The project is expected to be budget neutral, meaning that the amount spent on care for MiPCT patients will be equal to or less than the amount spent for similar patients not in the demonstration program.

All participating payers will provide funding to PO/PHO/primary care practices and providers to build and strengthen advanced primary care practice capability to deliver patient-centered care.   Practices or providers participating in the demonstration will receive three payment components as follows:

  • Care coordination payment – $3.00 per member per month ($4.50 for Medicare).   This is paid to the PO for distribution to practices as appropriate via a PMPM by governmental payers and by G and CPT care management codes for commercial payers.
  • Practice transformation payment – $1.50 per member per month ($2.00 for Medicare).   This is paid as a PMPM except in cases where a payer had preexisting payment for practice transformation that preceded the demonstration. In this case, the payer is credited for this payment component.
  • Performance incentives – $3.00 per member per month. This is paid as a retrospective incentive in six month increments for governmental payers, and is incorporated in commercial payers’ existing payment and is thus credited.

Payers also support a small administrative payment for central demonstration operations, including stewardship and governance, data and dashboards, evaluation, care management training, learning collaboratives, communication and resource support, etc.

What are the roles of POs/PHOs/IPAs in the Demonstration?

The PO/PHO/IPA is responsible for assisting with implementation of the MiPCT Project and for supporting affiliated Practices in their development of PCMH capabilities.

Specific responsibilities include:

  • Assist with the initial recruitment and enrollment of eligible Practices for participation in the MiPCT Demonstration Project (see Enrollment section below)
  • Inform MiPCT of significant practice changes and changes in participating physicians throughout the Demonstration
  • Arrange Care Coordination services for those Practices that choose not to hire their own Care Manager or Complex Care Manager
  • Distribute MiPCT payments to participating Practices as specified in the approved PO implementation plan
  • Provide supportive services, in accordance with agreements in place, to enable Practices to continue developing their PCMH capabilities and to achieve or exceed the Year One PCMH Infrastructure Thresholds
  • Enter into a Business Associate and Data Use Agreement with MDCH, CMS, and UMHS
  • Submit quarterly narrative and financial reports to MDCH on practice progress and receipt, distribution, and use of funds
  • As needed, assist in providing requested registry/EHR data for Demonstration purposes
  • Support the State and the National Demonstration Project evaluation by assisting with the dissemination of physician/staff surveys to Practices and encouraging Practices to respond and by responding directly to PO surveys within the requested timeframe.  Both surveys will be conducted twice during the project, at baseline and year 3

What are the terms and conditions of PCMH practice participation?

Practices must:

  • Sign the demonstration application and collaborate with the PO in development of the MiPCT PO/Practice Implementation plan (see Enrollment Process below)
  • Plan to remain in the Demonstration throughout the 3 years of the project
  • Participate in education/training programs such as learning collaboratives, Lean workshops, practice-based coaching, webinars, and seminars
  • Enter into a Business Associate and Data Use Agreement with MDCH,CMS, and UMHS
  • Cooperate with the MiPCT evaluation vendor, Michigan Public Health Institute, and provide information or data as needed

How does the Care Management component work?

Health care is delivered locally, so there may be considerable variation in how care management services will be provided in different settings. The care management payment is estimated to be sufficient to cover the cost of employing one care manager and one complex care manager to provide services for approximately every 5,000 beneficiaries enrolled in participating health plans.

  • Care Managers and Complex Care Managers may be employed by the practice, or if more practical, by the Physician Organization or other entity
  • The PO and practice will jointly develop an Implementation Plan, using the MiPCT template, detailing how and when the care management component will be executed.  MiPCT must review and ultimately approve the plan before the payment of care management funds will be initiated.
  • Regardless of who employs the Care Manager or the Complex Care Manager, these individuals are expected to function as an integral part of the Practice’s care team to enable frequent communication with the team and have direct access to patient records
  • All Care Managers receiving financial support under the MiPCT demonstration must meet MiPCT Education and Training requirements
  • All Care Managers will use an appropriate EHR, patient registry and/or care management product to document care plans and encounters for patients enrolled in care management services
  • The Practice (or the PO) will submit MiPCT-specified G codes and modifiers with a zero dollar charge to document and/or bill for care management encounters

Monitoring and Technical Assistance

How is the Demonstration monitored?

The Michigan Department of Community Health is responsible for overall direction and control of the Demonstration Project and will assure that programmatic standards are met, provisions in agreements are adhered to, and program objectives are achieved.  Monitoring will be accomplished through:

  • Quarterly narrative and financial reports submitted by each Physician Organization on practice/PO progress in achieving MiPCT goals
  • Semi-annual payer reports
  • Financial reports
  • Standard audit procedures

What types of technical support will be provided?

  • Educational opportunities:
    • Learning Collaboratives, Lean training, webinars
    • Personalized coaching
  • The Michigan Care Management Resource Center (MiCMRC):
    • Development of a Care Management Consortium  – open to all POs/PHOs
    • Personalized consultation services for all Consortium members
    • Online Web-based resource for Consortium members
    • Calculate member attribution, risk stratification, and performance incentives
    • Generate feedback reports on MiPCT metrics
  • The Michigan Data Collaborative:
    • Create a robust, multi-payer claims database
    • Calculate member attribution, risk stratification, and performance incentives
    • Generate feedback reports on MiPCT metrics

Evaluation and Sustainability

How is the program evaluated?

The program is evaluated by the Research Triangle Institute, CMS’ national evaluator for the MAPCP demonstration. The first year evaluation has been released to date.   The evaluation concluded that MiPCT program savings for Medicare in Michigan were estimated at about $148 per full-year eligible Medicare beneficiary.   An all-payer evaluation will also be conducted by the Michigan Public Health Institute with results to be released later in in 2016.

What is the future of MiPCT? 

The program is in discussion with the State of Michigan’s State Innovation Model, CMS, Medicaid, commercial payers and other partners for program continuity after the demonstration period has concluded.

See also:

About MiPCT

Guiding Principles