practice FLASH will be distributed on Monday December 11, 2016

 

 


 

October 26, 2016

October 26, 2016 Practice FLASH will be published on November 14, 2016.


September 26, 2016

In this week’s edition of the MiPCT PRACTCE FLASH, you will find the following articles:

  • SIM PCMH/MiPCT Partnership Initiative Application
  • Registration for 2016 MiPCT Regional Annual Summits
  • Important Dates
  • MiPCT 2016 Regional Summits – Afternoon Care Manager Sessions
  • 2016 Summit Pre-Work Webinars
  • MiCMRC/MiPCT Complex Care Management Course
  • New 2016 Medication Reconciliation HEDIS Measure
  • Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update
  • Cornerstone Family Practice Learns It Takes a Trusting Relationship with the Patient and the Family To Achieve Quality Care
  • BEHIND THE DATA: By Michigan Data Collaborative
  • MiPCT SUMMIT FLYER

SIM PCMH/MiPCT Partnership Initiative Application Period –

Submission Deadline September 30

As the MiPCT transitions to an ongoing program in partnership with the State Innovation Model (SIM), all current MiPCT practices in good standing are eligible to apply for the SIM PCMH Initiative for Medicaid PMPM funding in 2017. Included as attachments to this edition’s Flash as are the links to the applications and other material.

Please keep in mind that payment will flow to the submitter of the application, as will the responsibilities for all reporting and compliance.  Thus if a PO submits for its MiPCT practices and any PCMH practices in the five SIM regions then the PO receives the funding and is responsible for compliance and reporting.  Conversely, if a practice submits, they receive the funding , compliance, and reporting obligations.   Many POs have already reached out to practices to discuss this and how they can best support practices to ensure that a seamless transition from 2016 to 2017 for SIM PCMH Initiative Medicaid funding.

The link for Physician Organizations applying on behalf of practices, click this link.

If you are a practice applying individually, please click this  link.   

Note: Link to attachments is also located in the index table on page 2.


REGISTRATION OPEN!

2016 MiPCT Regional Annual Summits

Once again this year, the MiPCT Project will convene a Stakeholder Annual MiPCT Summit in three statewide regional locations.

Summit North – Thompsonville, MI

Tuesday, October 13, 2016

Crystal Mountain Resort & Conference Center

12500 Crystal Mountain Drive Thompsonville, Michigan 49683

 Register Here for Thompsonville Summit

 *Registration CLOSES 10/03/2016*


 Summit West – Grand Rapids, MI

Tuesday October 18, 2016

Frederik Meijer Gardens and Sculpture Park 1000 E Beltline Ave NE

Grand Rapids, MI 49525

Register Here for Grand Rapids Summit

*Registration CLOSES 10/07/2016*


Summit Southeast – Ann Arbor, MI

Wednesday, October 26, 2016

University of Michigan North Campus Research Center (NCRC)

2800 Plymouth Road, Building 18

Ann Arbor, MI 48105

Register Here for Ann Arbor Summit

 *Registration CLOSES 10/17/2016*


MiPCT 2016 Regional Summits – Afternoon Care Manager Sessions

 The 2016 in-person Summit Care Manager session: “Social Determinants of Health, Agenda Setting, and Population Management when Delivering Self-Management Support” focuses on the complex and/or high risk disengaged patient.

Learn “how to” identify the right patients for care management. Build upon your population management skills and learn new techniques for working with complex and/or high risk disengaged patients that you can apply in your daily practice!

The Summit 2016 MiPCT Care Management session consists of two parts:

  • *Completion of Pre-work: Viewing recorded Webinar(s) highly recommended prior to in-person session, however may be completed at your convenience. Access at https://mipct.org/
  • Attend a Summit Afternoon in-person session.

Learning Objectives: Summit Care Management afternoon session (in person)

  • Describe the impact of health disparities in patient care
  • Describe the critical Social Determinants of Health when supporting patients
  • Describe techniques for agenda setting with the the complex/high-risk disengaged patient
  • Describe tools to facilitate shared decision making and patient empowerment
  • Discuss the importance of population segmentation for delivering self-management support
  • Learn how to apply population segmentation to a care manager’s caseload

 Expert Presenters from The Centre for Collaboration, Motivation and Innovation: Kathy Reims, MD; Cory Sevin, RN, MSN, NP; Connie Davis, RN, MN, GNP; and Kelly Reilly, RN, MS, CDE

Summit Locations and dates:

Thompsonville, MI   October 13, 2016

Grand Rapids, MI     October 18, 2016

Ann Arbor, MI           October 26, 2016

For additional Care Management Summit in person session details please see the 2016 MiPCT Summit Flyer below

Registration: Register for the MiPCT Summit at https://mipct.org/ Early registration is STRONGLY encouraged.

Continuing Education – In Person MiPCT Care Manager Session

“MiPCT Summit 2016 Care Management Session” is approved for 3.0 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.

This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 081116-06

*Summit Pre-work recorded webinars designed for MiPCT Care Mangers are available. Nursing and Social work continuing education contact hours are available for the Summit Pre-work webinars. Access at https://mipct.org/


 

2016 Summit Pre-Work Webinars

 MiPCT 2016 Annual Summit Care Manager Afternoon Session PREWORK

 Earn Nursing or Social Work Contact Hours for Completing Summit PREWORK Recorded Webinars:

  • We have partnered with the Centre for Collaboration, Motivation and Innovation (CCMI) to design a series of five pre-work webinars to enrich your learning experience at the in-person Summit afternoon CM education session.
  • The presenter is Connie Davis, RN, MN, GMP, and Co-director of the CCMI. Connie is an internationally known trainer, educator, speaker and consultant on health care design and health behavior change.
  • Viewing the webinars prior to the live Summit CM afternoon session is highly recommended.
  • Each of the 5 webinars listed below and the Summit afternoon CM in-person session are standalone in terms of earning contact hours.
  • *Recorded webinars are now available*

 Steps to complete the Summit CM Prework and receive nursing or social work contact hours:

  1.  Access the link on the MiPCT Summit 2016 pre-work web page http://www.centrecmi.ca/mipct-summit-cm-prework/
  2. View the entire online recorded webinar
  3. Click the link below the webinar titled “Request CE Credit” Click Here
  4. Complete the brief form, include your e-mail address, click submit
  5. This will generate an email message to you containing a link to complete the CE request and required evaluation form
  6. Follow instructions in the e-mail: Complete the evaluation and submit. This step generates an email to you containing the CE certificate

New For 2016:

 Stepped Care for Self-Management Support

  •  This Webinar addresses population segmentation, agenda setting, social determinants of health, and patient shared decision making with complex patients.
  • “Stepped Care for Self-Management Support” is approved for 1.0 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.
  • “Stepped Care for Self-Management support” is approved by the Michigan Social Work Education Collaborative. Course approval #: 080416-07

MiPCT care managers who did not have the opportunity to view 2015 MiPCT Summit pre-work webinars or would like a refresher, the following webinars are available. *Please note: if you received Nursing CE credit for the 2015 Summit pre-work webinars listed below in 2015, you will not be eligible to receive credit in 2016.

Understanding Motivational Interviewing (MI): How the elements of Motivational Interviewing provide a context for BAP

  •  “Understanding Motivational Interviewing (MI): How the elements of Motivational Interviewing provide a context for Brief Action Planning (BAP)” is approved for 1.5 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.
  • This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 081116-00
  • *If you received nursing continuing education contact hours in 2015 for this educational offering, you are not eligible to receive CE credit in 2016

Effective Communication with Patients (Ask-Tell-Ask): Identify ways to provide information consistent with the Spirit of MI

  •  “Effective Communication with Patients: Ask-Tell-Ask” is approved for 1.5 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.
  • This course is approved by the Michigan Social Work Continuing Education Collaboration. Course approval #: 081116-01
  • *If you received nursing continuing education contact hours in 2015 for this educational offering, you are not eligible to receive CE credit in 2016

 Understanding Brief Action Planning: Describe the components of BAP

  •  “Understanding Brief Action Planning” is approved for 1.5 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.
  • This course is approved by the Michigan Social Work Continuing Education Collaboration. Course #: 081116-02
  • *If you received nursing continuing education contact hours in 2015 for this educational offering, you are not eligible to receive CE credit in 2016

 Applying Brief Action Planning in the Care Setting: Identify the application of BAP in work settings

  •  “Applying Brief Action Planning in the Care Setting” is approved for 1.5 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.
  • This course is approved by the Michigan Social Work Continuing Education Collaboration. Course #: 081116-03
  • *If you received nursing continuing education contact hours in 2015 for this educational offering, you are not eligible to receive CE credit in 2016

 MiCMRC/MiPCT Complex Care Management Course

The 2016 MICMRC/MIPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiCMRC/MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiCMRC/MiPCT CCM Course occurs over a 4 day period. The course consists of:

  • Live Webinar on day 1 – introduction of MiCMRC/MiPCT CCM course
  • Self-study modules and post- tests which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • In person training days 3 and 4

Upcoming course dates and course registration close dates:

October 3-6 , 2016. Introductory Webinar October 3rd , 2016. Total six hour self-study modules and post-tests October 3-6, 2016. In-person training October 5-6 2016. NOTE:   Registration for this course will close as of September 29th , 2016.

November 7-10 , 2016. Introductory Webinar November 7th , 2016. Total six hour self-study modules and post-tests November 7-8th,, 2016. In-person training November 9-10 2016. NOTE:   Registration for this course will close as of November 3rd , 2016.

Register for all MiCMRC/MiPCT CCM Courses Here:

http://micmrc.org/programs/micmrc-mipct-complex-care-management-course/registration

Please submit questions regarding the MiCMRC/MiPCT CCM course to: micmrc-requests@med.umich.edu.


New 2016 Medication Reconciliation HEDIS Measure

An inconsistency on the drug list is found in two-thirds of discharge summaries1, which contributes to nearly one in five Medicare patients being readmitted to the hospital within 30 days.2 One approach to resolving this is to reconcile medication lists with the patient shortly after discharge, which is why the National Committee for Quality Assurance Healthcare Effectiveness Data and Information set includes a quality improvement measure3 aimed at ensuring that all patients receive a medication reconciliation within 30 days of any discharge. To satisfy the measure, the medication reconciliation must be recorded in the outpatient medical record.

Medication reconciliation can be defined as a comparison of a patient’s current medications against what they were taking in a previous setting of care, to identify any discrepancies or medication-related issues4. Here are tips for performing a high-quality medication reconciliation, and improving transitions of care:

  • Ask the patient to bring discharge instructions, medication bottles and lists, including non-prescription products (over-the-counter, vitamins, supplements)
  •  Address all potentially clinically significant drug therapy problems, such as therapy duplication or drug interactions, with the prescriber(s)
  • After  reconciling  medications, create a new list of all medications the patient should be on.
  • Go through the new list with the patient, and make sure there is one copy for the patient and another copy in the patient’s medical record.
  • Talk  to your patients about the importance of maintaining an accurate and up-to-date record of all active medications. Medications can often change between settings and the list of medications can be inaccurate or outdated.
  • Encourage your patients to keep a copy of the updated medication list and bring it to all appointments. A comprehensive list of medications should include all prescription medications, herbal supplements, vitamins, nutritional supplements, over-the-counter drugs, vaccines, diagnostic and contrast agents, radioactive medications, parenteral nutrition, blood derivatives and intravenous solutions.
  • Explain to your patients that this reconciliation is done to avoid medication errors as they relate such matters as duplications, omissions, dose, timing and adverse drug interactions.
  • Establish a process asking patients to bring their medication bottles, including all over-the-counter preparations, to every health care encounter.
  • A computer order entry system should be used when possible. It reduces errors and confusion caused by illegible handwriting.
  • The updated hospital medication list and discharge instructions are printed for education and review with the patient before he or she leaves the hospital. Request the medication list to better assist in your review and update of the chart during post-discharge medication reconciliation.
  • Always include medication reconciliation in your post-discharge visit note, whether you see your patient during an outpatient visit or you review medications over the phone with your patient.

    New Medicare star ratings measure: Medication reconciliation post-discharge

About the measure The measure assesses patients age 18 and older who were discharged from an acute or non-acute inpatient stay between Jan. 1 and Dec. 1 of the measurement year. It looks at patients whose medications were reconciled from the date of discharge through 30 days after discharge (31 days total).

Medical record documentation requirements Health care providers must meet certain criteria when documenting evidence of medication reconciliation in Medicare patients’ medical records for the reconciliation to count toward this measure. Documentation in the medical record must include evidence of medication reconciliation and the date it was performed. Any of the following meets documentation criteria:

  • A note from the provider that current and discharge medications were reconciled
  • The current medication list with a notation that references the discharge medications (for example, no changes in medication since discharge, same medications at discharge, discontinue all discharge medications)
  • Current medication list with a notation that the discharge medications were reviewed
  • Documentation of a current medication list, a discharge medication list and notation that both lists were reviewed on the same date of service
  • Notation that no medications were prescribed or ordered upon discharge

Only documentation in the outpatient chart meets the intent of the measure; an outpatient visit isn’t required. Medication reconciliation can also be done by phone.


How to receive BCBSM reimbursement for medication reconciliation post-discharge

When Medicare Advantage PPO members are discharged after a hospital stay, schedule a post-discharge office visit as soon as possible and perform medication reconciliation during the visit.

The outpatient medical record must state that the “current and discharge medications were reconciled.”

  • Bill $10 for *1111F with the post-discharge office visit claim within 30 days of the discharge.
  • Medication reconciliation should be performed after every inpatient discharge.
  • CPT 2 code *1111F states, “Discharge medications reconciled with the current medication list in outpatient medical record.”

In addition to the office visit, Blue Cross will reimburse providers an additional $10 for billing 1111F within 30 days of a patient’s discharge.

 

Description

Codes
· Discharge medications reconciled with the current medication list in the outpatient medical record · *1111F
· Transitional care management services:

· Communication (direct contact, telephone or electronic) with the patient or caregiver within two business days of discharge.

· Medical decision-making of at least moderate complexity during the service period.

· Face-to-face visit within 14 calendar days of discharge.

· *99495
· Transitional care management services:

· Communication (direct contact, telephone or electronic) with the patient or caregiver within two business days of discharge.

· Medical decision-making of at least high complexity during the service period.

· Face-to-face visit within seven calendar days of discharge.

· *99496

Reimbursement for codes 99495 or 99496 include medication reconciliation and therefore 1111F should not be billed with transitional of care codes.

There is no member cost share for 1111F.

On 7/11/16 or after, if a provider has conducted medication reconciliation post-discharge within 30 days but did not bill 1111F, a claim for 1111F can be submitted (alone.) Make sure the date of service was within 30 days of the hospital discharge to home.

Providers who have billed 1111F after 7/11/16, but with a charge of $0.01 instead of $10, providers may rebill with a $10 charge.

  1. Perren et al. Omitted and unjustified medications in the discharge summary. Qual Saf Health Care 2009;18:205-208.
  2. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009; 360:1418.
  3. NCQA. Measure #46 (NQF 0097): Medication Reconciliation Post-Discharge – National Quality Strategy Domain: Communication and Care Coordination. Available at: http://store.ncqa.org/index.php/performance-measurement.html#vol2. Accessed August 28, 2016.
  4. Gleason KM, Brake H, Agramonte V, Perfetti C. Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation. AHRQ Publication No 11(12)-0059. Rockville, MD: Agency for Healthcare Research and Quality. Revised August 2012.

Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

 For information about MiCMRC approved self-management programs please see the document titled “Care Management Resource Center Approved Self-Management Support Training Programs” at https://mipct.org/care-management-resource-center/ 

This document includes details for each MiCMRC approved self-management program: location, objectives, modality, resources, course date/criteria to schedule, trainer qualifications, certification/CEs, and cost.

MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. For questions please submit to: micmrc-requests@med.umich.edu


Cornerstone Family Practice Learns that it Takes a Trusting Relationship with the Patient and the Family

Situation: Cornerstone Family Practice was selected as a Best Practice site based on high HEDIS scores in measures. The practice achieved this by finding ways to establish a trusting relationship with patients and families and the care team. This was done through development of shared tools. Cornerstone Family Practice’s tag line is “Your Foundation for Good Health”.

Strategy: Cindy Denk, PA and Care Manager in the practice states that patients and their families are actively engaged in improving their health and receiving quality care (HEDIS measures) over many touch points in the practice. The practice started with creating the Welcome Patient Information Brochure. This introduction to the practice lays the foundation for a trusting partnership between Cornerstone Family Practice and the patient/family. The brochure provides patients and families with key information regarding what is a medical home, scope of their practice, practice responsibilities, patient responsibilities, communication methods, open access and preferred urgent care facilities. To take this a step further the practice provides each patient, each visit with a Patient Visit Information form to fill out and utilize during their visit to help document their needs, describe chronic condition control and work on an action plan to improve their health. From the front office to the back patient room clinical area, all staff members are aware of and working with the patient on goals and closing gaps in care. They use standard chart preparation, chart flags, standing orders and a referral coordinator who works to schedule tests and appointments with the patient and family. In addition the practice has developed specific responsibilities for the MAs to create standard work and reminders.

The practice uses monthly staff meetings as the opportunity to review data and reasons for missed gaps in care. The meeting is centered on how the team may improve their process and care for the patient.

Cindy states “We achieved these results because everyone including the patient is actively involved and on the same page in improving care both in the office and in the medical neighborhood.”


Behind the Data

By Michigan Data Collaborative

MDC’s Behind the Data section provides high-level information about the data for the MiPCT project in a Q & A format.

Q: What is the incentive period used to calculate the performance incentive scores?

A: MDC published release 18 of the MiPCT Dashboard on Thursday, September 8, 2016. The data from this release will be used for the 48 month incentive measure calculations. The 48 month incentives are based on the measurement year 1/01/2015 thorough 12/31/2015, although some clinical quality metrics include an additional look-back period.

Viewing the data in release 18 will provide an early opportunity to review metrics and quantify incentive result expectations. Incentive metrics are found on both the Quality page and Utilization page of the Dashboard, and the underlying data can be viewed by clicking the See Detail link on each page. For additional information and instructions about viewing the data, see the MiPCT Dashboard User Guide (https://www.michigandatacollaborative.org/MDC/assets/MiPCT_New_Dashboard_UG.pdf). Other helpful documentation can be found on the MDC Website Support page (https://www.michigandatacollaborative.org/MDC/#/support).

New Measures Added in the 2015 MiPCT Performance incentive  Program

  • Childhood Immunizations/Combo 3
  • Adult ED Risk Adjusted Visits (per 1000 attributed patients)
  • Pediatric ED Risk Adjusted Visits (per 1000 attributed patients)

2014 Measures Retired in 2015

  • Part I: Primary Care Sensitive ED visit rates
  • Part IV: Notification of Hospital Admissions & Discharges
  • Part IV: Follow-­Up Referrals to a Community-­‐Based Program or Agency
  • Part IV: Self‐Management Support Offered for Chronic Condition of Focus

For more details on the incentive metrics or methodology, please refer to the MIPCT 2015 Performance Incentive documents located at https://mipct.org/resources/performance-incentives/ or contact MDC at MichiganDataCollaborative@med.umich.edu.


attachment-2016-mipct-regional-annual-summits-flyer-v3

mipct-practice-flash-09262016



 

August 29, 2016

In this week’s edition of the MiPCT PRACTCE FLASH, you will find the following articles:

  • Update on SIM PCMH/MiPCT Partnership 2017 Application Timing
  • Important Dates
  • Regional Annual Summit Registration
  • Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update
  • MiPCT Pediatric Summit 2016
  • MiPCT Pediatric Summit Pre-Work
  • MiPCT Pediatric Pre-Work Webinars
  • MiCMRC/MiPCT Complex Care Management Course
  • Protecting Adults: Are You Meeting the Standards for Adult Immunization Practice
  • Submitting Your MiPCT Success Story Just Got Easier
  • Cherry Health Westside Ensures that Reviewing and Improving Quality Care is a Priority
  • Behind the Data by MDC

 


 

Update on SIM PCMH/MiPCT Partnership 2017 Application Timing

All 345 currently participating MiPCT practices (or their POs on their behalf) successfully completed and submitted Intents to Participate in the 2017 State Innovation Model (SIM) PCMH MiPCT Partnership. This partnership is part of the MiPCT’s transition from a multipayer demonstration to an ongoing multipayer program, and, among other things, is key to ongoing 2017 Medicaid payments for participants (MiPCT practices and the selected PCMH practices in the Community Health Innovation Regions).

The next step in the process will be for practices (or POs on their behalf) to complete full applications.   As you may be aware the SIM Team was targeting last week for the release of the PCMH Initiative Application, but has apprised that the application will be released in the near future.  Please keep your eyes open for the communications from the SIM team which will outline more details regarding payment, expectations, etc.  Also included will be an FAQ fact sheet in an effort to provide helpful information.  Informational webinars will also be conducted with an opportunity for Q&A.     The application process, once opened, will remain open for four weeks to allow sufficient time for respondents to gather information, discuss with partners, and complete the application.  In the interim, if you have questions, please reach out to the SIM team at SIM@mail.mihealth.org.


Once again this year, the MiPCT Project will convene a Stakeholder Annual MiPCT Summit in three statewide regional locations.

Summit North – Thompsonville, MI

Tuesday, October 13, 2016

Crystal Mountain Resort & Conference Center

12500 Crystal Mountain Drive Thompsonville, Michigan 49683

 Register Here for Thompsonville Summit

 *Registration CLOSES 10/03/2016*


 Summit West – Grand Rapids, MI

Tuesday October 18, 2016

Frederik Meijer Gardens and Sculpture Park 1000 E Beltline Ave NE

Grand Rapids, MI 49525

Register Here for Grand Rapids Summit

*Registration CLOSES 10/07/2016*


Summit Southeast – Ann Arbor, MI

Wednesday, October 26, 2016

University of Michigan North Campus Research Center (NCRC)

2800 Plymouth Road, Building 18

Ann Arbor, MI 48105

Register Here for Ann Arbor Summit

 *Registration CLOSES 10/17/2016*


Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

For information about MiCMRC approved self-management programs please see the document titled “Care Management Resource Center Approved Self-Management Support Training Programs” at https://mipct.org/care-management-resource-center/ 

This document includes details for each MiCMRC approved self-management program: location, objectives, modality, resources, course date/criteria to schedule, trainer qualifications, certification/CEs, and cost.

MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. For questions please submit to: micmrc-requests@med.umich.edu

MiPCT Pediatric Summit 2016

The MiPCT Pediatric Care Manager Summit this year will address the clinical focus areas of 1) social determinants of health, specifically Adverse Childhood Experiences (ACEs) and Resiliency and 2) integration of behavioral health in primary care, including specific screening tools, as well as cultural diversity.  We will offer presentations and panel discussions about how to address these themes when working with children, youth, and families. Parents of children/youth with special health care needs will join us to help keep us family-centered in all that we do. Small group discussions will give participants the opportunity to learn from each other and to build networking relationships.

MiPCT Pediatric Summit 2016

September 20, 2016    8:30 am – 4 pm

BCBSM Lyon Meadows Facility

53200 Grand River Avenue

New Hudson, MI 48165

 To register for the MiPCT Pediatric Summit 2016, please Click Here

Continuing Education:This activity has been submitted to Michigan Nurses Association for approval to award contact hours. The Michigan Nurses Association is an approver of continuing nursing education by the State of Michigan Board of Nursing.

This course is approved by the Michigan Social Work Continuing Education Collaborative.  Course approval #: 081616-00

MiPCT Pediatric Summit  Pre-Work

MiPCT Pediatric Care Managers will also find that the pre-summit webinar on “Specific Screening Tools for ACES and Behavioral Health” to be aligned with the summit, and is highly recommended.

The MiCMRC/MiPCT Educational Webinar: “Specific Screening Tools for ACES and Behavioral Health” will enable the learner to develop a deeper understanding of adverse childhood experiences (ACES) and behavioral health issues that are commonly treated in the pediatric primary care practice. The expert presenters are: Jane Turner, MD, Professor HP, Pediatrics and Human Development Michigan State University and Laurisa Cummings, LMSW, MiPCT Pediatric Care Manager, Care Management Supervisor, MiPCT Pediatric Clinical Lead, Children’s Medical Group of Saginaw Bay.

Nursing and Social Work continuing education contact hours for the “Specific Screening Tools for ACES and Behavioral Health” webinar may be obtained by listening to the recorded webinar which is NOW available on www.micmrc.org/continuing-ed.

The CE request link is posted on www.micmrc.org/continuing-ed. Click this link to initiate a request for CE Credits. This will generate an email message containing a link to complete the CE request and required evaluation form. Follow the CE instructions contained in the email. Once the required evaluation is submitted, an email will be sent containing the CE certificate.

CE credit for viewing the recorded webinar will be available until August 12, 2017. While the webinar will still be available for viewing, please note that CE credit for the viewing the recorded webinar will not be available after August 12, 2017.

2016 Summit Pre-Work Webinars

MiPCT 2016 Annual Summit Care Manager Afternoon Session PREWORK

Earn Nursing or Social Work Contact Hours for Completing Summit PREWORK Recorded Webinars:

  • We have partnered with the Centre for Collaboration, Motivation and Innovation (CCMI) to design a series of five pre-work webinars to enrich your learning experience at the in-person Summit afternoon CM education session.
  • The presenter is Connie Davis, RN, MN, GMP, and Co-director of the CCMI. Connie is an internationally known trainer, educator, speaker and consultant on health care design and health behavior change.
  • Viewing the webinars prior to the live Summit CM afternoon session is highly recommended.
  • Each of the 5 webinars listed below and the Summit afternoon CM in-person session are standalone in terms of earning contact hours.
  • Steps to complete the Summit CM Prework and receive nursing or social work contact hours:
  1. Access the link on the MiPCT Summit 2016 pre-work web page https://mipct.org/2015-summit-prework-webinars
  2. View the entire online recorded webinar
  3. Click the link below the webinar titled “Request CE Credit” Click Here
  4. Complete the brief form, include your e-mail address, click submit
  5. This will generate an email message to you containing a link to complete the CE request and required evaluation form
  6. Follow instructions in the e-mail: Complete the evaluation and submit. This step generates an email to you containing the CE certificate

 New For 2016:

Stepped Care for Self-Management Support

  • This Webinar addresses population segmentation, agenda setting, social determinants of health, and patient shared decision making with complex patients.
  • “Stepped Care for Self-Management Support” is approved for 1.0 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.
  • “Stepped Care for Self-Management support” is approved by the Michigan Social Work Education Collaborative. Course approval #: 080416-07Understanding Motivational Interviewing (MI): How the elements of Motivational Interviewing provide a context for BAP

MiPCT care managers who did not have the opportunity to view 2015 MiPCT Summit pre-work webinars or would like a refresher, the following webinars are available. *Please note: if you received Nursing CE credit for the 2015 Summit pre-work webinars listed below in 2015, you will not be eligible to receive credit in 2016.

  • “Understanding Motivational Interviewing (MI): How the elements of Motivational Interviewing provide a context for Brief Action Planning (BAP)” is approved for 1.5 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.
  • This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 081116-00
  • *If you received nursing continuing education contact hours in 2015 for this educational offering, you are not eligible to receive CE credit in 2016

Effective Communication with Patients (Ask-Tell-Ask): Identify ways to provide information consistent with the Spirit of MI

  • “Effective Communication with Patients: Ask-Tell-Ask” is approved for 1.5 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.
  • This course is approved by the Michigan Social Work Continuing Education Collaboration. Course approval #: 081116-01
  • *If you received nursing continuing education contact hours in 2015 for this educational offering, you are not eligible to receive CE credit in 2016

Understanding Brief Action Planning: Describe the components of BAP

  • “Understanding Brief Action Planning” is approved for 1.5 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.
  • This course is approved by the Michigan Social Work Continuing Education Collaboration. Course #: 081116-02
  • *If you received nursing continuing education contact hours in 2015 for this educational offering, you are not eligible to receive CE credit in 2016

Applying Brief Action Planning in the Care Setting: Identify the application of BAP in work settings

  • “Applying Brief Action Planning in the Care Setting” is approved for 1.5 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.
  • This course is approved by the Michigan Social Work Continuing Education Collaboration. Course #: 081116-03
  • *If you received nursing continuing education contact hours in 2015 for this educational offering, you are not eligible to receive CE credit in 2016

MiCMRC/MiPCT Complex Care Management Course

The 2016 MICMRC/MIPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiCMRC/MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiCMRC/MiPCT CCM Course occurs over a 4 day period. The course consists of:

  • Live Webinar on day 1 – introduction of MiCMRC/MiPCT CCM course
  • Self-study modules and post- tests which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • In person training days 3 and 4

 

 Upcoming course dates and course registration close dates:

September 12-15th , 2016. Introductory Webinar September 12th , 2016.  Total six hour self-study modules and post-tests September 12-13, 2016.  In-person training September 14-15 2016.  NOTE:   Registration for this course will close as of September 8th , 2016.

October 3-6 , 2016. Introductory Webinar October 3rd  , 2016.  Total six hour self-study modules and post-tests October 3-6, 2016.  In-person training October 5-6 2016.  NOTE:   Registration for this course will close as of September 29th , 2016.

Register for all MiCMRC/MiPCT CCM Courses Here: http://micmrc.org/programs/micmrc-mipct-complex-care-management-course/registration

 

Please submit questions regarding the MiCMRC/MiPCT CCM course to: micmrc-requests@med.umich.edu.


Protecting Adults: Are You Meeting the Standards for Adult Immunization Practice?

Jacklyn Chandler, M.S., Outreach Coordinator, MDHHS Division of Immunization

 

Making sure your adult patients are up-to-date on vaccines recommended by the Centers for Disease Control and Prevention (CDC) and the Michigan Department of Health and Human Services (MDHHS) gives them the best protection available from several serious diseases and related complications. The National Vaccine Advisory Committee (NVAC) recently revised and updated the Standards for Adult Immunization Practice to reflect the important role that all healthcare professionals play in ensuring adults are getting the vaccines they need.

These new standards were drafted by the National Adult Immunization and Influenza Summit (NAIIS) of over 200 partners, including medical associations, state and local health departments, pharmacists associations, federal agencies, and other immunization stakeholders1. What makes adult immunization a priority for leaders in medicine and public health?

Every year, tens of thousands of adult Americans suffer serious health problems, are hospitalized, and even die from diseases that could be prevented by vaccines2. These diseases include shingles, influenza, pneumococcal disease, hepatitis A, hepatitis B-related chronic liver disease and liver cancer, HPV-related cancers and genital warts, pertussis (“whooping cough”), tetanus and more. Adult vaccination rates are extremely low. For example, coverage rates for Tdap and zoster vaccination are less than 30% for adults who are recommended to receive them3. In Michigan, even high risk groups are not getting the vaccines they need – only 30.6% of adults younger than 65 years old who are high risk for complications from pneumococcal disease are vaccinated4.

Make it clear to your patients that vaccination is important because it not only protects the person receiving the vaccine, but also helps prevent the spread of certain diseases, especially to those that are most vulnerable to serious complications, such as infants and young children, elderly, and those with weakened immune systems. Immunizing adults creates healthier communities and protects the places in which we live, work, and play.

Adults trust their healthcare provider to advise them about important preventive measures. Most health insurance plans provide coverage for recommended adult vaccines. Furthermore, research indicates that most patients are willing to get vaccinated if recommended by their provider5, 6. However, many patients report their healthcare providers are not talking with them about vaccines, missing critical opportunities to immunize7.

MDHHS is calling on all healthcare professionals to make adult immunizations a standard of routine patient care in their practice by integrating four key steps8:

  1. ASSESS immunization status of all your patients at every clinical encounter. This involves staying informed about the latest CDC recommendations for immunization of adults and implementing protocols to ensure that patients’ vaccination needs are routinely reviewed.
  2. Strongly RECOMMEND vaccines that patients need. Key components of this include tailoring the recommendation for the patient, explaining the benefits of vaccination and potential costs of getting the diseases they protect against, and addressing patient questions and concerns in clear and understandable language.
  3. ADMINISTER needed vaccines or REFER your patients to a provider who can immunize them. It may not be possible to stock all vaccines in your office, so refer your patients to other known immunization providers in the area to ensure that they get the vaccines they need to protect their health. Coordinating a strong immunization referral network will reduce a substantial burden on your adult patients and your practice. If your adult patients do not have insurance, or if their insurance does not cover any of the cost of an immunization, check with your local health department to see if your patient qualifies for the following public vaccines: Td, Tdap, MMR, HPV9, PCV13, PPSV23, Hep A, Hep B or Zoster.
  4. DOCUMENT vaccines received by your patients. Help your office, your patients, and your patients’ other providers know which vaccines they have had by documenting in the Michigan Care Improvement Registry (MCIR). And for the vaccines you do not stock, follow up to confirm that patients received recommended vaccines.

Want to learn more? MDHHS hosts a continuing education opportunity entitled Adult Immunization in Michigan: Using the Standards to Increase Coverage. This presentation is offered in-person or via live webinar. For more information, please contact Jackie Chandler at ChandlerJ3@michigan.gov.

Informational brochures about immunization topics are available free of charge from MDHHS. A variety of materials is available, and can be ordered online at www.healthymichigan.com – click “Enter Site” and “Immunizations” to begin adding resources to your cart. In spring 2016, the “AIM Packet – Adult” was added: the contents focus on adults and include the immunization schedule, brochures, posters, and other educational flyers and resources for your practice.

References:

  1. National Adult and Influenza Immunization Summit (NAIIS). Organizations Supporting the NVAC Adult Standards. Accessed May 17, 2016.
  2. Centers for Disease Control and Prevention (CDC). Reasons to Vaccinate. Accessed May 17, 2016.
  3. Williams WW et al. Surveillance of Vaccination Coverage Among Adult Populations — United States, 2014. MMWR Surveill Summ 2016; 65(No. SS-1):1–36.
  4. Centers for Disease Control and Prevention (CDC). Pneumococcal vaccination coverage among adults 18-64 years at increased risk and ≥65 years by State, HHS Region, and the United States, BRFSS, 2008 through 2014. Accessed May 17, 2016.
  5. Ding H et al. Influenza Vaccination Coverage Among Pregnant Women — United States, 2014–15 Influenza Season. MMWR Morb Mortal Wkly Rep 2015; 64(36):1000-1005.
  6. Malosh R et al. Factors Associated with Influenza Vaccine Receipt in Community Dwelling Adults and Their Children. Vaccine 2014; 32(16): 1841-1847.
  7. Ylitalo KR et al. Health Care Provider Recommendation, Human Papillomavirus Vaccination, and Race/Ethnicity in the US National Immunization Survey. Am J Public Health 2013; 103(1): 164-169.
  8. Centers for Disease Control and Prevention (CDC). Standards for Adult Immunization Practice. Accessed May 17, 2016.

 

 

Submitting Your MiPCT Success Story Just Got Easier

The Michigan Care Management Resource Center now features a new single web based MiPCT Success Story Template located on the micmr.org web site. The new web based template link is designed for submission of your MiPCT care managers, practice and PO success stories. This link is available on MiCMRC website http://www.micmrc.org

Also, The Michigan Care Management Resource Center (CMRC) is proud to announce a new Team Based Best Practice web page http://micmrc.org/best-practices This page is dedicated to the great work that is happening across the state by MiPCT Practice Teams. The page features best practice stories that have been published in the Flash newsletters. In addition, you will able to access the tools and/or resources that have been shared by the practice.

Opportunity to Earn MiPCT Practice Learning Activity Credits: If you would like to share a Team Based Best Practice of your own; please submit your story via the new Success Story Template on micmrc.org


Cherry Health Westside Ensures that Reviewing and Improving Quality Care is a Priority

Situation: Cherry Health Westside recognizes the importance of integrating HEDIS measures   into patient care.Strategy: Each Morning the Cherry Health Westside practice starts their day with a team huddle. Per Nancy Pagan, Westside site manager, “I see the staff hurrying to make huddle each day because of the value it provides to the team and the patients.” The huddles purpose: to coordinate care and share knowledge to ensure patient satisfaction and outcomes. The huddle consists of the Primary Care Physician Dr. Perez; the RN Care Managers Colleen McGuire and Lexie Bryce; as well as the Medical Assistant working with the physician that day; as well as the lead MA Gabriella Medina. The huddle also includes a Community Health Worker (CHW) Maria Sanchez; as well as Joanne Rapp the Front Desk Supervisor. During this time Dr. Perez and the team utilizes  the day before appointment chart prep,to review gaps in care that will need to be addressed with the upcoming patients during their visit. This chart prep covers the eleven steps the MA completes the day before the appointment to ensure care needs are being met.

During the patient visit, the team utilizes workflows specific to the patients’ chronic condition, (hypertension and diabetes) with swim lanes. Each lane is designated by the team member role: provider, MA, CHW/CM and their corresponding responsibilities in the delivery of patient care. The workflow also identifies referrals needed either internally, i.e. diabetic educator, externally to community resources. Most recently a new addition to the team was made by way of a Community Health Worker. The CHW has a deep understanding of the community and its available resources. Being a part of the community the CHW has the ability to visit patients in their homes, help them access needed community resources and help support their self-management goals. The practice has been advertising this new team member by way of a community health worker flyer.

Dr. Perez has seen the success of team-based care in the practice. Dr. Perez states that he did not learn about team-based care during his residency, but here in the practice.

Dr. Perez shared, “Without the care team approach, we would not be achieving our outcomes. We learn together and build trust in team and with the patients. We work on closing gaps in care. Our results show A1C now in control, decreased use of the ED, increased physician visits for chronic condition control, and increased time with the physician.”


Behind the Data


MiCMRC Recorded Webinar Flyer V5 (2)


MiCMRC Recorded Webinar Flyer V5

Practice FLASH 08292016

The next edition of the:

  • MiPCT PO FLASH will be distributed on September 12, 2016
  • MiPCT Practice FLASH will be distributed on September 26, 2016

 

 

July 25, 2016  

Practice FLASH July 25, 2016

Billing and Coding Collaborative:                                           The Next Steps Imprtant Dates

Thanks to those practices and POs that participated in the Billing and Coding Collaborative March webinar. The remaining schedule for those participating in the collaborative (for four practice learning credits) is anticipated to be (dates are in process of confirmation):

  • An August 30 (11am to noon) webinar on “What claims analysis can help to tell us about follow-up PCP care after hospitalizations”
  • A September 27 (noon to 1) webinar on “Practice Level Care Management Code by Code Analysis”
  • A November 15 (noon to 1) webinar on “Care Management Billing and Coding and the 2017 SIM PCMH MiPCT Partnership”

To obtain credit, as with the other billing and coding collaborative sessions, a physician does not have to participate, however a Care Manager and at least one other practice team member (front office team member, Practice Manager, biller, coder, etc.) must participate in each session or review the taped session and keep short notes on meaningful team discussion to apply the learning to improvements for the practice. POs may transmit the learning in a facilitated way to their practices with the same requirement for notes on meaningful discussion. The goal of the note-taking is not for documentation only, but to facilitate actual improvements in performance and identification of areas of opportunity as well as next steps for the practice. We will provide additional detail and notice of any prework in advance.

SUCCESS!  100% of MiPCT Participating Practices Submitted SIM PCMH Intents to Participate!

A note of thanks to all involved in submitting Intents to Participate (ITP) for the 2017 SIM PCMH MiPCT Partnership by the June 30 deadline.  All 345 MiPCT practices (or POs on their behalf) submitted ITPs, and will be eligible to receive the application for participation when it is issued in August.   In addition, PCMH practices in the five identified SIM regions for 2017 were also eligible for ITP submission and several MiPCT POs also submitted ITPs for these as well.

MiPCT Pediatric Summit 2016

The MiPCT Pediatric Care Manager Summit this year will address the clinical focus areas of 1) social determinants of health, specifically Adverse Childhood Experiences (ACEs) and Resiliency and 2) integration of behavioral health in primary care, including specific screening tools, as well as cultural diversity.  We will offer presentations and panel discussions about how to address these themes when working with children, youth, and families. Parents of children/youth with special health care needs will join us to help keep us family-centered in all that we do. Small group discussions will give participants the opportunity to learn from each other and to build networking relationships.

ATTENDEES:  All MiPCT Care Managers, Physicians, and Practice Staff are invited to attend. PO Leaders and MiPCT Partners are welcome. Please note: the MiPCT Pediatric Summit is open to MiPCT Care Managers, Physicians, and Practice Staff only.

Date:         September 20, 2016

Time:         8:30 am – 4:00 pm

Location:  BCBSM Lyon Meadows Facility  53200 Grand River Avenue, New Hudson, MI 48165

To register for the MiPCT Pediatric Summit 2016, please Click Here

MiPCT Pediatric Care Managers will also find that the pre-summit webinar on “Specific Screening Tools for Adverse Childhood Experiences (ACES) and Behavioral Health” to be aligned with the summit, and is highly recommended. This webinar will be held on August 12, 2016 from 10 – 11 am.

To register for the pre-summit webinar on “Specific Screening Tools for ACES and Behavioral Health, please click on http://micmrc.org/webinars

For questions or further information, please submit to http://micmrc.org/contact-us

MiPCT CARE MANAGER WEBINARS – Nursing and Social Work FREE CE Opportunities

Nonpharmacological Approaches for Behavioral and Psychological Symptoms of Dementia

  • Presented by Linda Keilman, DNP, GNP-BC
  • Presentation date: July 27, 2016 – 2:00pm
  • “Non-Pharmacological Approaches for behavioral and Psychological Symptoms” is approved for 1.0 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.
  • This course is approved by the Michigan Social Work Continuing Education Collaborative.
  • Course approval #: 052616-01

Specific Screening Tools for Adverse Childhood Experiences (ACES) and Behavioral Health

  • Presented by Jane Turner, MD Professor HP, Pediatrics and Human Development and Laurisa Cummings, LMSW, MiPCT Pediatric Clinical Lead, Children’s Medical Group of Saginaw Bay
  • Presentation date: August 12, 2016 – 10:00am
  • This activity has been submitted to Michigan Nurses Association for approval to award contact hours. The Michigan Nurses Association is an approver of continuing nursing education by the State of Michigan Board of Nursing.
  •  This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 063016-00

For details on opportunities for no-cost CE credit, and to register for these webinars: http://micmrc.org/continuing-ed

MiCMRC/MiPCT Complex Care Management Course

The 2016 MICMRC/MIPCT Complex Care Management (CCM) Course is provided in a blended learning activity format.  The MiCMRC/MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiCMRC/MiPCT CCM Course occurs over a 4 day period.  The course consists of:

  • Live Webinar on day 1 – introduction of MiCMRC/MiPCT CCM course
  • Self-study modules and post- tests which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • In person training days 3 and 4

 Register for upcoming MiCMRC/MiPCT CCM course dates at the following site

Upcoming course dates and course registration close dates:

August 1-4th, 2016. Introductory Webinar August 1st, 2016.  Lansing.  Total six hour self-study modules and post-tests August 1-2, 2016.  In-person training August 3-4th 2016.  NOTE:   Registration for this course will close as of July 28th, 2016.

August 22-25th, 2016. Introductory Webinar August 22nd, 2016.  Saginaw.  Total six hour self-study modules and post-tests August 22-23, 2016.  In-person training August 24-25th  2016.  NOTE:   Registration for this course will close as of August 18th, 2016.

Register for all MiCMRC/MiPCT CCM Courses Here: http://micmrc.org/programs/michigan-primary-care-transformation-mipct-project/registration

Please submit questions regarding the MiCMRC/MiPCT CCM course to:  micmrc-requests@med.umich.edu

 

MiPCT Care Managers – An Invitation to Earn Continuing Education Contact Hours

Educational Offering:  MiCMRC/MiPCT Pediatric Care Manager Webinar “Specific Screening Tools for Adverse Childhood Experiences (ACES) and Behavioral Health”

The MiCMRC/MiPCT Educational Webinar: “Specific Screening Tools for ACES and Behavioral Health” will enable the learner to develop a deeper understanding of adverse childhood experiences (ACES) and behavioral health issues that are commonly treated in the pediatric primary care practice. The expert presenters are: Jane Turner, MD, Professor HP, Pediatrics and Human Development Michigan State University and Laurisa Cummings, LMSW, MiPCT Pediatric Care Manager, Care Management Supervisor, MiPCT Pediatric Clinical Lead, Children’s Medical Group of Saginaw Bay.

Nursing and Social Work continuing education contact hours for the “Specific Screening Tools for ACES and Behavioral Health” webinar may be obtained by one of the following activities:

  • Attend the live webinar on August 12, 2016 from 10:00 -11:00 am -OR-
  • Listen to the recorded webinar which will be available in September.

To Register for the Live webinar:   http://micmrc.org/

Following the webinar a CE request link will be posted on http://micmrc.org/. Click this link to initiate a request for CE Credits. This will generate an email message containing a link to complete the CE request and required evaluation form. Follow the CE instructions contained in the email. Once the required evaluation is submitted, an email will be sent containing the CE certificate.

The CE request process will be the same for the recorded webinar. CE credit for viewing the recorded webinar will be available until August 12, 2017. While the webinar will still be available for viewing, please note that CE credit for the viewing the recorded webinar will not be available after August 12, 2017.

Continuing Education:

  • This activity has been submitted to Michigan Nurses Association for approval to award contact hours. The Michigan Nurses Association is an approver of continuing nursing education by the State of Michigan Board of Nursing.
  • This course is approved by the Michigan Social Work Continuing Education Collaborative.
  • Course approval #: 063016-00

For more information regarding contact hours, or for other questions, please submit to
micmrc-requests@med.umich.edu

The Michigan Care Management Resource Center Announces a New Team Based Best Practice Website Page

The Michigan Care Management resource Center is proud to announce a new Team based Best Practice web page http://micmrc.org/best-practices

This page is dedicated to the great work that is being done across the state by Practice Teams. The page features best practice stories that have been published in the Flash newsletters. In addition, you will able to access the tools and/or resources that have been shared by the practice.

Opportunity to Earn MiPCT Practice Learning Activity Credits: If you would like to share a Team based Best Practice of your own; Please submit your story by Clicking Here.  There is a brief web based template to complete and subsequently a member of the CMRC team will contact you. MiPCT Practices may earn two MiPCT Practice Learning Activity Credits for sharing a best practice document and posting the material on the MiCMRC web site.  The practice may earn two additional Practice Learning Activity Credits if the story is published in an issue of the Flash newsletter.  If you have questions regarding the best practices you may contact the Michigan Care Management Resource Center at http://micmrc.org/contact-us.

From the MI Department of Health and Human Services – Your Public Health Partner

Diabetes Management and Metabolic Surgery

Patients with Type 2 diabetes are often overweight. According to the American Diabetes Association more than 80% of people are obese at the time of diagnosis.As a provider, you may feel there is little you can do to help patients facing these health challenges, but there are options.

Consider a referral to a recognized (American Diabetes Association – ADA) or accredited (American Association of Diabetes Educators – AADE) Diabetes Self-Management Education (DSME) program. Teams of educators working within such programs can help your patients learn behavior change techniques and self-management skills that can lead to a reduction in body weight and improvement in blood glucose. The ADA, AADE and Academy of Nutrition and Dietetics have created an algorithm outlining four critical times for making a referral to DSME:  1) at diagnosis, 2) annually, 3) when new complicating factors present, and 4) when there is a transition in care.

Patients with a BMI of 35.0-39.9 kg/m²* who have participated in a DSME program and attempted to make lifestyle changes, but have not lost or kept off an adequate amount of weight or seen improvement in their blood glucose readings may benefit from more aggressive treatment. For them, metabolic surgery may be an option. Patients with a BMI ≥ 40 kg/m²* may benefit from metabolic surgery regardless of their level of blood glucose control (see table below).

The Delegates of the 2nd Diabetes Surgery Summit (DSS-II) prepared guidelines to educate providers on the benefits metabolic surgery may have as a treatment for their patients with Type 2 diabetes as evidence suggests that it can have a positive impact. 2

The guidelines are summarized in this table:

BMI Thresholds

Surgery should be performed in locations with multi-disciplinary teams that have experience in the management of diabetes and metabolic surgery. follow post-operative guidelines developed by professional societies, and management of their nutrition status following the procedure.

You can help your patients with diabetes live healthier lives by empowering them to adopt healthy habits. DSME teaches knowledge and skills that they need to make successful lifestyle changes, including reducing their weight. The Michigan Department of Health and Human Services has certified 93 DSME programs across the State so there is likely a program nearby. A list of DSME programs can be found at www.michigan.gov/diabetes. For more public health information, resources, and continuing education opportunities, visit the MDHHS primary care website, at: www.michigan.gov/primarycare.


1 Life with diabetes: A series of teaching outlines by the Michigan Diabetes Research and Training Center/Martha Funnell. – 5th Edition (2014).

2 Rubino F, Nathan DM, Eckel R, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes:  A joint statement by International Diabetes Organizations. Diabetes Care. 2016 June; 39(6): 861-77. http://care.diabetesjournals.org/content/39/6/861

Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

For information about MiCMRC approved self-management programs please see the document titled “Care Management Resource Center Approved Self-Management Support Training Programs” at https://mipct.org/care-management-resource-center/

This document includes details for each MiCMRC approved self-management program: location, objectives, modality, resources, course date/criteria to schedule, trainer qualifications, certification/CEs, and cost.

MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. For questions please submit to: micmrc-requests@med.umich.edu                 

Submitting Your MiPCT Care Management Success Story Just Got Easier

The Michigan Care Management Resource Center now features a new single web based MiPCT Success Story Template located on the micmr.org web site. The new web based template link is designed for submission of your MiPCT care managers, practice and PO success stories. This link is available on MiCMRC website’s home page.

UMHS Canton Health Center Utilizes Everyday Lean Ideas to Meet Quality and HEDIS Measures

Situation: With 100,000 patients visiting the UMHS Canton Health Center practice annually, the practice needed a robust system to ensure that quality patient care is rendered at every visit and that gaps in care are closed. Their system starts with clearly defined team roles, shared responsibility, accountability, team problem solving, recognizing and rewarding staff for key successes.

Strategy:  Clear roles and standard work help staff take responsibility for HEDIS measures starting with the initial call into the clinic, at the front desk, and throughout the visit and at checkout. Accountability for outcomes takes place during the Daily Huddle held every morning around the Lean in Daily Work board. The board displays quality data as well as problems documented on the Everyday Lean Idea (ELI form) that identifies a probable cause and suggested improvement. The ELI problem and improvement suggestion is discussed, and a decision is made to implement the idea or to investigate further. The Everyday Lean Idea (ELI) is posted on the board until the problem is resolved. The board also includes quality performance trend reports, STAR performance, and gap reports that help identify patients that are missing certain health screenings.

The team also celebrates success through recognizing when an improvement impacts outcomes on the daily board, and annually shares rewards for meeting measures by way of a quality performance bonus. This success is shared through a staff letter indicating points earned based on metrics, along with the appropriate bonus going to staff.

In addition, the team has worked on adding flags within the EMR alerting staff of gaps in

care to be addressed, regardless of the reason for the visit. Furthermore, the practice was innovative in filling their panel manager role by hiring a nursing student. This allowed for more flexibility in times to reach out to patients during off office hours such as evenings and weekends in order to help remind patients of their needed tests.

The practice also worked on an Introduction to their Care Navigator letter that is shared with the patient to help them understand the services the Care Navigator (CN) provides. Included with the introduction is the CN contact information which helps with the warm handoff from the physician to the patient.

Cheryl West the administrative manager stated “our success is not linked to one improvement but to the team’s focus on the patient, the data, using their voice and vigilance to spot problems and commitment to continuing improvement. These improvements also include the patient as a partner in the quality of their care.”

For more information regarding the best practice contact Nora Errickson @ nisack@med.umich.edu

Slide1MiCMRC Recorded Webinar Flyer V5 (2)

 

Printable PDF Copies:

The next edition of the:

  • MiPCT PO FLASH will be distributed on August 1, 2016
  • MiPCT Practice FLASH will be distributed on August 29, 2016

 

June 20, 2016

Practice FLASH June 20, 2016

SIM PCMH Intent to Participate

Respond Before the June 30 Deadline to Continue in 2017!

With the transition of the MiPCT from a demonstration to an ongoing program, MDHHS has released a nonbinding Notice of Intent process for practices who wish to participate in the PCMH Initiative, an MiPCT partnership with the State Innovation Model, in 2017.   The process has been streamlined for current MiPCT practices and is available at: https://umichumhs.ut1.qualtrics.com/SE/?SID=SV_4IOAWwthVPkDDed.

The deadline for returned responses is 5pm on June 30, 2016. 

If desired by practices, POs may respond to the Notice of Intent on their behalf.  This will be followed in fall by a formal application process, with subsequent contracting.

Note that while the response to the Notice of Intent is nonbinding (i.e. a provider/practice can choose not to apply after submitting their intent), it is required to be eligible to submit an application in fall.   Thus, MiPCT practices are highly encouraged to file responses to the Notice of Intent.    Below are some guidelines to help practices and POs to ensure that their MIPCT practices as well as PCMH practices in the five SIM regions who are not currently in the MIPCT complete the Intent to Participate process:

Q:   Who should respond to the ITP?

A:   Only existing MiPCT practices (in any Michigan location even if outside one of the 2017 SIM regions) who maintain PCMH designation and who are in good standing with MiPCT contractual requirements, and PCMH practices in the 2017 SIM regions (identified below) are eligible to respond to the ITP for 2017.

Thus, the 2017 Eligible Provider/Practices for the PCMH SIM MiPCT Initiative are:

  • Providers/practices physically located in one of the five SIM regional test locations, which include:
      • Genesee County
      • Jackson County
      • Muskegon County
      • Northern Michigan, which includes the following counties: Antrim, Benzie, Charlevoix, Emmet, Grand Traverse, Kalkaska, Leelanau, Manistee, Missaukee and Wexford
      • Washtenaw and Livingston Counties
  • Currently participating Michigan Primary Care Transformation Project (MiPCT) providers/practices located anywhere in Michigan

Please remember that this ITP process is nonbinding but required to be invited to complete a full application later in the year when payment details are available.  Thus, practices (or POs on their behalf) are encouraged to respond to the ITP so that they remain eligible for full application completion after greater detail is available, and can make an informed decision at that point.

Q:   What do I need to complete the ITP?

A. The ITP process has been streamlined to leverage currently available data to make the response process as streamlines as possible for the respondents. Thus:

  • For current MiPCT practices (or POs on their behalf), if all your practices wish to be considered for 2017 participation, the process is very streamlined and can be completed in a few moments. Only primary and secondary contact information (names, addresses, phones and emails) is needed.  If any of your practices do not wish to continue, information about their name and location is requested on an Excel attachment.   Attached for your reference are two attachments:  1) Information Requested of Existing MiPCT Practices.pdf; and 2) Required Attachment for MiPCT Practices Who Do NOT Intend to Participate.xls.  The first outlines the array of information you will need to complete the ITP and the second is an Excel spreadsheet for your completion only required for existing MiPCT practices who do NOT wish to continue in future years.
  • For practices who are not currently MiPCT practices, but who are PCMH designated and who are in a 2017 SIM region (identified above), the ITP collects a minimal amount of information in a survey format and then provides a downloadable Excel spreadsheet for responding providers/practices to complete and upload within the online survey system. The ITP is designed to assist the SIM Team in identifying the number of interested providers, the populations served by those providers/practices and the practice capabilities in place to build from as part of the PCMH Initiative. This information will be used in stakeholder engagement efforts going forward as well as PCMH Initiative operationalization.  Attached for your reference are two attachments:  1) Information Requested of New Practices in SIM Regions.pdf and 2) Required Attachment to SIM Notice of Intent-Detailed New Practices.xls.     The first outlines the array of information you will need to complete the ITP and the second is an Excel spreadsheet for your completion that you will be asked to upload in the weblink.

Q:  Must each practice respond or could a PO respond on their behalf?

A. If a provider/practice is affiliated with a Physician Organization or other integrator organization, the organization may complete this form on behalf of its affiliated/member practices. Integrator organizations must obtain consent from the practice(s) and designate a primary contact from the practice(s) to receive subsequent communication and correspondence in addition to the integrator organization itself.

Save the Date! Announcing MiPCT Pediatric Care Manager Summit September 20, 2016

Mark your calendars for this year’s Pediatric Summit:

  • Tuesday, September 20, 2016
  • Blue Cross Blue Shield of Michigan Lyon Meadows Facility 53200 Grand River Avenue New Hudson, MI 48165
  • Full Day Event 9am – 4pmRegistration information available in future FLASH Newsletters soon, or check back to https://mipct.org/

The MiPCT Pediatric Care Manager Conference will address the clinical focus areas of social determinants of health and integration of behavioral health in primary care. The keynote topic will be Adverse Childhood Experiences (ACES) and Resiliency. We plan to have panel presentations about how to address these themes when working with children, youth and families. Parents of children/youth with special health care needs will join us to keep us family-centered in all that we do. Small group discussions will give participants the opportunity to learn from each other and to build networking relationships.

Registration information available in future FLASH Newsletters soon, or check back to https://mipct.org/

Please send questions to micmrc-requests@med.umich.edu

MiPCT Care Managers An Invitation to Earn Continuing Education Contact Hours

Educational Offering: MiCMRC/MiPCT Care Manager Webinar “Nonpharmacologic Approaches for Depression”

The MiCMRC/MiPCT Educational Webinar: “Nonpharmacologic Approaches for Depression” will enable the learner to define nonpharmacologic approaches/interventions, identify evidence-based approaches, and determine expected health outcomes after nonpharmacologic approaches are implemented in order to improve the care of patients with depression. The expert presenter is: Linda J. Keilman, DNP, GNP-BC, Assistant Professor, Michigan State University.

New this year! Nursing and Social Work continuing education contact hours for the “Nonpharmacologic Approaches for Depression” webinar may be obtained by one of the following activities:

  • Attend the live webinar on June 22, 2016 from 2:00 – 3:00 pm -OR- 
  • Listen to the recorded webinar which will be available in July.

To Register for the Live webinar:  http://micmrc.org/

Following the webinar a CE request link will be posted on http://micmrc.org/. Click this link to initiate a request for CE Credits. This will generate an email message containing a link to complete the CE request and required evaluation form. Follow the CE instructions contained in the email. Once the required evaluation is submitted, an email will be sent containing the CE certificate.

The CE request process will be the same for the recorded webinar. CE credit for viewing the recorded webinar will be available until June 22, 2017. While the webinar will still be available for viewing, please note that CE credit for the viewing the recorded webinar will not be available after June 22, 2017.

Continuing Education:

“Non-Pharmacological Interventions for Depression” is approved for 1.0 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.

This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 041916-02

For more information regarding contact hours, or for other questions, please submit to micmrc-requests@med.umich.edu

Upcoming MiPCT Care Manager Webinars Nursing and Social Work No-Cost CE Opportunities:

June 22, 2016 – 2:00pm

Nonpharmacological Approaches for Depression

Presented by Linda Keilman, DNP, GNP-BC

“Non-Pharmacological Interventions for Depression” is approved for 1.0 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.

This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 041916-02


July 13, 2016 – 2:00pm

Nonpharmacological Approaches for Pain Management

Presented by Linda Keilman, DNP, GNP-BC

This activity has been submitted to Michigan Nurses Association for approval to award contact hours.

The Michigan Nurses Association is an approver of continuing nursing education by the State of Michigan Board of Nursing.

This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 051916-00.


July 27, 2016 – 2:00pm

Nonpharmacological Approaches for Behavioral and Psychological Symptoms of Dementia

Presented by Linda Keilman, DNP, GNP-BC

This activity has been submitted to Michigan Nurses Association for approval to award contact hours.

The Michigan Nurses Association is an approver of continuing nursing education by the State of Michigan Board of Nursing. 

This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 052616-01

For details on opportunities for no-cost CE credit, and to register for these webinars: http://micmrc.org/continuing-ed

MiCMRC/MiPCT Complex Care Management Course

The 2016 MICMRC/MIPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiCMRC/MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiCMRC/MiPCT CCM Course occurs over a 4 day period. The course consists of:

Live Webinar on day 1 – introduction of MiCMRC/MiPCT CCM course

Self-study modules and post- tests which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)

In person training days 3 and 4

Register for upcoming MiCMRC/MiPCT CCM course dates at the following site

Upcoming course dates and course registration close dates:

July 11-14, 2016. Introductory Webinar July 11th, 2016. Total six hour self-study modules and post-tests, July 11-12, 2016.  In-person training July 13-14, 2016.  NOTE:   Registration for this course will close as of July 7th , 2016.

July 18-22, 2016. Introductory Webinar July 18th, 2016. Total six hour self-study modules and post-tests, July 18-21, 2016.  In-person training July 21-22, 2016.  NOTE:   Registration for this course will close as of July 15th , 2016.

Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

For information about MiCMRC approved self-management programs please see the document titled “Care Management Resource Center Approved Self-Management Support Training Programs” at https://mipct.org/care-management-resource-center/

This document includes details for each MiCMRC approved self-management program: location, objectives, modality, resources, course date/criteria to schedule, trainer qualifications, certification/CEs, and cost.

MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. For questions please submit to: micmrc-requests@med.umich.ed

MiCMRC Care Manager Monthly Update June 2016

May 11th, 2016 MiCMRC hosted a webinar titled “Transitions of Care-Clinical Lead Best Practice” presented by Della Slavsky RN, BSN, BA MiPCT Clinical Lead Upper Peninsula Health Plan and Janet Pund BSN, RN-BC MiPCT Clinical Lead University of Michigan Health system.

May 25th 2016, MICMRC hosted “Summary of the 2016 CDC Guidelines for Prescribing Opioids for Chronic Pain” presented by Catherine Reid, MD Consulting Physician for the Office of Medical Affairs, MDHHS.

Also on June 7th 2016, MiCMRC hosted “Overview of Current Opioid Use in Michigan” presented by Catherine Reid, MD Consulting Physician for the Office of Medical Affairs, MDHHS. This recorded webinar offers no-cost continuing education credit. Please visit http://micmrc.org/continuing-ed

The MiCMRC/MiPCT Care Manager recorded webinars, PowerPoint presentations as well as related articles and handouts are posted on the Michigan Care Management Resource Center website.

Please submit questions to: micrmc-requests@med.umich.edu

Practice Success Story: Most Improved Pediatric Practice

The Briarwood Center for Women, Children and Young Adults Looks to Improve Access to the Medical Neighborhood and Reduce Gaps in Asthma Management.

Situation: In 2015 the Center for Women, Children and Young Adults received the MiPCT best-practice award for most improved pediatric practice. This was due in large part to the hard work and dedication of the practice staff and commitment to their patients. The practice staff identified a need to better connect patients with community resources within the medical neighborhood as well as a need to reduce gaps in care with asthma management. So what made a difference in their practice?

Strategy: To start, the practice received a high level of support and direction from their leadership in ambulatory care. In addition, when speaking with Jennet Malone, Administrative Manager she stated one of the biggest impacts on the practice was the development of a multidisciplinary Medical Home Committee which allowed input from multiple disciplines to provide the necessary resources for their patients by linking community services to the patient’s needs. Furthermore, the development of standard workflows, setting clear goals and objectives, and obtaining and understanding key reports and data kept the practice in focus. One area in particular was the need to reduce its gaps in care related to asthma. Therefore the group developed an asthma workflow designed to reduce the gaps they were seeing in its management of asthma. This workflow helped the practice to be more efficient with its assessment and treatment plans for their patients. The Briarwood Center identified helpful hints: First, make sure you have the right people at the table. Don’t wait for others to provide you with the answers. Meet regularly, keep good notes, and make sure there is good follow up and follow through. Finally, share your project/idea with as many people as you can. But most importantly, celebrate your improvements as you go along.

 

NEXT ISSUE DATES:

  • P.O. FLASH: July 11, 2016
  • Practice FLASH: July 25, 2016

May 23, 2016

Practice FLASH May232016

Sustainability Key Messages

As a resource to MiPCT participants and stakeholders, a set of key messages regarding the transition of the MiPCT demonstration to program continuity beginning in 2017 has been developed and can be used for communication with your teams, as follows:

The Michigan Primary Care Transformation Project (MiPCT) demonstration period will end on December 31, 2016. The program will transition from a demonstration to an ongoing program in partnership with the State Innovation Model’s PCMH Initiative. The SIM PCMH Initiative is intentionally building upon and sustaining involvement of MiPCT providers and multi-payer participation, and leveraging the project’s existing infrastructure to advance the project model. Of note:

  • Discussions with participating commercial MiPCT payers is in process and looking positive for continuing participation. We are also interested in recruiting additional payers.
  • The existing 350 MiPCT practices will have the opportunity to apply for SIM PCMH Initiative participation, as will PCMH practices in the initial five SIM Community Health Innovation Regions (Muskegon County, Jackson County, Genesee County, Northern Michigan, and Washtenaw/Livingston Counties). The application process will begin in the summer of 2016 for a January 1, 2017 start date.
  • The PCMH SIM Initiative is foundational for effective Accountable Systems of Care (ASC), and all ASCs are also POs currently participating in MiPCT.
  • Continued Medicare participation and payment for the PCMH Initiative is critical, and we are exploring alternatives with CMS and CMMI, including the CPC+ program as well as a “custom” application permitted by CMS guidance.

 

Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

For information about MiCMRC approved self-management programs please see the document titled “Care Management Resource Center Approved Self-Management Support Training Programs” at https://mipct.org/care-management-resource-center/

This document includes details for each MiCMRC approved self-management program: location, objectives, modality, resources, course date/criteria to schedule, trainer qualifications, certification/CEs, and cost.

MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. For questions please submit to:  micmrc-requests@med.umich.edu

 

MiPCT Care Manager Webinars

May 25, 2016 – 2:00pm

Summary of the 2016 CDC Guidelines for Prescribing Opioids for Chronic Pain

Presented by Catherine Reid, MD Consulting Physician for the Office of Medical Affairs, MDHHS

June 7, 2016 – 2:30pm-3:30pm

Overview of Current Opioid Use in Michigan

Presented by Catherine Reid, MD Consulting Physician for the Office of Medical Affairs, MDHHS

Continuing Education: This activity has been submitted to Michigan Nurses Association for approval to award contact hours. The Michigan Nurses Association is an approver of continuing nursing education by the State of Michigan Board of Nursing.

June 22, 2016 – 2:00pm

Nonpharmacological Approaches for Depression

Presented by Linda Keilman, DNP, GNP-BC

Continuing Education: This activity has been submitted to Michigan Nurses Association for approval to award contact hours. The Michigan Nurses Association is an approver of continuing nursing education by the State of Michigan Board of Nursing. This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 041916-02

July 13, 2016 – 2:00pm

Nonpharmacological Approaches for Pain Management

Presented by Linda Keilman, DNP, GNP-BC

Continuing Education: This activity has been submitted to Michigan Nurses Association for approval to award contact hours. The Michigan Nurses Association is an approver of continuing nursing education by the State of Michigan Board of Nursing. This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 051916-00

July 27, 2016 – 2:00pm

Nonpharmacological Approaches for Behavioral and Psychological Symptoms of Dementia

Presented by Linda Keilman, DNP, GNP-BC

To register for these webinars: http://micmrc.org/webinars

 

MiCMRC Care Manager Monthly Update

On April 15th, 2016 the Michigan Care Management Resource Center (MiCMRC) hosted a webinar titled, “Autism Screening, Formal Testing, and Treatment: Determining the Next Steps in the Plan” Presented by Laurisa Cummings, LMSW Children’s Medical Group of Saginaw Bay.

Also, on April 27th, 2016 MiCMRC held a webinar titled, “Understanding the Complexities of Cognition” presented by Linda J. Keilman, DNP, GNP-BC, Assistant Professor at the Michigan State University, College of Nursing. Continuing education hours are available for watching the recorded webinar.

May 11th, 2016 MiCMRC hosted a webinar titled “Transitions of Care-Clinical Lead Best Practice” presented by Della Slavsky RN, BSN, BA MiPCT Clinical Lead Upper Peninsula Health Plan and Janet Pund BSN, RN-BC MiPCT Clinical Lead University of Michigan Health system.

The MiCMRC/MiPCT Care Manager recorded webinars, PowerPoint presentations as well as related articles and handouts are posted on the MiCMRC website.  To access the recorded webinars and associated information please visit: http://micmrc.org/webinars

Please submit questions to micrmc-requests@med.umich.edu

 

MiPCT Care Managers – An Invitation to Earn Continuing Education Contact Hours

Educational Offering:  MiCMRC/MiPCT Care Manager Webinar “Nonpharmacologic Approaches for Depression”

The MiCMRC/MiPCT Educational Webinar: “Nonpharmacologic Approaches for Depression” will enable the learner to define nonpharmacologic approaches/interventions, identify evidence-based approaches, and determine expected health outcomes after nonpharmacologic approaches are implemented in order to improve the care of patients with depression. The expert presenter is: Linda J. Keilman, DNP, GNP-BC, Assistant Professor, Michigan State University.

New this year!  Nursing and Social Work continuing education contact hours for the “Nonpharmacologic Approaches for Depression” webinar may be obtained by one of the following activities:

– Attend the live webinar on June 22, 2016 from 2:00 – 3:00 pm -OR-

–  Listen to the recorded webinar which will be available in July.

To Register for the Live webinar:   http://micmrc.org/

Following the webinar a CE request link will be posted on http://micmrc.org/webinars. Click this link to initiate a request for CE Credits. This will generate an email message containing a link to complete the CE request and required evaluation form. Follow the CE instructions contained in the email. Once the required evaluation is submitted, an email will be sent containing the CE certificate.

The CE request process will be the same for the recorded webinar. CE credit for viewing the recorded webinar will be available until June 22, 2017. While the webinar will still be available for viewing, please note that CE credit for viewing the recorded webinar will not be available after June 22, 2017.

Continuing Education:

This activity has been submitted to Michigan Nurses Association for approval to award contact hours. The Michigan Nurses Association is an approver of continuing nursing education by the State of Michigan Board of Nursing.

This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 041916-02

For more information regarding contact hours, or for other questions, please submit to: micrmc-requests@med.umich.edu

 

MiCMRC/MiPCT Complex Care Management Course – For MiPCT Care Managers

The 2016 MiCMRC/MiPCT Complex Care Management (CCM) Course is provided in a blended learning activity format.  The MiCMRC/MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiCMRC/MiPCT CCM Course occurs over a 4 day period. The course consists of:

  • DAY 1 – Live Webinar – Introduction of MiCMRC/MiPCT CCM course
  • DAY 2 – Self-study modules and post-tests which are completed prior to the in-person training (total expected time to complete the self-study and post-tests is six hours)
  • DAYS 3 and 4 – In-person training

Upcoming course dates and course registration close dates:

June 6-9, 2016. Introductory webinar June 6th, 2016.  Total six hour self-study modules and post-tests, June 6-7, 2016. In-person training June 8-9th, 2016.  NOTE:   Registration for this course will close June 2, 2016.

July 11-14th, 2016. Introductory Webinar July 11th, 2016. Total six hour self-study modules and post-tests, July 11-12, 2016.  In-person training July 13-14, 2016.  NOTE:   Registration for this course will close as of July 7th, 2016.

Continuing Education:

Social Work

This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 021816-01

Number of Social Work CE Contact Hours approved: 16

Nursing

The activity listed above applies to the following Michigan Board of Nursing (MBON) Rules for Re-licensure:

Nursing Workshop dealing with patient care issues (no formal contact hours or CEs).

MBON Rule 2(1). A maximum of 10 continuing education hours may be earned for participation in a workshop dealing with patient care issues offered by a health care organization or professional organization that falls outside the already accepted methods of approval that have already been adopted by the Board.

Register for MiCMRC/MiPCT CCM courses here.

Please submit questions regarding the MiCMRC/MiPCT CCM course to: micmrc-requests@med.umich.edu.

 

Practice Success Story

Pediatric Consultants of Troy Ensures its Ability to Continue Patient-Centered Medical Home Capabilities

Situation: In 2015 Pediatric Consultants of Troy received the best practice award for the best overall pediatric practice. The practice needed to provide appointments at times which worked for their patients. In addition, there was a need to increase organization around patient appointments to ensure all areas were being addressed, including self-management goals, setting future appointments, and closing gaps in care.

Strategy:  A solution to meeting parents needs resulted in opening the Night Owl Pediatric Clinic to accommodate after hour visits.  The Clinic is open Sunday through Thursday from 5pm to 8pm on a walk-in basis and Saturday mornings from 8am to Noon on a scheduled basis.   In addition to the regularly scheduled appointments, same day sick appointments are available Monday through Friday. Furthermore, after hours phone calls are returned by the physicians, giving parents the reassurance they need when calling after hours. In addition, the practice has set aside same day sick appointments Monday through Friday. This schedule helps to promote continuity with patient’s physicians.

In order to prepare for upcoming visits and to ensure all areas are addressed at each visit, the practice created some simple yet effective processes. Prior to scheduled visits, charts are prepared the day before. Google calendar is used for scheduling dietician, social work, and care manager appointments. In addition, a tracking process is in place which includes a checklist and tracking book. The practice team designed several patient checklists depending on the type of visit that goes to the physician to ensure that everything has been addressed such as self-management goals, medication, etc. This checklist is returned to the front staff for follow-up and gap closures as needed. Items requiring additional follow-up, i.e. placing a call to a patient who missed their appointment or needs certain tests completed, are placed in a tracking book. If there is an emergency room visit the patient will receive a letter with information on how to reach the practice 24/7 and their office hours, encouraging patients to call the practice first.

To help close gaps in care with asthma management the practice developed two Asthma Self-Management Goal tools for both children nine and younger and ten an over. An Asthma Self-Management Action plan is incorporated as well. Finally, an Asthma navigator tool was developed to capture information up front to help determine if there is any indication of asthma or the potential for the development of asthma.

March 21, 2016

SAVE THE DATES! MiPCT Regional Annual Summits

The dates and venues for the 3 confirmed 2016 MiPCT Regional Annual Summits are:

Summit West – Grand Rapids, MI

  • Tuesday, October 18, 2016 – confirmed
  • Frederik Meijer Gardens and Sculpture Park
  • 8AM to Noon General Session open to all;
  • Afternoon Care Management Focus

Summit Southeast – Ann Arbor, MI

  • Wednesday, October 26, 2016 – confirmed
  • University of Michigan NCRC
  • 8am to Noon General Session open to all;
  • Afternoon Care Management Focus

Summit North – Thompsonville, MI

  • Thursday, October 13, 2016 – confirmed
  • Crystal Mountain Resort & Conference Center
  • 11 AM to Noon Project Leadership Briefing,
  • Afternoon Care Management Focus

Sign Up Now! Registration Opens for the 2016 MiPCT-Led Billing and Coding Collaborative (4 Practice Learning Credits)

Again this year, the MiPCT will centrally host a Multipayer Billing and Coding Learning Collaborative (4 practice learning credits for successful completion) to continue our efforts to assist and support POs and practices in robust structures that support G- and CPT-code billing for embedded care management services.

Expectations for 2016 practice team participants include:

Front office staff, Care Manager and other interested PO or non-physician practice team members would need to participate in three to four MiPCT-led team webinars (with pre and post work). The timing of webinars would be spread throughout the year (e.g., March, May, July, December). (Note: Physicians are not required to participate in the team webinars.) Practice teams will be need to participate in the majority of the hosted webinars (e.g., in the instance of scheduling conflicts, up to one webinar can be reviewed retrospectively from the posted online material.)

Physician participation in one Physician-focused webinar.

Depending upon the preferences of the collaborative participants, an in person half day session may also be included.

Expectations for 2016 PO representatives who wish to participate in the collaborative on behalf of their practices include:

  • Participation as outlined above
  • Demonstration (via submitted minutes or other documentation) evidence that the collaborative material was conveyed in a meaningful way to practices and is incorporated in workflow/practice.
  • Submission of the names and addresses of practices involved

Please register using the links in Steps 1, 2 and 3 below, if your practices (or your PO on behalf of practices) intend to participate in the 2016 Billing and Coding Collaborative.

  • Step 1: Sign up to Participate in the 2016 MiPCT Billing & Coding Learning Collaborative as EITHER a PO or Practice Team using the appropriate link below:

Link for Practices:

https://umichumhs.ut1.qualtrics.com/SE/?SID=SV_4Tw9p1UZmHykbJP

Link for PO on Behalf of Practices:

https://umichumhs.ut1.qualtrics.com/SE/?SID=SV_bpx81S9xBQZGWIl

  • Step 2: RSVP to this link to let us know you’re attending the 3/29/2016, 1:00PM webinar:

Link to RSVP to 3/29 Webinar:

https://umichumhs.ut1.qualtrics.com/SE/?SID=SV_3VH2oor9zhFSOeV

  • Step 3: Pre-Register with WebEx to receive Webinar Login:

REQUIRED – PRE-REGISTRATION PLEASE READ INSTRUCTIONS CAREFULLY

The following webinar requires all individuals to register for participation. Please follow the link below and select one of the “register” options to complete the registration in full. Once you have registered, a confirmation email with instructions for joining the meeting will be sent to you by messenger@webex.com. The email subject line will state: Registration approved for Web seminar: MiPCT Billing & Coding Learning Collaborative Webinar. Please be sure to save the confirmation email to access the webinar. If you have any questions, please contact the MiPCT mailbox at: mipctdemo@michigan.govmipctdemo@michigan.gov

  • Topic: MiPCT Billing & Coding Learning Collaborative Webinar
  • Date: Tuesday, March 29, 2016
  • Time: 1:00pm, Eastern Standard Time (New York, GMT-05:00)
  • Duration: 1 hour

Register for this Webex Using THIS LINK!

You’re Invited to Join Now! MiPCT EHR User Groups

MiPCT is facilitating the formation of 5 user groups based on shared EHRs/registries and we invite you to participate. The purpose of the groups is to identify and provide shared solutions to issues specific to each EHR. Participation by both POs and practices is welcome. The first meetings will be held as webinars, and will include identification of the issues each group would like to address (as well as potential solutions), a discussion of outside speakers and future meeting times.

MiPCT has scheduled the first webinars for users of AllScripts Professional, Athena Health, Epic, NextGen and Wellcentive. MiPCT will facilitate the formation of user groups for all other EHRs and registries, but will be unable to attend the meetings.

Following are the dates of all 5 upcoming EHR User Group Webinars for your reference:

  • Wellcentive User Group Webinar: Monday April 18, 2016, 11AM to Noon
  • NextGen EHR User Group Webinar: Monday, April 18, 2016, 4-5PM
  • Athena Health EHR User Group Webinar: Tuesday, April 19, 2016, 1-2PM
  • Epic EHR User Group Webinar: Monday, April 25, 2016, 11AM to Noon
  • AllScripts Professional EHR User Group Webinar: Monday, April 25, 2016, 4-5PM

If you are interested in joining the of these EHR User Groups, please email Amanda First at

afirst@med.umich.edu indicating:

  • The EHR User Group you are interested in
  • Name and Contact information for each person you would like to be included in the group’s initial webinar meeting

We will then include you in the webinar’s Outlook notice, which includes the webinar login instructions.

Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

For information about MiCMRC approved self-management programs, please see the document titled, “Care Management Resource Center Approved Self-Management Support Training Programs,” at: https://mipct.org/care-management-resource-center/

This document includes details for each MiCMRC-approved self-management program: location, objectives, modality, resources, course date/criteria to schedule, trainer qualifications, certification/CEs, and cost.

MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course.

For questions please submit to: micmrc-requests@med.umich.edu

MiPCT Care Managers – An Invitation to Earn Nursing and Social Work Continuing Education Contact Hours

Educational Offering: MiCMRC/MiPCT Care Manager Webinar: “Understanding the Complexities of Cognition”

The MiCMRC/MiPCT Educational Webinar: “Understanding the Complexities of Cognition” webinar focuses on the complexities of cognition. The expert presenter is: Linda J. Keilman, DNP, GNP-BC Assistant Professor Michigan State University.

New this year! Nursing and Social Work continuing education contact hours for the “Understanding the Complexities of Cognition” webinar may be obtained by the following activities:

  • Attend the LIVE webinar on April 27th, 2016 from 2:00 – 3:00 pm -OR-
  • Listen to the recorded webinar which will be available early May. For details “coming soon,” check www.micmrc.org

Details about the steps and requirements for completion will be coming soon – via upcoming FLASH Newsletter and www.micmrc.org

To Register for the Live webinar: http://micmrc.org/

Continuing Education:

“Understanding the Complexities of Cognition” is approved for 1.0 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.

This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 022316-07

For more information regarding contact hours, or for other questions, please submit to micmrc-requests@med.umich.edu.

Addressing Social Determinants of Health (SDOH) and Behavioral Health Integration (BHI) – the Role of the Practice Team

  • 80% of health care outcomes depend on factors outside of clinical care delivery. (ROBERT WOOD JOHNSON COMMUNITY HEALTH RANKINGS)
  • Mental health high-cost patients were younger, lived in poorer neighborhoods, and had different health care utilization patterns, compared to other high-cost patients, ie., those with complex chronic disease or cancer. (HEALTH AFFAIRS, JAN 2016)
  • The simple question, “Do you (ever) have difficulty making ends meet at the end of the month?,” has a sensitivity of 98% and specificity of 60% in predicting poverty. (AAFP)

As the advanced medical home begins to address these complex situations it requires:

  • Practice teams which utilize registries which capture and address these at a population level
  • Partnerships with our medical neighborhoods
  • Processes within our practices to optimize treatment protocols and community linkages

MiPCT has created a toolkit to support POs and practices to be successful in addressing SDOH and BHI.

The link is: https://mipct.org/https://mipct.org/

A Practice-focused webinar will be held on “Toolkit for Integrating Social Determinants of Health and Behavioral Health”: Wednesday, April 13, 2016 from 1:30pm – 2:30pm.

Click here to join!

MiCMRC Care Manager Monthly Update – March 2016

On February 24th, 2016 the Michigan Care Management Resource Center (MiCMRC) hosted a webinar titled, “2105 Summit Best Practice Award Presentations” Presented by Alpine Internal Medicine and Pediatrics, Cereal City Pediatrics, Moazami Pediatrics, New Day Family Medicine, and CHC Fort Gratiot.

Also, on March 9th, 2016 MiCMRC held a webinar titled, “Depression in the Older Adult,” presented by Linda J. Keilman, DNP, GNP-BC, Assistant Professor at the Michigan State University, College of Nursing.

The MiCMRC/MiPCT Care Manager recorded webinars, PowerPoint presentations, as well as related articles and handouts are posted on the Michigan Care Management Resource Center website.

To access the recorded webinars and associated information please visit: http://micmrc.org/webinars .

Please submit questions to micrmc-requests@med.umich.edu.

Practice PAC Recruitment – Flyer Attached

Attached is a flier that Care Managers or Physicians in MiPCT practices can give to MiPCT members or caregivers who would be good candidates for Patient Advisory Council participation. To make things even easier, at your request, we will send you a set of hardcopy fliers ready for you to hand out. If you want a set mailed to you, please let us know via the mipctdemo mailbox at mipctdemo@Michigan.gov.

If you have any questions about the Patient Advisory Council, please contact Diane Marriott (dbechel@umich.edu) or 734 998 0390.

MiCMRC/MiPCT Complex Care Management Course – For MiPCT Care Managers

The 2016 MICMRC/MIPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiCMRC/MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiCMRC/MiPCT CCM Course occurs over a 4 day period. The course consists of:

  • DAY 1 – Live Webinar – introduction of MiCMRC/MiPCT CCM course
  • DAY 2 – Self-study modules and post-tests which are completed prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • DAYS 3 and 4 – In-person training

Upcoming course dates and course registration close dates:

  • March 28-31, 2016. Introductory Webinar March 28th, 2016. Total six hour self-study modules and post-tests, March 28-29, 2016. In-person training March 30-31, 2016. NOTE: Registration for this course will close as of March 24th, 2016.
  • May 23-26, 2016. Introductory Webinar May 23, 2016. Total six hour self-study modules and post-tests, May 23 – 24, 2016. In-person training May 25-26, 2016. NOTE: Registration for this course will close as of May 26th, 2016.

Continuing Education: Social Work

This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 021816-01

Number of Social Work CE Contact Hours approved: 16

Continuing Education: Nursing

The activity listed above applies to the following Michigan Board of Nursing (MBON) Rules for Relicensure:

Nursing Workshop dealing with patient care issues (no formal contact hours or CEs).

MBON Rule 2(1). A maximum of 10 continuing education hours may be earned for participation in a workshop dealing with patient care issues offered by a health care organization or professional organization that falls outside the already accepted methods of approval that have already been adopted by the Board.

Register for all MiCMRC/MiPCT CCM Courses Here!

Please submit questions regarding the MiCMRC/MiPCT CCM course to: micmrc-requests@med.umich.edu.

MiPCT Care Manager Webinars

Upcoming 2016 MiCMRC/ MiPCT Care Manager Educational Webinars:

  • Date: March 23, 2016 (2PM)
  • Title: Effective Communication with Physicians
  • Presenter: Maureen Murphy, RN, BS, FNP-BC
  • Date: April 15, 2016 (10AM)
  • Title: Autism Screening, Formal Testing, and Treatment: Determining the Next Steps in the Plan
  • Presenter: Laurisa Cummings, LMSW, Children’s Medical Group of Saginaw Bay
  • Date: April 27, 2016 (2PM)
  • Title: Cognition 101
  • Presenter: Linda J Keilman, DNP, GNP-BC, Assistant Professor, Michigan State University

To register for these webinars: www.micmrc.org/webinars

Behind the Data by MDC

Dear MiPCT Partner:

We have fielded many questions and investigated the possibility of using the MiPCT project clinical data repository as an option for Meaningful Use specialized registry reporting.

A recent FAQ from CMS has clarified the exclusion rule, and therefore eliminated the immediate need for Specialized Registry attestation in 2016, but we wanted to make our partners aware that the MiPCT project clinical data repository may be an option for 2017. As you know, sustainability is a focus of our efforts for the MiPCT project and we hope to be able to provide this option to you next year. We will keep you informed as we know more about those efforts.

  • CMS FAQ 14397 – What counts as an allowable exclusion.
  • CMS FAQ 13653 – What counts as a specialized registry.

Stories of Your Care Management Success, featuring Jennifer Train, St. John Providence Partners in Care

Northpointe Pediatrics was looking to ensure adequate and appropriate follow-up for newly diagnosed ADD/ADHD patients. This was due in part to HEDIS measures requiring that patients be seen within 30 days after “index prescription start date,” and then again two more times in the following 270 day period. Initially, there was difficulty establishing a way to identify those who were newly diagnosed. One idea that the office tried was to make a master list of patients with the diagnosis of ADD or ADHD then compare a new registry search on a monthly basis for new names. This proved time consuming and inaccurate. The office tried a few different ways to keep an accurate account of newly diagnosed patients but nothing proved very helpful or time effective. Initial trials were not successful. Subsequently, our physician had an idea, which we implemented:

To help ensure that we were tracking and following-up with our newly diagnosed ADD/ADHD patients, physician champion, Dr. Engel, created an internal ICD 10 code. Providers in the office would use this code along with the pertinent ICD 10 code for ADD/ADHD on the “index prescription start date”. This new code allowed the gaps in care coordinator along with the care manager to utilize the electronic registry to track patients who were newly diagnosed with ADD or ADHD. Once the list was generated it was easy to ensure adequate follow-up was taking place. In addition, the care manager and gaps in care coordinator now had the ability to check on those patients monthly who had been started on medication in the past nine months and ensure that they were being followed closely and met the HEDIS measure.

The change the practice made has led to an increase in medication compliance as well as follow up needed for those patients with ADD/ADHD. In addition, we have been able to identify those patients who have been non-adherent due to side effects of medication, difficulty obtaining those medications and those not progressing well on their new medication regimen. As a result of this, our gaps in care coordinator created a spreadsheet of newly diagnosed patients designated by month. Those patients are then checked to ensure they have follow up appointments scheduled. If patients do not have a current appointment scheduled or have expressed concerns regarding medication, side effects, or other areas of concern she then forwards that information to the care management team or the provider for further follow up as needed.

Note from the Editor: A Fond Farewell

Dear Stakeholders:

I have accepted a promotion in another department within the University of Michigan and this will be the last issue of the FLASH on which I will serve as editor. We are in the process of identifying my replacement now and expect to offer a seamless transition to you in terms of communications regarding the FLASH.

It has been my sincere pleasure to have served the MiPCT since the beginning, and I will miss it very much.

As a reminder, should you have any questions going forward, please send them to the mipctdemo@michigan.gov mailbox, where they will be promptly forwarded to the most appropriate person to address your question.

Best Wishes for a Successful Future!

Jody Fisher

MiPCT FLASH Editor/Project Assistant/Event Planner

NEXT ISSUE DATES:

  • Next MiPCT P.O. FLASH Issue: April 4, 2016
  • Next MiPCT Practice FLASH Issue: April 18, 2016

 

February 22, 2016

NOTE: Enrollment is now CLOSED for this event: MiPCT Practices: Earn Eight (8) Practice Learning Credits! MiPEC Improvement Summit 3/23/2016

In addition to the MiPCT Practice Learning Credit options outlined in the 2016 agreement, an additional option has been approved. Practices may earn eight (8) MiPCT Practice Learning Credits by attending the Michigan Patient Experience of Care (MiPEC) Improvement Summit on March 23, 2016 from 8:00 AM to 4:00 PM. The summit will be held on the Lansing Community College-West campus at 5708 Cornerstone Drive, Lansing, MI.

As with the other practice learning activity options, to receive credit, a primary care provider, care manager and one other member of the office team must attend. The MiPEC Improvement Summit flier is attached to today’s issue of the FLASH for further information about the Summit.

This option may hold special appeal for MiPCT Practices that also participate in the MiPEC, although POs and primary care practices not currently participating in MiPEC are also welcome to attend if they are interested in learning more. Practices interested in attending should contact Lisa Mason at lmason@gdahc.org at the Greater Detroit Area Health Council (GDAHC) and include the following information:

  • Practice name
  • PO or other organization
  • Email address
  • Phone number, and
  • Whether they are a MiPCT practice

If you have additional questions, please send a message to mipctdemo@michigan.gov mailbox with “MiPEC Improvement Summit Practice Learning Credits” in the subject line, or contact Lisa Mason at (313) 596-0811.

Addressing Social Determinants of Health (SDOH) and Behavioral Health Integration (BHI) – the Role of the Practice Team

  • 80% of health care outcomes depend on factors outside of clinical care delivery. (Robert Wood Johnson Community Health Rankings)
  • Mental health high-cost patients were younger, lived in poorer neighborhoods, and had different health care utilization patterns, compared to other high-cost patients, ie., those with complex chronic disease or cancer. (Health Affairs, Jan 2016)
  • The simple question, “Do you (ever) have difficulty making ends meet at the end of the month?,” has a sensitivity of 98% and specificity of 60% in predicting poverty. (AAFP)

 

As the advanced medical home begins to address these complex situations it requires:

  • Practice teams which utilize registries which capture and address these at a population level
  • Partnerships with our medical neighborhoods
  • Processes within our practices to optimize treatment protocols and community linkages

MiPCT has created a toolkit to support POs and practices to be successful in addressing SDOH and BHI.

The link is:

 

A webinar will be held onToolkit for Integrating Social Determinants of Health and Behavioral Health“:

Thursday, February 25, 2016 from 12:00 pm – 1:00pm.

Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

For information about MiCMRC approved self-management programs, please see the document titled, “Care Management Resource Center Approved Self-Management Support Training Programs,” at: https://mipct.org/care-management-resource-center/

This document includes details for each MiCMRC-approved self-management program: location, objectives, modality, resources, course date/criteria to schedule, trainer qualifications, certification/CEs, and cost.

MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course.

For questions please submit to: micmrc-requests@med.umich.edu

MiCMRC Care Manager Monthly Update – February 2016

On January 25th, 2016 the Michigan Care Management Resource Center (MiCMRC) hosted a webinar titled, “Get Connected. Get Answers. 2-1-1.” Presented by Sarah Kile B.S Executive Director 211. This MiCMRC/MiPCT Care Manager recorded webinars, PowerPoint presentations as well as related articles and handouts are posted on the Michigan Care Management Resource Center website. To access the recorded webinars and associated information please visit: http://micmrc.org/webinars

Also, on February 10th, 2016 MICMRC held a webinar titled, “2015 Updated Beers Criteria” presented by Kim Moon, PharmD, Manager, and Clinical Pharmacy Stars Team BCBSM. For those who were unable to attend the live webinar, the recording of this webinar will be posted March 2016 on the Michigan Care Management Resource Center website and continuing education contact hours will be available; see below for details.

Coming soon! Nursing and Social Work continuing education contact hours for the “High Risk Medications in Older Adults – Beers Update 2015” webinar may be obtained by the following activity:

  • Listen to the recorded webinar which will be available March 2016. For details “coming soon” check www.micmrc.org

 

Continuing Education:

“High Risk Medication in Older Adults – Beers’ Update 2015” is approved for 1.0 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.

This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 100816-05

For more information regarding contact hours, or for other questions, please submit to: micmrc-requests@med.umich.edu

MiCMRC/MiPCT Complex Care Management Course – For MiPCT Care Managers

The 2016 MiCMRC/MiPCT Complex Care Management (CCM) Course is provided in a blended learning activity format. The MiCMRC/MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiCMRC/MiPCT CCM Course occurs over a 4-day period. The course consists of:

  • DAY 1 Live Webinar – Introduction of MiCMRC/MiPCT CCM course
  • DAY 2 Self-Study Modules and Post-Tests, which are completed prior to the in-person training; (total expected time to complete the self-study and post tests is six hours).
  • DAYS 3 & 4 In-Person Training Days

Upcoming course dates and course registration close dates:

  • March 28-31 2016. Introductory Webinar – March 28, 2016. Total six hours of self-study modules and post-tests, March 28-29, 2016. In-person training, March 30-31. NOTE: Registration for this course will close on March 24, 2016, at 4pm.
  • April 4-7, 2016. Introductory Webinar – April 4, 2016. Total six hours of self-study modules and post-tests, April 4-5, 2016. In-person training, April 6-7, 2016. NOTE: Registration for this course will close on March 31, 2016, at 4pm.

Register for all MiCMRC/MiPCT CCM Courses Here: https://mipct.org/care-management-resource-center/ccm-online-registration-page/

Please submit questions regarding the MiCMRC/MiPCT CCM course to: micmrc-requests@med.umich.edu.

MiPCT Care Manager Webinars

Upcoming 2016 MiCMRC/ MiPCT Care Manager Educational Webinars:

  • Date: February 24, 2016 (2PM)
  • Title: 2015 Summit Best Practice Award Presentations
  • Presenters: Dr. Gerald Lee, Alpine Internal Medicine & Pediatrics, Spectrum Health Medical Group; Dee Dailey, Integrated Health Partners, PO Leader, Representing Cereal City Pediatrics and Moazami Pediatrics; Chelsea Hauschild, New Day Family Medicine, Practice Coach
  • Date: March 9, 2016 (2PM)
  • Title: Depression in the Older Adult
  • Presenter: Linda J. Keilman, DNP, GNP-BC, Assistant Professor, Michigan State University, Gerontological Nurse Practitioner
  • Date: March 18, 2016 (10AM)
  • Title: Children and Youth with Epilepsy
  • Presenter: Cynthia L. Leino-Handford, RN, Education & Advocacy Specialist, Epilepsy Foundation of Michigan
  • Date: March 23, 2016 (2PM)
  • Title: Effective Communication with Physicians
  • Presenter: Maureen Murphy, RN, BS, FNP-BC

To register for these webinars: www.micmrc.org/webinars

MiPCT Practice PAC Recruitment Flier – Attached

Attached is a flier that Care Managers or Physicians in MiPCT practices can give to MiPCT members or caregivers who would be good candidates for Patient Advisory Council participation. To make things even easier, at your request, we will send you a set of hardcopy fliers ready for you to hand out. If you want a set mailed to you, please let Jody Fisher (fishjody@umich.edu) know.

If you have any questions about the Patient Advisory Council, please contact Diane Marriott (dbechel@umich.edu) or 734 998 0390.

Antidepressant Medication Management: HEDIS, Submitted by Amanda Haddad and Jacob Sweeny

Within the Healthcare Effectiveness Data and Information Set (HEDIS) is a measure that assesses antidepressant adherence for patients who are 18 and older and were prescribed antidepressant therapy for major depressive disorder (MDD). The key assessment points are at 12 weeks and 6 months.7

Antidepressant discontinuation rates have been reported to average around 20% at 1 month, and 50% at 6 months.2 To improve antidepressant adherence, we must address key counseling points and reasons for discontinuation.

  • Counseling Points
    • Expectations of therapy: Regularly addressing apprehension and/or fears of continued therapy through the initial 4-6 weeks required for symptomatic improvement can facilitate sustained adherence.
    • Active participation:1 Assessing a patient’s social support system, and addressing barriers to or misconceptions of therapy can lead to a more encouraged, active patient, thus increasing adherence.
    • Dose Tapering/Discontinuation: Discussing the necessity of tapering certain antidepressants if discontinuation is necessary will increase patient understanding of potential withdrawal symptoms, which may include sweats/chills, nausea, insomnia, irritability, vertigo, and sensory disturbances. 1,9
    • Special populations
      • Pregnancy: Continuing therapy throughout pregnancy is appropriate in many cases, however risks such as congenital malformations (which are generally low) need to be weighed against the risk of severe depression relapse.4,6,10
      • Breast-Feeding: Maintaining therapy on certain medications, such as sertraline or paroxetine, may be safe; these medications have shown up in negligible concentrations in breastfed infants. Formula is an option if continued therapy poses an unacceptable risk to the infant.11
    • When to contact the physician
      • Suicidal ideation (Black Box Warning): Antidepressants have shown an increased risk of suicidal ideation in those < 24 years old.
      • Serotonin Syndrome: Symptoms include anxiety, agitation, delirium, diaphoresis, tachycardia, hypertension, hyperthermia, gastrointestinal distress, tremor, muscle rigidity, myoclonus, and hyperreflexia.
      • QT Prolongation: patients often have no symptoms, however tachycardia, fainting or seizures may be present. Has been associated with citalopram – patients should not take more than 40mg per day
      • Clinical worsening of mood or unusual changes in behavior.3
      • Intolerable adverse effects
  • Reasons for Poor Medication Adherence
    • Forgetfulness:8 By incorporating the use of pill boxes, phone reminders, or a daily routine (i.e. taking medication with morning coffee), adherence can significantly improve.
    • Cost1,5
      • Up to 32% of older adults avoid filling their prescriptions due to costs. Strategies to maximize affordability include:
        • Generic alternatives
        • 90-day supplies
        • Mail-order services
        • Manufacturer discounts
        • Patient assistance programs
    • Common adverse effects13,14
      • Weight gain: If patient is concerned with weight gain, advise physician to avoid SSRIs, and consider bupropion.
      • Sexual dysfunction: Treatment options for managing sexual dysfunction include: reducing dose; allowing for spontaneous remission; switching to an alternative antidepressant (non-SSRI/SNRI, such as bupropion); and/or providing adjunct therapy to treat sexual dysfunction. 12
      • Bupropion: common side effects include xerostomia, nausea, insomnia and dizziness. Bupropion can also lower the seizure threshold.
      • Mirtazapine: common side effects include drowsiness and xerostomia.
      • SNRIs: common side effects include nausea and dizziness.
1. American Psychiatric Association (APA). Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. Arlington (VA): American Psychiatric Association (APA); Oct. 2010
2. Sansone, Randy A., and Lori A. Sansone. “Antidepressant adherence: are patients taking their medications?.” Innovations in clinical neuroscience 9 (2012).
3. Product Information: REMERON(R) oral tablets, mirtazapine oral tablets. Merck Sharp & Dohme Corp. (per FDA), Whitehouse Station, NJ, 2015.
4. Cohen LS, Altshuler LL, Harlow BL, et al. Relapse of Major Depression During Pregnancy in Women Who Maintain or Discontinue Antidepressant Treatment. JAMA. 2006;295(5):499-507. doi:10.1001/jama.295.5.499.
5. Briesacher, B. A., Gurwitz, J. H., & Soumerai, S. B. (2007). Patients at-risk for cost-related medication nonadherence: a review of the literature. Journal of general internal medicine, 22(6), 864-871.
6. Cohen, Lee S., et al. “Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment.” Jama 295.5 (2006): 499-507
7. National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2014.
8. National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2014.
9. Shelton RC. Steps Following Attainment of Remission: Discontinuation of Antidepressant Therapy. Primary Care Companion to The Journal of Clinical Psychiatry. 2001;3(4):168-174.
10. Kulin NA, Pastuszak A, Sage SR, et al. Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors. JAMA 1998;279:609-10.
11. Weissman AM, Levy BT, Hartz AJ, et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry 2004;161:1066-78.
12. Baldwin, D. S., & Foong, T. (2013). Antidepressant drugs and sexual dysfunction. The British Journal of Psychiatry, 202(6), 396-397.
13. Keller, M. B., Hirschfeld, R. M. A., Demyttenaere, K., & Baldwin, D. S. (2002). Optimizing outcomes in depression: focus on antidepressant compliance. International clinical psychopharmacology, 17(6), 265-271.
14. Fava, M. (2000). Weight gain and antidepressants. The Journal of clinical psychiatry, 61(suppl 11), 1-478.

NEXT ISSUE DATES:

  • Next MiPCT P.O. FLASH Issue: March 7, 2016
  • Next MiPCT Practice FLASH Issue: March 21, 2016

 

January 25, 2016

MiPCT Practices:   Earn Eight (8) Practice Learning Credits!    MiPEC Improvement Summit 3/23/2016

In addition to the Practice Learning Credit options outlined in the 2016 agreement, an additional option has been approved.   Practices may earn eight (8) MiPCT Practice Learning Credits by attending the Michigan Patient Experience of Care (MiPEC) Improvement Summit on March 23, 2016 from 8:00 AM to 4:00 PM.  The summit will be held on the Lansing Community College-West campus at 5708 Cornerstone Drive, Lansing, MI.

As with the other practice learning activity options, to receive credit, a primary care provider, care manager and one other member of the office team must attend.  The MiPEC Improvement Summit flier is attached to today’s version of the FLASH for further information about the Summit.

This option may hold special appeal for MiPCT Practices that also participate in the MiPEC, although POs and primary care practices not currently participating in MiPEC are also welcome to attend if they are interested in learning more.  Practices interested in attending should contact Lisa Mason at lmason@gdahc.org at the Greater Detroit Area Health Council (GDAHC) and include the following information:

  • Practice name
  • PO or other organization
  • Email address
  • Phone number, and
  • Whether they are a MiPCT practice

If you have additional questions, please send a message to mipctdemo@michigan.gov mailbox with “MiPEC Improvement Summit Practice Learning Credits” in the subject line or contact Lisa Mason at 313-596-0811.

MiPCT Care Managers — An Invitation to Earn Nursing and Social Work Continuing Education Contact Hours

Educational Offering: 

MiCMRC/MiPCT Care Manager Webinar:  “High Risk Medications in Older Adults – Beers Update 2015”

The MiCMRC/MiPCT Educational Webinar: “High Risk Medications in Older Adults – Beers Update 2015” webinar focuses on the recently updated Beers guidelines.   The American Geriatrics Society (AGS) Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults is an explicit list of PIMs best avoided in older adults in general, and in those with certain diseases or syndromes, prescribed at reduced dosage or with caution or carefully monitored.  The updated Beers criteria were announced October, 2015. The expert presenter is Kim Moon, PharmD, Manager, Clinical Pharmacy Stars BCBSM.

New this year!  Nursing and Social Work continuing education contact hours for the “High Risk Medications in Older Adults – Beers Update 2015” webinar may be obtained by one of the following activities:

  • Attend the LIVE webinar on February 10, 2016 from 2:00 – 3:00 pm -OR-
  • Listen to the recorded webinar which will be available late February, 2016.  For details “coming soon” check www.micmrc.orgwww.micmrc.org

Details about the steps and requirements for completion will be coming soon –  via upcoming FLASH Newsletter and www.micmrc.org
To Register for the Live webinar:  http://micmrc.org/

Continuing Education:
“High Risk Medication in Older Adults – Beers’ Update 2015” is approved for 1.0 contact hours by the Michigan Nurses Association, an approver of continuing nursing education by the Michigan Board of Nursing.

This course is approved by the Michigan Social Work Continuing Education Collaborative. Course approval #: 100816-05

For more information regarding contact hours, or for other questions, please submit to:
micmrc-requests@med.umich.edu

Practice PAC Recruitment Flyer Attached

Attached is a flier that Care Managers or Physicians in MiPCT practices can give to MiPCT members or caregivers who would be good candidates for Patient Advisory Council participation. To make things even easier, at your request, we will send you a set of hard copy fliers ready for you to hand out. If you want a set mailed to you, please let Jody Fisher (fishjody@umich.edu) know.

If you have any questions about the Patient Advisory Council, please contact Diane Marriott (dbechel@umich.edu) or 734 998 0390.

Free Technical Support to POs Who Would Like to Improve Process Flows & EHR Capture Related to Depression & Alcohol Use Screening via MPRO – Flyer Attached

Addressing the Social Determinants of Health is a focus area of MIPCT in 2016 – 2017.  Depression screening is connected to quality measures and meaningful use. MPRO  is currently offering free technical support to POs who would like to improve their process flows and EHR capture related to depression and alcohol use screening. POs who actively  engage with MPRO on this initiative may apply for consideration of learning credits.  See flyer for additional details.

CMMI Grant Funding Opportunity for Social Determinants of Health:
Accountable Health Communities Model Article Attached

The attached article, Accountable Health Communities — Addressing Social Needs through Medicare and Medicaid by Dawn E. Alley, Ph.D., Chisara N. Asomugha, M.D., Patrick H. Conway, M.D., and Darshak M. Sanghavi, M.D. from the New England Journal of Medicine (1/7/2016), discusses the CMMI opportunities for funding for addressing social determinants with community partners – Accountable Health Communities Model.

Critical Dates
Jan. 21          Webinar with CMS
Jan. 27          Repeat of webinar
Feb.  8           Nonbinding  letter of intent

https://innovation.cms.gov/initiatives/ahcm

Position Open at the Michigan Department of Health and Human Services

The Michigan Department of Health and Human Services, Division of Chronic Disease and Injury Control, is seeking interested candidates for a DCDIC Population Health Integration Coordinator.

This is an affiliate position with the Michigan Public Health Institute and will be responsible for forging linkages at the local and state levels to facilitate integration of evidence-based chronic disease and injury/violence strategies and align with the State Innovation Model (SIM) Blueprint for Health and other statewide healthcare and community services transformation initiatives to support achievement of population health goals.

Please click here for more information: https://www.mphi.org/careers/.

Announcing The Michigan Care Management Resource Center Enhanced Website

New for January 2016, The Michigan Care Management Resource Center (MiCMRC) unveils the updated and enhanced website www.micmrc.org

The new site features:

  • Clinical programs (MiPCT and more)
  • MiCMRC/MiPCT Complex Care Management course registration
  • Upcoming MiCMRC/MiPCT  Care Management Webinar announcement and registration
  • Care Management 101- A suggested roadmap of staged content for the new care manager to guide developmental activities over the first year
  • New Topics page with organized resources and tools: Advance Care Planning, Palliative Care, Pediatrics, Medication Management, Transition of Care, PCMH and Team Based Care, Chronic Conditions, Quality and Population Health Management, Elderly Population and Behavioral Health
  • Features a searchable library of recorded MiCMRC/MiPCT  Care Management webinars and associated materials

NOTE: The website redesign entailed transitioning to an open, non-password protected www.micmrc.org website. Please take a few minutes to visit www.micmrc.org. MiPCT participants are encouraged to contribute tools and best practices to assist with enhancing delivery of care management statewide.  To submit best practice/tools/resources, please contact:  micmrc-requests@med.umich.edu

Your feedback and suggestions for enhancements are welcome.  Please provide feedback via: micmrc-requests@med.umich.edu

Billing Medicare the Chronic Care Management Code for Non-MiPCT Patients

CMS has asked us to remind practices and POs that the 99490 Chronic Care Management code is billable on a monthly basis for non-face-to-face care coordination services furnished to non-MiPCT Medicare beneficiaries with multiple chronic conditions. The code cannot be billed for Medicare MiPCT patients who appear on monthly member lists, as Medicare already pays a PMPM for these patients.  If the code is billed and paid for a MiPCT patient, the payment will be retracted after a CMS reconciliation. For additional information on the code, please see page 5 of the Multipayer MiPCT Billing and Coding grid on the “Billing, Coding, and Payment” dropdown tab of the www.mipct.org website under “Resources.”

Michigan Care Management Resource Center Approved Self-Management Support Training Programs – Update

For information about MiCMRC approved self-management programs please see the document titled “Care Management Resource Center Approved Self-Management Support Training Programs” at:
https://mipct.org/care-management-resource-center/

This document includes details for each MiCMRC approved self-management program: location, objectives, modality, resources, course date/criteria to schedule, trainer qualifications, certification/CEs, and cost.

MiPCT Moderate, Complex and Hybrid Care Managers are required to complete a MiCMRC-approved self-management course. For questions please submit to:
micmrc-requests@med.umich.edu

MiCMRC Care Manager Monthly Update – January 2016

On December 9th, 2015 Michigan Care Management Resource Center (MiCMRC) hosted a webinar titled, “Normal Communication in Lives That Are Anything But,” presented by Renee L McCune, PhD, RN, Associate Dean, McAuley School of Nursing, University of Detroit-Mercy. Also, on December 18th,  2015  MICMRC held a webinar titled, “Mandated Reporting,” presented by Chris Blood, LLMSW, Children’s Protective Services Supervisor, Ingham County Department of Health and Human Services.

The MiCMRC/MiPCT Care Manager recorded webinars, PowerPoint presentations as well as related articles and handouts are posted on the Michigan Care Management Resource Center website.  The December 2015 recorded webinars listed above are also available on the MiCMRC website.  To access the recorded webinars and associated information please visit: http://micmrc.org/webinars

Please submit questions to:
micrmc-requests@med.umich.edu

MiCMRC/MiPCT Complex Care Management Course Registration – 2016 Updates

New in 2016, the MiCMRC/MiPCT Complex Care Management (CCM) course is  open to Care Managers who are interested in learning about complex care management and not employed as a Care Manager in a MiPCT practice.  The MiCMRC/MiPCT CCM course is designed to prepare the health care professional for the role of Complex Care Manager.   In an effort to meet the learners’ needs, MiCMRC has posted a 2016 course schedule exclusively for non- MiPCT Care Managers.  The 2016 CCM course schedule for Non MiPCT Care Managers is available at:
http://micmrc.org/programs/pdcm-phase-iii/registration

Course Fee for Non-MiPCT Care Managers:  The MiCMRC/MiPCT CCM $250.00 course fee for non-MiPCT Care Managers includes the standardized evidence-based course and access to MiCMRC live and recorded webinars.  Opportunities to earn Nursing and Social Work Contact Hours via future webinars will be provided periodically.  Please see the attached ATTACHMENT MiCMRC MiPCT CCM Course Flyer v2 FINALfor details.

Registration: To register non-MiPCT Care Managers for the MiCMRC/MiPCT CCM course please access:
http://micmrc.org/programs/pdcm-phase-iii/registration

NOTES:   If you have 15 or more non-MiPCT Care Managers in your area and would like the MiCMRC team to provide a regional training at your location please submit your request to:  micmrc-requests@med.umich.edu

For PO Leaders who support both MiPCT and non-MiPCT practices, the registration for MiPCT Care Managers has not changed.  To register MiPCT Care Managers please access: http://micmrc.org/programs/michigan-primary-care-transformation-mipct-project/registration

Processing CCM Course Fee for the Non-MiPCT Care Managers: The MiCMRC will use an invoice process to receive the course fee.  The individual who registers for the course will need to identify the person responsible for the course fee.   The invoice will be sent to the person identified at time of registration as follows:  < Name, e mail, Address, City, State, Postal Code, and Country. >

Reconciliation Steps: BCBSM PDCM Phase III value-based reimbursement CCM   training requirement for non-MiPCT Care Managers will be confirmed with BCBSM (MiCMRC/MiPCT CCM course completion date, Care Manager name, BCBSM Practice Unit ID) .  Following completion of the course each month your PO will receive a table with the names of the non-MiPCT Care Managers who completed the course.  We will request your assistance in providing the BCBSM Practice unit ID for each non-MiPCT CM.

For questions please contact:
micmrc-requests@med.umich.edu

MiCMRC/MiPCT Complex Care Management Course – For MiPCT Care Managers

The 2016 MICMRC/MIPCT Complex Care Management (CCM) Course is provided in a blended learning activity format.  The MiCMRC/MiPCT CCM course is designed for new MiPCT Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs).

Completion of the MiCMRC/MiPCT CCM Course occurs over a 4 day period.  The course consists of:

  • DAY 1 Live Webinar – Introduction of MiCMRC/MiPCT CCM course\
  • DAY 2 Self-Study Modules and Post-Tests which are completed  prior to the in-person training (total expected time to complete the self-study and post tests is six hours)
  • DAYS 3 & 4 In-Person Training Days

Upcoming course dates and course registration close dates:

  • February 1-4, 2016. Introductory Webinar February 1, 2016.  Total six hour self-study modules and post-tests, February 1-2, 2016.  In-person training February 3-4, 2016. NOTE: Registration for this course will close as of January 25, 2016 4p.m. \
  • March 28-31 2016. Introductory Webinar March 28, 2016.  Total six hour self-study modules and post-tests, March 28-29, 2016.  In-person training March 30-31. NOTE: Registration for this course will close as of March 24, 2016, 4p.m.
  • April 4-7, 2016. Introductory Webinar April 4, 2016.  Total six hour self-study modules and post-tests, April 4-5, 2016.  In-person training April 6-7, 2016. NOTE: Registration for this course will close as of March 31, 2016, 4p.m.

Register for all MiCMRC/MiPCT CCM Courses Here:
https://mipct.org/care-management-resource-center/ccm-online-registration-page/

Please submit questions regarding the MiCMRC/MiPCT CCM course to:micmrc-requests@med.umich.edu.

MiPCT Care Manager Webinars

2016 MiPCT Care Manager Educational Webinars:

  • Date:  Monday, January 25, 2016 (2PM)
  • Title:  Get Connected. Get Answers, 211
  • Presenter: Sara Kile, BS, Executive Director, 211

Please see link below for upcoming MiPCT Care Manager Webinars:
https://mipct.org/care-manager-webinar-conference-call-calendar/

  • Date: February 10, 2016 (2PM)
  • Title: 2015 Updated Beers Criteria
  • Presenter:  Kim Moon, PharmD, Manager, Clinical Pharmacy Stars Team, BCBSM

NEW! For information on Nursing and Social Work Continuing Education, see related article on Page 2, “MiPCT Care Managers — An Invitation to Earn Nursing and Social Work Continuing Education Contact Hours“.

Please see link below for upcoming MiPCT Care Manager Webinars:
https://mipct.org/care-manager-webinar-conference-call-calendar/

  • Date:  February 24, 2016 (2PM)
  • Title:  2015  Summit Best Practice Award Presentations
  • Presenters: Dr. Gerald Lee, Alpine Internal Medicine & Pediatrics, Spectrum Health Medical Group; Dee Dailey, Integrated Heapth Parters, PO Leader, Representing Cereal City Pediatrics and Moazami Pediatrics; Chelsea Hauschild, New Day Family Medicine, Practice Coach

Please see link below for upcoming MiPCT Care Manager Webinars:
https://mipct.org/care-manager-webinar-conference-call-calendar/

  • Date:    March 9, 2016 (2PM)
  • Title:    Depression in the Older Adult
  • Presenter:    Linda J. Keilman, DNP, GNP-BC, Assistant Professor, Michigan State University, Gerontological Nurse Practitioner

Please see link below for upcoming MiPCT Care Manager Webinars:
https://mipct.org/care-manager-webinar-conference-call-calendar/

  • Date: March 23, 2016 (2PM)
  • Title: Effective Communication with Physicians
  • Presenter: Maureen Murphy, RN, BS, FNP-BC

Please see link below for upcoming MiPCT Care Manager Webinars:
https://mipct.org/care-manager-webinar-conference-call-calendar/

Stories of Your Team -Based Success:  Improving Care for Patients with Asthma Integrated Health Partners, Cereal City Pediatrics/Moazami Pediatrics, Dee Dailey, Practice Coach

Cereal City Pediatrics and Moazami Pediatrics wished to increase staff awareness of asthma as a means of improving patient care for patients who have asthma.  The practice identified the need for precise, accurate, and informative training for existing and new staff.  They sought to have training that would address the topics of allergy injections, respiratory distress symptoms, telephone triage, and spirometry use.

The practices made the decision to implement changes to their training program.  The PO Leader, PCP, MiPCT Care Manager, and Office Support Staff worked together to ensure the success of their new program.  An asthma educator conducted an in-service training with the entire office, including front office staff.  An asthma allergy center provided training on injections.  Additionally, physicians conducted an in-service with the nursing staff on the topic of identifying respiratory distress.

Many improvements were recognized as a result of this change in training.  Content from the training topics was included in new employee orientation.  Staff now receives annual training, which was developed during the new training program.  Patient asthma education folders were created and are given to newly diagnosed asthma patients.

Individual care management education sessions are conducted to teach patients how to use a spacer, inhaler, or nebulizer.  Refill requests are monitored to assess for medication adherence.  Annual well visits with an asthma action plan are required for all medication refills and school notes for medication usage for patients with asthma.  Priority calls are placed to patients with asthma when flu vaccines arrive, along with other high-risk patients, before reminder calls are made for healthy patients.

Standard tools and processes were also developed.  A cough protocol and algorithm for the front desk and triage staff were created to screen phone calls and prioritize appointments.  The office purchased a spirometer and had the vendor develop tools and conduct training.  Asthma patients are tracked and flagged in our EMR and gaps in care reports to ensure that services are provided.

Implementing a designated Asthma Champion had a significant impact.  Metrics were collected that demonstrated the success of this team-based improvement program.

Seeking MiPCT Care Manager Success Stories

As we reflect on the MiPCT accomplishments, we would like to thank all of the MiPCT Care Managers who submitted their MiPCT Care Manager Success stories!  The feedback we receive about the FLASH newsletter “ MiPCT Care Manager Success stories” column is very positive.

As we begin 2016, we are seeking stories of MiPCT Care Manager success.  We know they are out there!  You may be wondering why take time to submit a MiPCT Care Manager Success story?  Not only do you receive the recognition that you deserve, but you also help out colleagues who may be facing a similar situation.  Please submit your Care Manager Success stories via www.micmrc.org

Please submit questions to:  micmrc-requests@med.umich.edu

Microsoft Word - Seeking Care Manager Success Stories v1.docx

NEXT ISSUE DATES:

  • Next MiPCT P.O. FLASH Issue:  February 8, 2016
  • Next MiPCT Practice FLASH Issue:  February 22, 2016

Upcoming Practice FLASH Issues:

  • Volume 5, Issue 4, (April 18, 2016)
  • Volume 5, Issue 5, (May 23, 2016)
  • Volume 5, Issue 6, (June 20, 2016)
  • Volume 5, Issue 7, (July 25, 2016)
  • Volume 5, Issue 8, (August 29, 2016)
  • Volume 5, Issue 9, (September 26, 2016)
  • Volume 5, Issue 10, (October 24, 2016)
  • Volume 5, Issue 11, (November 14, 2016)
  • Volume 5, Issue 12, (December 12, 2016)