The Michigan Primary Care Transformation (MiPCT) Project is a three-year, multi-payer, state-wide project aimed at reforming primary care payment models and expanding the capabilities of patient-centered medical homes (PCMH) throughout the state. The selection of Michigan as one of eight states in the Multi-Payer Advanced Primary Care Practice Demonstration (MAPCP), sponsored by the Centers for Medicare and Medicaid (CMS), was the catalyst for bringing together Medicare, Michigan Medicaid Health Plans, Blue Cross Blue Shield of Michigan and Blue Care Network to improve upon the strong PCMH foundation in the state and create a uniform, sustainable primary care platform. Additional payers are expected to join as the project proceeds.
As noted in the diagram below, the MiPCT approach to population management encompasses patients at all stages of health. The goal of the Transformation Project is to improve overall population health via risk reduction for healthy individuals, self-management support to prevent patients with moderate chronic disease levels from progressing to the complex category, care coordination and support for patients with complex chronic diseases and appropriate, coordinated end-of-life care.
Recognizing that no two practices are alike, MiPCT allows flexibility in meeting the project goals. In order to participate, practices must create an individualized plan to address the four MiPCT functional areas and required PCMH infrastructure noted in the diagram below. Care Managers and Complex Care Managers must be included in this plan, incorporated as part of the primary care team. In addition, practices must track care coordination activity via the use of G-codes and CPT modifiers.
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, beginning January 2012:
- Care coordination payment – $3.00 per member per month ($4.50 for Medicare)
- Practice transformation payment – $1.50 per member per month ($2.00 for Medicare)
- Performance incentives – $3.00 per member per month