2012 PO FLASH

December 17, 2012

BCN Update

BCN has issued the checks to BCN participating PCPs for practice transformation for the third quarter of 2012. As a reminder, we pay the $1.50pmpm for practice transformation on a PCP’s assigned applicable membership to FFS providers.

 FLASH Distribution Moving to BiMonthly

Beginning in January, the MiPCT FLASH will move to a bimonthly distribution schedule. You will now receive the FLASH twice monthly. Following is the FLASH schedule for 2013:

  • January 14 & 28, 2013
  • February 11 & 25, 2013
  • March 11 & 25, 2013
  • April 8 & 22, 2013
  • May 6 & 20, 2013
  • June 10 & 24, 2013
  • July 8 & 22, 2013
  • August 12 & 26, 2013
  • September 9 & 23, 2013
  • October 14 & 28, 2013
  • November 11 & 25, 2013
  • December 2 & 16, 2013

Steering Committee Representative

Congratulations to Paul Szilagyi for his election to the MiPCT Steering Committee. Paul joins us from Henry Ford Medical Group, where he is Regional Vice President of Primary Care & Medical Centers, overseeing 27 primary care sites, 240 physicians and over 500 support staff.

 Registration for Town Hall Dinner Meetings is Open!

The Town Hall Dinners are an opportunity for physicians and care managers to meet with colleagues, have a wonderful dinner, and share stories and experiences of the MiPCT transformation journey, as well as to share best practices and find solutions for areas that have been challenging in implementing care management in the workflow at MiPCT practices.

The registration site can be found at:

https://jodyooo.wufoo.com/forms/registration-for-town-hall-dinner-meetings/

Attendees must register in advance. Dates and meeting locations are listed below for your convenience:

Day, Region, Venue

Tuesday, 1/15 Detroit (Dearborn) Dearborn Inn

Wednesday, 1/16 Ann Arbor: Weber’s

Tuesday, 2/05 Okemos: Dusty’s Cellar

Tuesday, 3/19 Muskegon: Mia & Grace

Thursday, 3/21 Grand Rapids: Mangiamo!

Tuesday, 4/23 Novi: TBD

Wednesday, 4/24 Troy: TBD

Thursday, 6/06 Okemos: Dusty’s Cellar

Monthly Open Forum PO Conference Calls Begin December 18

As an opportunity to enable an additional communication channel with POs, a series of monthly “Open Forum PO Calls” will be held from December 2012 through March 2013. An email to POs from the mipctdemo mailbox was sent to POs on December 14th regarding the Open Forum calls. The first call will focus on questions regarding the 2013 MDCH/PO/Practice agreements for 2013. There will also be an opportunity to discuss additional items. As a reminder the dial in information follows:

Topic: December MiPCT PO Open Forum Call on the MiPCT 2013 PO/Practice Agreement

Date: Tuesday, December 18

Time: 5-6 pm

Dial in: 877-366-0711

Access code: 6589 3559#

A full schedule of 2013 January through March dates will be published shortly.

Thank You!

Thank you to all of our stakeholders for a successful 2012. We wish you happy holidays and a great new year.

Next Issue: January 14, 2013.

December 10, 2012

Multipayer Member List On Track!

The multipayer MiPCT member list is on track to be available to POs early next week (the week of December 17th). The Michigan Data Collaborative (MDC) will distribute them, and as communicated at the PGIP quarterly meeting and in the FLASH last week, there will be a two month (December 2012 and January 2013) overlap period when BCBSM will continue to distribute their list to POs using their normal process (in addition to the MDC distributing the four-payer member list). This is intended to provide a transition period for POs. Please note that also that the Medicare Advantage population will be included on the multipayer member list, which is sortable by a number of fields, including “payer”.

 MDCH PO/Practice Agreement Distribution Has Begun

The MDCH has begun to distribute the 2013 MDCH/PO/Practice agreements for their review and response. As last year, each PO is responsible to obtain signatures from the practices that they represent. Please note that the agreement was reviewed and approved by the MiPCT Steering Committee. We look forward to another year of working in partnership with you!

Six-Month Incentive Score Review Period Ends Friday, December 5 at 5:00 PM

All POs have received six month incentive metric score results. The one-week review period ends on December 14 at 5pm to allow POs to apprise of any calculation errors (responses must be sent to mipctdemo@michigan.gov by 5pm on Friday, December 14)* The target date for POs to receive notification of the dollar amount of their incentive payment is December 19th. Following this, payment processing will begin for receipt in January.

Registration for Town Hall Dinner Meetings is Open!

The Town Hall Dinners are an opportunity for physicians and care managers to meet with colleagues, have a wonderful dinner, and share stories and experiences of the MiPCT transformation journey, as well as to share best practices and find solutions for areas that have been challenging in implementing care management in the workflow at MiPCT practices.

The goal is to initiate conversations, and to create communities of physician leader/care manager teams. Dinners will be held at restaurants throughout the state, and will be held midweek.

The registration site can be found at:

https://jodyooo.wufoo.com/forms/registration-for-town-hall-dinner-meetings/

Attendees must register in advance. Dates and meeting locations are listed below for your convenience:

Day of Week, Region, Venue

Tuesday, 1/15 Detroit (Dearborn) Dearborn Inn

Wednesday, 1/16 Ann Arbor Weber’s

Tuesday, 2.05 Lansing (Okemos) Dusty’s Cellar

Tuesday, 3/19 Muskegon TBD

Thursday, 3/21 Grand Rapids Mangiamo! Italian Restaurant

Tuesday, 4/23 Novi TBD

Wednesday, 4/24 Troy TBD

Thursday, 6/06 Lansing (Okemos) Dusty’s Cellar

Run-Off Election for Steering Committee Open PO Seat–VOTE NOW!

Thanks to all POs that voted in the election last week to fill the open PO seat on the MiPCT Steering Committee. The voting resulted in a tie between Mike Sparkia (CIPA) and Paul Szilagyi. POs are now invited (one vote per PO – earliest vote submitted during the run-off period will count in the event of more than one vote from a PO) to vote in a “run-off” election. The candidate profiles for Mike and Paul are attached for your review. The voting period is open and will end on December 14 at 5pm. POs may submit their vote at:

 https://jodyooo.wufoo.com/forms/runoff-vote-for-steering-committee-open-seat/.

Next Issue: December 17, 2012

December 3, 2012

Multipayer Member List Update
As you know, the Michigan Data Collaborative (MDC) will begin distributing MiPCT member lists for all four payers for December 2012 and January 2013. As a transition period, there will be a two month (December 2012 and January 2013) period when BCBSM will continue to distribute their list to POs using their normal process (in addition to the MDC distributing the four-payer member list). This is intended to provide a transition period for POs.
New BCBSM Slides Posted to Website
The slides from the PDCM/MiPCT Follow-Up Meeting held with Care Managers on November 15 at Lyon Meadows have been posted on the mipctdemo.org website (under the Resources tab in the Presentations dropdown menu).

Six Month Incentive Calculations
Metric score results have been calculated for each PO for the six month incentives. To ensure robustness of results, each resulting score was checked multiple times. Metric scores will be released by the MDC during the week of December 3rd to each PO for a one-week (five business days) review period. An FAQ document detailing each measure’s calculation will accompany the distribution of metric score results. Following this, POs will receive the dollar amounts that their score equates to, and payment is expected to be issued prior to the holidays.

Important Dates:
12/3 METRIC SCORES RELEASED BY MDC THIS WEEK
12/5 LEARNING COLLABORATIVE WAVE 2.1, GR.RAPIDS
01/8 LEARNING COLLABORATIVE WAVE 3.1, N.HUDSON
01/22 FIRST DAY OF CCM TRAINING COURSE, SESSION I
01/29 LEARNING COLLABORATIVE WAVE 1.2, LANSING
02/4 LEARNING COLLABORATIVE WAVE 2.2, GR.RAPIDS
02/12 FIRST DAY OF CCM TRAINING COURSE, SESSION II
02/27 LEARNING COLLABORATIVE WAVE 4.1, LANSING
03/1 BCN CARE COORDINATION PAYMENT DUE
03/6 LEARNING COLLABORATIVE WAVE 3.2, N.HUDSON
03/25 LEARNING COLLABORATIVE WAVE 1.3, LANSING
04/10 LEARNING COLLABORATIVE WAVE 4.2, LANSING
04/17 LEARNING COLLABORATIVE WAVE 2.3, GR.RAPIDS
05/7 LEARNING COLLABORATIVE WAVE 3.3, N.HUDSON
06/19 LEARNING COLLABORATIVE WAVE 4.3, LANSING
New Incentive Metric Set Approved by Steering Committee
The MiPCT Steering Committee approved the “year two” metric set at their November 19, 2012 meeting. The same metrics will be used for both incentive measurement periods in “year two” (the 18 and 24 month periods), and they are shared in the attached document.
Care Management Corner:  Stories of Success!
Curtis Johnson, RN, BSN, Complex Care Manager, Wexford Mercy PHO, Cadillac Family Physicians

Mr. H was scheduled to have his hemoglobin drawn on a Tuesday, but did not keep his appointment. He intended to save himself a trip and planned to have his lab test done on the way to his doctor’s appointment on Thursday. When Curtis discovered Mr. H had not been to the lab on Tuesday, he called to follow up. He learned that Mr. H had bright red blood in his stool, and a new onset of dizziness and weakness. Mr. H. did not recognize these were indications of a worsening condition and warranted a call to his doctor right away.
Curtis’ phone assessment with Mr. H identified symptoms of possible GI bleeding. Curtis contacted Mr. H’s daughter, with the patient’s permission, and requested he be taken to have his blood drawn the same day. The daughter arranged for a family member to take Mr. H to the hospital lab. Curtis received the lab results on Wednesday: Mr. H’s hemoglobin was 6.1. He called the physician with the results. Curtis then informed the family of the physician’s instructions to have the patient return to the hospital to receive blood and assess for active signs of bleeding. Mr. H was evaluated at the hospital and admitted for a three-day stay, where he received 6 units of blood and one unit of fresh frozen plasma while in the hospital.
The care coordination and intervention that Curtis provided greatly improved Mr. H’s quality of care. If Curtis had not intervened, the patient could have potentially suffered a fall at home due to his dizziness or additional health complications related to delayed treatment of an acute condition.
IF YOU WOULD LIKE TO SHARE A STORY OF CARE MANAGEMENT SUCCESS WITH US, PLEASE VISIT:

https://jodyooo.wufoo.com/forms/stories-of-your-care-management-success/. If you would like your photo included in the article, please email it to fishjody@umich.edu. Publishing your photo is optional.
PO Voting is Now Open for the Open Steering Committee Seat
Nominations have been received for the open PO seat with financial expertise on the Steering Committee mentioned in last month’s FLASH. The attached document summarizes the nominees. Each PO is eligible to cast one vote for the open seat (again, one vote per PO). In the event of a PO submitting multiple votes, the one submitted first will be counted. Please vote by 5pm on Wednesday, December 12 at:. https://jodyooo.wufoo.com/forms/vote-for-steering-committee-open-seat/
CCM Course Dates for Jan/Feb 2013 – Sessions I and II

• Session I – Lansing; Jan 22nd, 23rd, 24th
• Session 2 – Lansing; Feb 12th, 13th
The MiPCT Jan/Feb 2013 CCM course registration is available online: https://jodyooo.wufoo.com/forms/janfeb-mipct-ccm-training-in-lansing/
MiPCT is Hiring Four Clinical Positions
The MiPCT project team is expanding. We are adding 4 full time clinical positions, a Central Clinical Lead and 3 Regional Clinical Leads who will be hired by the project and will report to the Lead of the Clinical Management Resource Center (CMRC) and fully dedicated to supporting the implementation of care management within the MiPCT. The Central Clinical Lead will be located in Ann Arbor. The Regional Clinical Lead positions are located as follows: Ann Arbor/SE Michigan, Grand Rapids/Muskegon area, and the Saginaw area. To view the job posting: http://umjobs.org/search?career_interest=&work_location=&position=&regular_temporary=&keyword=mipct
The following is a brief description of the positions:
Regional Clinical Lead: This position has preceptor responsibility for new Care Managers in a defined geographic region and provides support to MiPCT Physician Organization Leaders in the assigned region. Preceptor responsibilities include individual Complex Care Manager (CCM), Hybrid Care Manager (HCM), and Moderate Care Manager (MCM) coaching/ mentoring and facilitation of care manager group discussions, networking and sharing best practices. Collaborates with the Master Trainers to identify care manager‘s training needs and to develop ongoing care manager curriculum, tools and resources. In collaboration with Master Trainers contributes to the development of ongoing curriculum for MiPCT care managers and provides training at a regional and occasionally statewide level. Completes MiPCT Complex Care Manager Fundamentals course which consists of a Complex Care Management didactic course in Michigan and 2 consecutive weeks of training out of state.
Central Clinical Lead: The Central Clinical Lead will provide day to day support for the development of care management capabilities in the in the Michigan Primary Care Transformation Project (MiPCT) primary care practices. With the Michigan Care Management Resource Center (MiCMRC) Senior Project Manager, MiPCT Medical Director and MiPCT Clinical Leadership team and Master Trainers, assists Physician Organizations with embedding care management in the MiPCT primary care practices. Provides education, mentoring, and coaching of Regional Clinical Leads, Clinical Leads and care managers, as assigned. Completes MiPCT Complex Care Manager Fundamentals course which consists of a Complex Care Management didactic course in Michigan and 2 consecutive weeks of training out of state.
A few of the Required Qualifications for the open positions include:
• Bachelor’s degree in Nursing, or higher
• Three to five years of experience with adult medicine population in primary care/ambulatory care, within the past five years.
Note: A desired qualification includes pediatric experience for one of the Regional Clinical Lead positions.
For questions, please contact Marie Beisel, mbeisel@umich.edu.
Next Issue: December 10, 2012.

November 19, 2012

Provider/Staff Survey Results

Recently, MiPCT practices took part in a brief confidential survey on their current work experience and satisfaction. The measured domains included demographics, job satisfaction, stress, burnout, likelihood of leaving, chaos, communication openness, adaptive reserve, culture of learning, and MiPCT knowledge. These scoring domains may be associated with practice transformation success.

Below are some highlights from the survey results:

  • Over 80% of all categories of staff & providers were satisfied with their current job
  • Respondents reported feeling stress

– Across 4 questions assessing stress, the average response was “neither agree nor disagree”

– About a third described their work environment as ‘chaotic’

– About 20% reported actual burnout

  • Most respondents reported open communication in their practice; although providers reported higher levels of openness than other staff
  • The majority of respondents also reported facilitative leadership, good teamwork and good overall work environment. Providers rated these 3 dimensions more favorably when compared to other staff.

You can see how your PO compares to the average by accessing the MiPCT evaluation provider/staff experience report on your PO’s MDC portal, available soon.

MiPCT is Hiring Four Clinical Positions

The MiPCT project team is expanding. We are adding 4 full-time clinical positions: a Central Clinical Lead and 3 Regional Clinical Leads, who will be hired by the project and will report to the Lead of the Clinical Management Resource Center (CMRC). They will be fully dedicated to supporting the implementation of care management within MiPCT.

The Central Clinical Lead will be located in Ann Arbor. The Regional Clinical Lead positions are located as follows:

  • the Ann Arbor/SE Michigan area,
  • the Grand Rapids/Muskegon area, and
  • the Saginaw area.

To view the job posting: Go to University of Michigan Jobs at:

http://umjobs.org/search?career_interest=&work_location=&position=&regular_temporary=&keyword=mipct

The following is a brief description of the positions:

Regional Clinical Lead: This position has preceptor responsibility for new Care Managers in a defined geographic region, and provides support to MiPCT Physician Organization Leaders in the assigned region.

Preceptor responsibilities include individual Complex Care Manager (CCM), Hybrid Care Manager (HCM), and Moderate Care Manager (MCM) coaching/mentoring, and facilitation of care manager group discussions, networking and sharing best practices.

Collaborates with the Master Trainers to identify Care Managers’ training needs, and to develop ongoing Care Manager curriculum, tools and resources.

In collaboration with Master Trainers, contributes to the development of ongoing curriculum for MiPCT Care Managers, and provides training at a regional, and occasionally statewide, level.

Completes MiPCT Complex Care Manager Fundamentals course, which consists of a Complex Care Management didactic course in Michigan, and 2 consecutive weeks of training out of state.

Central Clinical Lead: The Central Clinical Lead will provide day-to-day support for the development of care management capabilities in the Michigan Primary Care Transformation Project (MiPCT) primary care practices.

With the Michigan Care Management Resource Center (MiCMRC) Senior Project Manager, MiPCT Medical Director, and MiPCT Clinical Leadership team and Master Trainers, assists Physician Organizations with embedding care management in the MiPCT primary care practices.

Provides education, mentoring, and coaching of Regional Clinical Leads, Clinical Leads and Care Managers, as assigned.

Completes MiPCT Complex Care Manager Fundamentals course, which consists of a Complex Care Management didactic course in Michigan and 2 consecutive weeks of training out of state.

A few of the Required Qualifications for the open positions include:

  • Bachelor’s degree in Nursing, or higher
  • Three to five years of experience with adult medicine population in primary care/ambulatory care, within the past five years.

Note: A desired qualification includes pediatric experience for one of the Regional Clinical Lead positions.

For questions, please contact Marie Beisel, mbeisel@umich.edu.

Care Management Corner: Stories of Success!
Paula Allerding, HCM, Hastings Internal Medicine

Paula Allerding had the opportunity to work with Mr. W. and his wife over a period of 3 months.  Mr. W. has a diagnosis of diabetes.  During a comprehensive assessment of his medical, functional ability and medications, Mr. W described the challenges he faces related to his diabetes.

Mr. W stated that he finally accepted the fact that he could not ignore his diabetes anymore. He had watched his father experience the complications of diabetes, and he was ready to change; he was ready to be engaged in learning about lifestyle changes. Mr. W. stated he wanted help in making dietary changes and in losing 10 pounds in 3 months.

Over the course of 3 months, Paula worked with Mr W. and together they set realistic goals, based on the topics Mr. W. selected.  Paula took time to understand the goals Mr W. identified and also shared resources.  Using a carbohydrate guide, they came up with a diet plan that would help Mr. W keep a stable blood sugar level.  Mr. and Mrs. W also attended Hastings Internal Medicine’s Care Management Group Visit, which provided a supportive environment for them to talk with others who have diabetes and who may have similar experiences.

By the end of the 3 months, Mr. W. lost 17 pounds, and in the process, learned how to take control of his own diabetes!  Mr. W’s A1C decreased from 7.8 to 6.4.  At their last visit before leaving for a warmer climate, Mr. and Mrs. W were talking about adding walking to their day as another benefit to their healthy lifestyle.

If you would like to share a story of care management success with us, please visit: https://jodyooo.wufoo.com/forms/stories-of-your-care-management-success/.  If you would like your photo included in the article, please email it to fishjody@umich.edu.  Publishing your photo is optional.

Giving Thanks

In the spirit of the Thanksgiving holiday, we give thanks for the efforts and energy of all our partners during our first year of the project. It is an honor to work with such an engaged and committed group of partners. The opportunity to work together to improve patient outcomes is important work and a chance for our state to shine. To our practice team partners, Care Managers, POs, vendor partners, participating health plans and stakeholders, THANK YOU and have a wonderful Thanksgiving!

There will not be an issue of the FLASH published on November 26, 2013, due to the Thanksgiving Holiday.

Next Issue: December 3, 2012.

November 12, 2012

PAYER UPDATES

November Medicare Care Coordination Payments:

Medicare was late in processing their October 2012 claims to the University of Michigan. As a result, Care Coordination payments will not be made in November 2012. The next payment will be made in December 2012.

BCBSM’s New Inquiry Process to Verify Eligibility for PDCM/MiPCT:

As you know, providers can currently check whether a patient has active BCBSM coverage using the Web-DENIS or CAREN IVR system.

We are also working on implementing functionality in Web-DENIS that will allow providers to check whether a patient is eligible for PDCM/MiPCT, and we expect that process to be finalized in the next few months.

Six Month Medicare Incentive Payment Update

The data to allow calculation of the six month incentives has been secured. We are in process of rechecking each element to ensure accuracy.

When information submitted by POs is incomplete on a data element or is in conflict with training completion records, etc., follow up is occurring with POs. Subsequent to this, POs will receive their metric scores and results for a one-week review period.

After this review period, incentive payment amounts for Medicare will be released and payment will be issued from the funds provided to UMHS by CMS for the Medicare incentives. We anticipate that these incentive payments will be made in mid-December 2012.

This extensive review was performed as this marks the programs’ first incentive payment distribution. Please remember that for future reports, POs will be held responsible for the information that they submit on the quarterly reports.

For this reason, it is important that each PO review the narrative and financial reports prior to submission to ensure that their responses are accurate and complete.

Care Management Corner:  Stories of Success!

Laura Tom, Complex Care Manager

United Physicians, Inc. – Family Practice Offices, Dr. William Bowman

Laura Tom’s 71-year old patient, Mrs. S, has a new motto, “You’ve got me hooked on reading nutritional labels!” Mrs. S has a history of COPD, sleep apnea, obesity, HTN, hyperlipidemia, arthritis, and was newly diagnosed with type 2 diabetes. Mrs. S uses a cane to steady her ambulation. She was referred to care management for patient education, to help her lose weight, and to get her blood sugar under control.

Mrs. S was motivated to make changes and wanted help, and so she was referred for care management. She willingly meets with Laura monthly in the doctor’s office and asks questions. She likes receiving educational materials, which have helped her to achieve her self-management goals.

The patient has had an improvement in her labs since the start of care management. During Laura’s last visit with her, Mrs. S stated the doctor called her and said that her labs were good. However, the patient didn’t know the meaning of “good”. Laura was able to use the registry to show the patient her lab values, trends, and explain the meaning behind the lab values and target ranges. In four months, Mrs. S’ A1c has gone from 7.6 down to 6.8, her LDL has decreased from 84.8 to 78.3, her cholesterol has decreased from 167 to 156, and her triglycerides have decreased from 240 to 225.

Mrs. S enjoys eating out at restaurants. Laura was able to provide the nutritional information for her favorite restaurants, and she reviewed them with her patient. Mrs. S discovered that some of her favorite foods were okay to eat, and others were not good choices. Mrs. S was able to find other options on restaurant menus that would be better choices and not elevate her blood sugar.

Mrs. S went on a trip to Saskatchewan and required ventral hernia repair surgery during the past 4 months. She had no complications from her surgery, and she was able to maintain her healthy eating habits on her trip.

Mrs. S is getting ready to go on a trip to Ireland after her husband has a lengthy medical procedure in the hospital. Through education and individualized goal-setting, she is prepared for meal options, has been taught the signs/symptoms of hypo- and hyperglycemia, and is aware of interventions to help her maintain her healthy diet and blood sugar during stressful times, and times away from home.

Laura also referred Mrs. S to a registered dietician for certified diabetic education, and she found the visit very helpful. Together, Laura and the RD will be able to reinforce a healthy diet for their patient. While reviewing her labs, Mrs. S recently told Laura, “It’s amazing the effect my diet has had. Thank you for explaining my labs. These numbers make me want to keep going.”

If you would like to share a story of care management success with us, please visit:https://jodyooo.wufoo.com/forms/stories-of-your-care-management-success/

If you would like your photo included in the article, please email it to fishjody@umich.edu. Publishing your photo is optional.

MDC Dashboards Enhancements

PO Users who log in to view their MiPCT Dashboards on Friday, November 16, will notice a few enhancements based on suggestions from users.

These include:

  • Improving column and row label headings to be more clear and descriptive
  • Adding print/export options to tables on Quality Measures
  • Expanding the limit on the Excel export function.

A communication will be sent to the PO Users to notify them of the enhancements available November 16th, and a list of the enhancements will be posted (on the http://www.MichiganDataCollaborative.org website in the Support tab).

If you have other suggestions for improving the user-friendliness of the dashboards, please send your feedback and suggestions to MichiganDataCollaborative@umich.edu. Suggestions are assessed, prioritized and then incorporated in future enhancements. It is important that POs access the dashboards, and review and share them with practice teams. If you have trouble with your user account or logging in to the dashboards, contact us via the secure user account mailbox: MDC-Accounts@med.umich.edu.

Provider File Updates

Today, Monday, November 12, 2012, is the LAST DAY to receive Provider File updates for inclusion in the January to March Medicare Assignments.

Next Issue: November 19, 2012.

November 5, 2012

BCBSM Nurse Care Management Software Update

As mentioned at the September Quarterly Meeting and the March MiPCT webinar, MiPCT Care Managers should utilize care management software or other automated tools in their work with patients. These tools aid care managers in performing essential job functions, including:

• Generating and maintaining a list of active patients, including those who are scheduled for follow-up visits, and who have had previous appointments

• Documenting information from care management visits, including assessment, diagnoses, self-management goal-setting, and transitions of care information

• Creating and maintaining patient care plans

Care managers may also utilize the tools to perform advanced job functions, such as generating care manager activity reports and aligning the health information tools with existing care management workflows at your organization.

Examples of care management tools are electronic medical records, patient registries, and care management software.

Care Management Activity Reporting – Clarification

For the second care manager activity metric, we will not be requiring care managers to document electronic encounters. The second care manager metric should read “Number of Care Manager telephone encounters (by Care Manager, by practice, by primary payer).”

4 Q 2012 Care Management Activity Reporting Request

As noted in last week’s FLASH, Care Management activity reporting will be required on quarterly reports for 2013 and 2014. We will also include Care Management activity reporting as a highly desirable, requested element on the quarterly narrative report for 4 Q 2012. Not only would this information for 4 Q provide helpful data at a project level, it is also an opportunity for POs and practices to ensure that systems (electronic or manual) are in place for the reporting that will be required in 2013 and 2014.

Again these elements are:

* Number of Care Manager face-to-face encounters (by Care Manager, by practice, by primary payer)
* Number of Care Manager telephone encounters (by Care Manager, by practice, by primary payer)
* Number of unique patients (by Care Manager, by practice, by primary payer)

Care Management Corner: Stories of Success!
Debbie Mays, Family Tree Medical Associates

Debbie Mays is a care manager at Family Tree Medical Associates. She recently shared an example of collaboration with a Medicaid Health Plan to effectively co-manage a complex adult patient.

Ms. X is a 45 year old female, with history of diabetes, obesity, asthma, depression, bi-polar disorder, and gastroparesis. The patient’s Medicaid Health Plan, Meridian, routinely sends their physician offices the contact information for case managers assigned to a particular patient. Family Tree places this information on the demographic page in the patient’s medical record.

When Ms. X was having problems with the medication Reglan, she was frustrated and told Debbie she wanted to stop taking it. Because Meridian proactively contacted the practice, Debbie was able to easily identify the contact for the health plan case manager and worked with her to obtain non-formulary medication for Ms. X to treat her gastroparesis.

When the patient realized she had an advocate at her doctor’s office as well as at the health plan, and both care managers were working to find solutions on her behalf, she felt empowered. The Meridian Care Manager arranged for Ms. X to see a care team in Community Mental Health. Debbie attended the Community Care Team meeting along with Ms. X. During this meeting, Debbie used motivational interviewing strategies to elicit a goal of eating a cheese stick in place of ice cream. Setting this goal was the beginning of the journey of empowerment for Ms. X.

Over time, through her interactions with her care manager, Ms. X has transitioned from a complex patient to a moderate care level, and has sustained that level. “I really believe you need care managers at every level of the care system. It’s a necessity, not a duplicative service. This model really works and we see it every day in our interaction with our patients.”

If you would like to share a story of care management success with us, please visit: https://jodyooo.wufoo.com/forms/stories-of-your-care-management-success/. If you would like your photo included in the article, please email it to fishjody@umich.edu. Publishing your photo is optional.

Next Issue: November 12, 2012.

October 29, 2012

CMS Care Coordination Payment Distribution

The sixth round of CMS care coordination funding will be distributed this week.

Steering Committee Nominations

MiPCT is soliciting nominations for one slot for a PO representative with financial expertise on the Steering Committee. The purpose of the Steering Committee is to provide strategic direction to MiPCT Leadership and monitor progress toward the goals and objectives of MiPCT.

Please submit nominations to https://jodyooo.wufoo.com/forms/steering-committee-nomination-form/ by November 30, 2012.

Care Management Activity Reporting

The care management activity reporting requirements have been finalized and will be incorporated into the Quarterly Report beginning in the first quarter of 2013.

• Number of Care Manager face-to-face encounters (by Care Manager, by practice, by primary payer)

• Number of Care Manager telephone or electronic encounters (by Care Manager, by practice, by primary payer)

• Number of unique patients (by Care Manager, by practice, by primary payer)

If you have questions about these metrics, please contact Amanda First at afirst@umich.edu.

Provider File Updates to be Sent this Week

Tyrrell Jarrett will be sending you the most recent data we have for your PO’s participating practices and physicians, respectively. Please update these files if necessary. In addition, please add to the file any NPs/PAs that serve as PCPs and bill separately. The same billing information needed for physicians is needed for NPs/PAs. As a reminder, to receive Medicaid payments, the NP/PA must be the PCP of record for Medicaid managed care members and must be enrolled in CHAMPS.

Please look for an email from Tyrrell this week and return the forms by November 9, 2012 for inclusion in the January attribution. Tyrrell can be contacted at: tyrrellj@umich.edu.

MiPCT Dashboards Are Now Available

The first MDC Dashboard release is now available for your PO and the practices within it! This release was constructed using 2010-2011 Medicare and Medicaid claims data and September attribution lists. Here are some helpful hints to keep in mind:

• A webinar was held on Thursday, October 25 to overview the dashboards and their use. If you were unable to attend, the webinar recording and materials are posted on the mipctdemo.org website (just go to the “Resources” tab, and then the “Presentations” dropdown, and you will see the link near the top of the page).

• This release provides baseline data for your PO/practices for Medicare and Medicaid (as it reflects data January 2010 through December 2011). More recent data will be integrated over time (and other payers as detailed below) to aid in identifying opportunities for improvement (and best practice).

• Each PO has assigned users who have received an ID and password. The user for your PO can login via the Michigan Data Collaborative home page (www.MichiganDataCollaborative.org).

• User support and reference documents are posted to the “Support” page on the Michigan Data Collaborative website.

• The next release of dashboards is scheduled for January 2013 and will include BCBSM data. Future dashboards will be released every two months to provide data on your performance over time.

Any questions about the dashboards can be sent to MichiganDataCollaborative@umich.edu, and any questions about user accounts and passwords can be sent to MDC-Accounts@med.umich.edu.

Moderate Care Manager Programs

There are two upcoming programs aimed at moderate care managers.

Title: Moderate Care Manager Program

Location: 26550 John R Madison Heights Mi 48071

Contact: Mike Mellor, mmellor@transformcoach.org

Modality/schedule: Live, in-person

Course dates: November 6, 7, 14, 15. 8:30am-4:30pm (Must attend all 4 classes)

Title: Empowerment Training

Location: 2600 Green Rd Suite 150 A, Ann Arbor, MI 48105, in the shared conference room (directions attached if needed)

Contact: Cecilia Sauter, csauter@umich.edu Modality/ schedule: 2 sessions four hours each Course dates: Oct. 30 and Nov. 6

Care Management Corner: Stories of Success!

Pam Szymanski, University of Michigan Health System

Recently on a Monday morning, Lisha Bennett, a Care Manager at Meridian Medicaid Managed care plan called a MiPCT primary care practice. Lisha reviewed a patient’s claims from the Meridian Medicaid Managed Care Plan and identified Ms. M as a patient with multiple ER visits over the past several months. Lisha decided to call Ms. M’s primary care practice to coordinate care and discuss possible interventions. The MiPCT practice routed the call from Lisha to Pam Szymanski, MiPCT Care Manager.

Lisha informed Pam about Ms. M, who has been experiencing poorly controlled pain. Due to her uncontrolled pain, Ms. M has had multiple emergency room visits. The ER visits occurred in facilities external to the MiPCT primary care practice’s health system. Pam noticed the pain medication that the physician was considering to prescribe is not covered by the health plan based on Ms. M’s diagnosis. Pam discussed Ms. M’s history and medication barrier with the PCP at their practice. Subsequently, Ms. M. was referred to a pain clinic.

Patient was seen in a pain clinic, and since this appointment she has not returned to the ER. Pam is advocating for Ms. M. by coordinating care and addressing barriers. Pam is planning an in-person visit with Mrs. M to continue to assess this patient’s needs. Pam stated, “working with the health plan care manager makes my job easier since there are two of us advocating for the patient”.

If you would like to share a story of care management success with us, please visit: https://jodyooo.wufoo.com/forms/stories-of-your-care-management-success/

Next Issue: November 5, 2012.

October 22, 2012

Important Info About BCBSM’s Monthly Patient Lists

Please note that the BCBSM MiPCT patient lists include all members attributed to your PO who could potentially be eligible to receive MiPCT care management services, because our attribution methodology is based on historical utilization patterns, and may not reflect recent relationship changes.

Previously, we had communicated that all of your patients on the monthly patient lists were eligible to receive MiPCT-related services, but did not clarify that the list includes all members attributed to your PO who may be eligible, including members attributed to practice units that are not in MiPCT. The presence of a “1” in the mipct_member column indicates that according to our attribution methodology, the patient is attributed to a MiPCT-participating practice and is eligible for care management. Starting in November, your monthly patient list will be sorted according to whether or not the MiPCT flag is present; this means that MiPCT practice units will be at the top of the list (currently, the list is sorted by practice unit, so this change means that the primary sort will be eligibility for MiPCT and the secondary sort will be practice unit).

Patients who are not flagged with a “1” in the mipct_member column may still be eligible for care management services if they, in fact, are a patient of a MiPCT-participating physician.   When delivering care management services, please confirm that the member is a patient at one of the MiPCT-participating practices, and eligible for care management.

REMINDER:  October 25 Webinar on Financial Reporting and the MDC Dashboards

On October 25 from 3:00 – 4:30 p.m., a webinar will be held to:  1) provide an overview of the 3Q financial reporting templates; and 2) offer a demonstration of the MDC dashboards that will be released on October 26th.   The link can be found at:

Event:  MiPCT Financial Reporting/Dashboard Review Webinar
Date:     Thursday October 25, 2012
Time: 3:00pm Eastern Daylight Time
Event Number: 660 674 602
Event Password: mipct
——————————————————
To join the online event
——————————————————-
1. Go to https://mphievents.webex.com/mphievents/onstage/g.php?t=a&d=660674602
2. Click “Join Now”.
3. Follow the instructions that appear on your screen.
——————————————————-
To join the teleconference only
——————————————————-
Call-in toll number (US/Canada): 1-650-479-3207
Access code: 660 674 602

CCM Course Dates for Jan/Feb 2013 – Sessions I and II

•    Session I –   Lansing;  Jan 22nd, 23rd, 24th
•    Session 2 –  Lansing;  Feb 12th, 13th

The MiPCT Jan/Feb 2013 CCM course registration is available online:  https://jodyooo.wufoo.com/forms/janfeb-mipct-ccm-training-in-lansing/

Clinical Data Reminder

This is a reminder regarding the submission of MiPCT clinical data from your registries.

Thank you to all of those that have contacted David Shore at the Michigan Data Collaborative about submitting clinical data. If you have not contacted David Shore (dshore@med.umich.edu) already with the name of someone he can work with from your organization, please do so as soon as possible.

Co-Management with a Medicaid Health Plan

Do you have cases where an adult or pediatric patient received care management services from both an MiPCT Care Manager and a care manager from a Medicaid Health Plan during the same time period? If so, we would like to hear about the case, the patient’s reactions, and your thoughts and suggestions for process improvement.  Please email that information to Ashleigh Lipsey at lipseya@michigan.gov.

Care Management Corner: Stories of Success!
Dawn Klarich, United Physicians

Dawn’s patient, Mr. M was well known for “non-compliance” and uncontrolled type 2 diabetes.  He was not following any type of diet.  His A1c continued to increase at each visit, and he was not checking his glucose levels at all during the day. Mr. M was tired, and stated he just wasn’t feeling well.  He had no real support at home, but Dawn knew with ongoing support and education, he could turn his situation around and avoid future complications.

Dawn took the time needed to provide Mr. M with basic diabetic education, and continued to follow up with him, which has resulted in Mr. M gaining an understanding about how his diet impacts his blood sugar.  He made decisions about the changes he is willing to make.  Mr. M is now checking his glucose levels each morning, he verbalizes an understanding of basic carb counting, and takes his medications regularly.  He actually dropped a few pounds, and has often stated, “This is exactly what I needed to get and stay on track.”

Dawn works closely with Mr. M’s PCP.  Her visits with Mr. M. focus on providing support to assist with barriers and guidance to continue his regime.  Mr. M told Dawn, “I appreciate the phone calls and materials you send me to keep me motivated!”

If you would like to share a story of care management success with us, please visit: https://jodyooo.wufoo.com/forms/stories-of-your-care-management-success/

Next Issue:  October 29, 2012.

October 15, 2012

Medicaid Payment Update

Due to system issues, some of the third quarter Medicaid MIPCT practice transformation payments did not transmit on Thursday, October 4th as expected.  Those payments were transmitted on October 9th, and were shown on the 10/11/12 remittance advices.  We apologize for any inconvenience.

BCN Payment Update

As communicated earlier, for January 1 to March 31, 2012, BCN will pay a lump sum equal to three times the average monthly care coordination payment. This amount was to be based on the average BCN G code billing for July and August. BCN has graciously agreed to revise the approach as follows:

>    Average monthly care coordination payments will be calculated using an average of claims validated and billed for October and November (instead of July and August) 2012 dates of service

>    Payments will be made no later than March 1, 2013

2013 Town Hall Dinner Meetings for Physician/Care Manager Teams

As a part of the strategy to engage physician/care manager care teams, we will be hosting local town hall dinner meetings across the state in early 2013.   The key aspects are outlined below:

>    TIMING: These dinner meetings will be conducted between January and May 2013.

>    LOCATIONS: The dinners will be held regionally so that travel time for participants is minimized.

>    GOAL: Our goal is to provide a forum in the local communities where our providers/care managers can share the stories of their transformation journey including what they are most proud of and what has been most challenging for them in developing a successful team based care management program in their practice.

In preparation, we will be sending out a survey to all care managers in the aim of gauging the current status of provider engagement in team based care management.   More details about the dinners will be provided late in the quarter.

Webinar Link Now Available  RE: Physician Engagement Discussion with Dr. Fred Bloom

On October 10, 2012, we had the opportunity for Dr. Fred Bloom, the Assistant Chief Quality Officer, Geisinger Health System, to be with us in Michigan for the day to focus on physician engagement in the MiPCT.   We invite you to log on to http://www.mipctdemo.org, go to the “Resources” tab and select “Presentations”, where you will find a recording of this very informative webinar.

Note, this recording was started 90 seconds before the actual presentation began.  To avoid this null portion of the webinar, please scroll to the minute and thirty second mark of the recording.  We’re sorry for any inconvenience this may cause you.

Co-Management with BlueHealthConnection Care Managers?

We are currently seeking information about cases where the patient received care management services from both a MiPCT Care Manager and a Blue Cross (BlueHealthConnection) Care Manager during the same time period. If you are aware of cases where a patient was co-managed, we would like to hear about the case, the patient’s reactions, and your thoughts and suggestions for process improvement.  Please email that information to kvogelei2@bcbsm.com

Narrative Quarterly Reports

As a reminder, the 3rd quarter narrative report will be due on November 15th.  Please do not use the 2nd quarter template. The 3rd quarter template will have the same initial questions; however, the practice level detail on registry functionality is not needed at this time and will be removed from the template. Each PO should receive the 3rd quarter reporting template by October 15th.

Care Management Corner: Stories of Success!

Libby Tuck, RN, BSN Complex Care Manager, Wexford Mercy PHO

Libby Tuck, RN, BSN, is a Complex Care Manager at Wexford Mercy PHO.

She recently had a diabetic patient with a Hemoglobin A1C of 15. The patient had not been checking her blood sugar consistently and was not taking insulin as ordered.

Ms. Tuck assessed the patient’s needs and identified that the patient did not have a working glucometer. She arranged for the patient to get a new glucometer and provided education regarding insulin use and blood sugar monitoring for better control. In addition, she called the patient weekly to monitor progress, provide teaching, and offer support.

As a result, the patient began checking her blood sugar consistently and administering her insulin as instructed. Three months after care management services began, the patient’s hemoglobin A1C was down to 7.2.

If you would like to share a story of care management success with us, please visit: https://jodyooo.wufoo.com/forms/stories-of-your-care-management-success/

Next Issue, October 22, 2012

October 8, 2012

2012 MiPCT Learning Opportunity Requirement Update

We have received questions about how to interpret the MiPCT requirement that, “All Care Team members attend at least one MiPCT-approved learning opportunity,” listed in the PO 4th Quarter Expectations document and the MDCH contract.  For 2012, this requirement can be met by any of the following:

>    PO and/or practice attendance at an MiPCT launch meeting held in March 2012
>    Participation in a 2012 Learning Collaborative team
>    Participation and completion by at least one care manager of Complex Care Management training in 2012
>    Attendance, at least two MiPCT webinars in 2012
>    Attendance, at least two PGIP MiPCT segments at quarterly meetings in 2012

Though it is not necessary to submit documentation of the above, a PO must be able to provide documentation upon request.

MiPCT Complex Care Management Course

The MiPCT team recommends registering CCMs and HCMs for the Oct./Nov. Complex Care Management course if the individual has not previously completed the course.   Starting  October 2012, the Complex Care Management Course will be provided in two sessions:

>    Session I –  three consecutive days
>    Session II –  2 consecutive days and will be offered the following month
>    Completion of session one and two are required

A benefit to this CCM course schedule is CCMs and HCMs will not be off site, away from their practice location for the 5 consecutive days.

A.    CCM Course Dates for Oct./Nov. 2012 –  Sessions I and II
>    Session I –  Lansing;   Oct. 24th, 25th, 26th 2012
>    Session 2 –  Lansing;   Nov. 8th, 9th  2012

The MiPCT Oct./Nov.  2012 CCM course registration is available online at: Register for OCT/NOV CCM Training HERE

Next future date for the CCM course is set for Jan./Feb. 2013.

B.    CCM Course Dates for Jan./Feb. 2013 –  Sessions I and II
>       Session I –  Lansing; Jan. 22nd, 23rd, 24th
>       Session 2 –  Lansing;  Feb. 12th, 13th

The MiPCT  Jan./Feb. 2013 CCM course registration is available online at: Register for JAN/FEB 2013 CCM Training HERE

Eventually, we plan to offer the CCM course via a combination of live and recorded webinars.  This will occur when the number of CCMs and HCMs to train becomes very small.  For questions, please submit to mipctdemo@michigan.gov

Care Management Corner:
Stories of Success!

Debbie Schmidtke, RN, BSN
Care Navigator,
Canton Health Center, UMHS

Debbie Schmidtke is a Care Manager at the University of Michigan Healthcare System in Canton, MI. Debbie’s patient, Mrs. G., was discharged from the hospital with a new diagnosis of dyspnea on exertion with new onset of atrial fibrillation.
Mrs. G. was seen by her primary care physician (PCP) day 6 after hospital discharge.  The PCP noted no change in her dyspnea, and began a diuretic protocol with the patient: “Lasix 20mg to use only if she develops pedal edema or worsening shortness of breath, and to call the clinic.”
At Mrs. G.’s follow-up PCP visit 6 days post hospital discharge, the patient’s weight was 195 lbs., and she experienced increased shortness of breath ambulating from her bedroom.  This was the patient’s “baseline”.
Debbie followed up with Mrs. G via a phone visit one week following the PCP visit.  During this phone visit Debbie assessed Mrs. G.  Assessment findings included: patient reported increased ankle swelling, no increased shortness of breath, but low energy overall.  Mrs. G’s oxygen saturation was 97%.while using 3 L oxygen nasal cannula, and she reported a weight gain of 3 pounds.  Debbie instructed that Mrs. G. should start the Lasix protocol.
Debbie reviewed the Lasix protocol with Mrs. G to confirm Mrs. G understood the dose and frequency to take the medication. Debbie discussed the above with Mrs. G’s PCP.  Per PCP advice, Debbie instructed Mrs. G  if there was no change in her ankle swelling and difficulty breathing by the next day, to increase her Lasix 20mg: 2 tablets in the morning and 2 tabs in the evening.
Debbie called Mrs. G. the next day, and learned she gained 2 pounds, had no change in her ankle swelling, and no change in her shortness of breath. Mrs. G increased the Lasix 20 mg 2 tablets in the morning and 2 tablets in the evening, per the new order.
Debbie followed up with Mrs. G the following day. Her weight had decreased  8 pounds. Her oxygen saturation increased to 98% on 3-4 liters nasal cannula oxygen. Her ankle swelling was alleviated, and she was able to sleep through the night 8 hours without elevating her feet. Mrs. G. was ambulating with no increased shortness of breath.  Such an improvement from the day before!   Debbie advised Mrs. G. to stop taking the Lasix and keep her appointment the following morning with her PCP.
The PCP and Debbie worked together to provide care for Mrs. G.  The PCP initiated the diuretic protocol and developed the treatment plan.  Debbie closely monitored Mrs. G’s symptoms of shortness of breath, weight gain, and edema, and communicated findings with the PCP.    This PCP and care manager team successfully assessed and intervened with changes in treatment plan which resulted in Mrs. G. feeling better and avoidance of an emergency room visit.   Kudos to Debbie Schmidtke and the PCP!

If you would like to share a story of care management success with us, please visit: HERE!

Webinar 10.29.12 11am-12 noon:   “An Overview of the MiPCT Complex Care Management
One Week Course”   

MiPCT team will provide an overview of the MiPCT Complex Care Management one week course. The webinar will focus on the daily work of the Complex Care Manager, and is based on the content of the MiPCT Complex Care Management one week course.   PO leaders and the individuals the Complex Care Managers and Hybrid Care Managers report to are invited.
A Message From The MDC Account Team:

To all MiPCT Participants – The MDC Account Team has completed the processing of User Account Requests received. Information regarding your ID and password will arrive as soon as the dashboards and reports become available. If you should have any questions regarding your request, please feel free to email the MDC team at: MichiganDataCollaborative@umich.edu.

Next Issue, October 15, 2012

October 1, 2012

New Process for Questions or Problems with BCBSM/BCN G- and CPT-Code Billing

To enable quicker answers to your questions about BCBSM/BCN G and CPT code denials or documentation requirements, please use the PO Collaborative site to log your question or issue.   This replaces the old process of sending BCBSM billing issues to the mipctdemo@michigan.gov email address.   (Though this address can, of course, still be used for your questions on other topics).

A continuously updated frequently asked question (FAQ) document is also in development to help provide an easy reference.   This should be available soon and we will provide the direct link in an upcoming FLASH.

To use the new process for questions on BCBSM/BCN billing issues, simply:
•    Go to your PO Collaborative site.
•    Select “Log PGIP Issue” from the Links section on the right side of the screen.
•    Enter your question or denial with as much case-specific information as possible as shown in the screenshots below.

ScreenShot 1 for FLASH BCBSM-BCN Article 10 01 2012

screenshot 2 for FLASH BCBSM BCN article 10 1 2012

12-Month Incentive Metrics

The 12 month incentive metric specifications are attached, along with a list of Frequently Asked Questions. The 12 month metrics are primarily intended to reward the implementation of key infrastructure like enhanced access, registry functionality and hiring, and training care managers.  In addition, the 12 month set rewards POs whose practices have processes in place to receive notification of hospital admissions/discharges and adds a utilization metric, Primary Care Sensitive ED visits. If you have further questions, please contact Amanda First at afirst@umich.edu.

MiPCT Learning Collaboratives = Equation for Success

Like Coke and Mentos – the MiPCT Learning Collaborative allows us to create something bigger and better than its component parts.  We have the opportunity to transform the chaos of our daily care delivery.  As expressed by Dr. Phil Ptacin, a primary care physician completing his learning collaborative experience, “We have gone from struggling with our patients to dancing.” The Learning Collaborative experience creates wins for all involved physicians, transforming care while providing CME, available free of charge.

Upcoming Webinar: Financial Reporting is Moving to the Web

HOLD THE DATE:  Thursday, October 25, 2012
TIME:     3:00-4:30 PM
WHAT:  A webinar introduction to the new financial website (details to follow)
WHO SHOULD ATTEND:  The person submitting the quarterly report for each PO.
QUARTER 3 DUE DATE:  Extended to November 15, 2012

Benefits to web-based financial reporting:

  • Completing your report online through our secure website will eliminate the problems encountered with different software versions.

– One person from each PO will be able to submit the report.

– Login details to be provided later.

  •  Revenue and member month information will be pre-populated.
  • Information submitted in quarters 1 and 2 will be added to the database to provide a complete picture of year 1.

MiPCT Complex Care Management Course: October/November, 2012

The MiPCT team recommends CCMs and HCMs who need this training to register for the Oct/Nov CCM course.   Starting October 2012, the Complex Care Management Course will be provided in two sessions.

▫    Session I –  three consecutive days

▫    Session II –  2 consecutive days and will be
offered the following month

▫    Completion of session one and two are required

A benefit to this CCM course schedule is that CCMs and HCMs will not be away from their practice location for 5 consecutive days.

CCM Course Dates for Oct/Nov 2012 –
Sessions I and II

▫    Session I – Lansing;   Oct 24, 25, 26, 2012
▫    Session 2 – Lansing;   Nov 8, 9, 2012

The MiPCT CCM course registration is available online: https://jodyooo.wufoo.com/forms/mipct-complex-care-manager-training-in-lansing/
Dates and locations for the CCM course post Oct/Nov 2012 session will be determined based on need.  Eventually, we plan to offer the CCM course via a combination of live and recorded webinars.  This will occur when the number of CCMs and HCMs to train is reduced.  For questions, please submit an email to mipctdemo@michigan.gov.

MiPCT Care Manager Training Requirements Necessary for PDCM-MiPCT Billing* per BCBSM, BCN, BCBSM Medicare Advantage

Services provided by MiPCT Care Managers are billable once MiPCT Care Managers complete the following training requirements:

a.    Moderate care managers must complete a MiPCT-approved self-management program.

b.    Complex care managers and Hybrid care managers must complete a MiPCT-approved self-management program, and either complete the MiPCT Complex Care Management (CCM) course, or be registered online for the MiPCT CCM course.

MiPCT HCMs and CCMs can provide care management for moderate risk patients once they have completed a MiPCT-approved self-management training course.

*PDCM MiPCT Billing refers to G-Code and CPT-Code  billing per BCBSM, BCN, BCBSM Medicare Advantage.

A summary of the MiPCT-approved self-management programs may be found on http://www.mipctdemo.org:

https://mipctdemo.wordpress.com/care-management-resource-center/mipct-approved-training-programs-self-management-support-mcm-program-summary-32712/

Next Issue, October 8, 2012

September 24, 2012

Medicaid Payment Update

The third quarter (July- September 2012) Medicaid care coordination and practice transformation payments are scheduled to process on Thursday, September 27, 2012.

BCBSM Claims Rejections

As we previously indicated, though MESSA, U of M, Accident Fund, and BCBSM members are on the monthly patient lists, their claims are being rejected because they have a future effective date.  Providers may continue to deliver care management to these patients.  All claims for these groups will be made whole from the reward pool until their effective date. In addition, the Rehmann Group members will be added to the monthly patient list, also with a future effective date.  In the attachment labeled “PDCM Group List for MiPCT Monday Flash,” please find an updated list of all the groups (and their associated group numbers) with future effective dates.

NPs and PAs to be Added as PCPs

Effective January 1, 2013, NPs and PAs in MiPCT designated practices that serve as PCPs will receive credit for MiPCT payments for both Medicaid and Medicare. To receive Medicaid payments, the NP/PA must be the PCP of record for Medicaid managed care members and must be enrolled in CHAMPS.  In addition, in order for us to attribute Medicaid and Medicare members to PAs and NPs, they have to be added to our provider file. Later in the fall we will be asking for billing information for any NPs and PAs you would like included in the program as PCPs.

Third Quarter Financial Reporting:  Due Date Extended

We are in the process of revising the template for the third quarter MIPCT Financial Reporting. The template will be accessible through a web portal and POs will no longer be responsible for entering revenue or member months data. We will schedule a webinar to introduce you to the new reporting template.

DO NOT use the second quarter template to begin third quarter reporting. Please wait until you have received a link to the revised template and an introduction to the use of template through the webinar. The due date for the third quarter report will be delayed until mid-November; details to follow.

Care Management Corner:
Stories of  Success!
Della Slavsky, Clinical Lead
Marquette Internal Medicine, UPHP

A patient in Della’s practice is a 52 year-old female with a history of Type 2 Diabetes, hypertension and obesity. Her HbA1c was 12.0 and she was not checking her blood sugar very often. The patient did not want to have to start taking insulin, but knew she may have to if she could not get her blood sugar under control.
The patient received a referral from her PCP to work with care management. She was unsure if she wanted to participate in program, but decided to give it a try. The PCP was instrumental in encouraging the patient to participate in the program and talk with the care manager. “The patient was more willing to ‘give it a try’ with the support of her own doctor. We knew the patient would benefit because she had a specific goal to not go on insulin, and this was a way in which she could work towards her goal,” explains Della.  She believed in her patient’s ability to take charge of her own care and supported the patient in doing that.
The patient became more engaged and in charge in the daily care of her chronic disease. She made self-management goals in conjunction with the care manager, who completed follow up phone calls between office visits. The patient decided to check her blood sugar more frequently, and was consequently able to determine which foods were making her blood sugar higher, and she adjusted her diet. She was motivated to begin to exercise and has started a walking program. By working with a care manager on her self-management goals, the patient’s HbA1c has gone from 12.0 down to 9.2 over the last 4 months.  It is hopeful that her next HbA1c will be even lower.

Thank you, Della for sharing your inspiring story with us!

Do You Have a Care Manager Success Story to Share With Us?  

We would love to hear from you!  Please go to https://jodyooo.wufoo.com/forms/stories-of-your-care-management-success/ to share your success story, and we hope you enjoy reading Della Slavsky’s submission, adjacent.

MiPCT Complex Care Manager Course: October/November, 2012

The MiPCT team recommends CCMs and HCMs who need this training, register for the October//November CCM course.  Starting October-2012, the Complex Care Management Course will be provided in two sessions:

–    Session I    3 consecutive days
–    Session II    2 consecutive days, and will be
offered the following month.
–    Completion of Session I & II are required.

A benefit to this CCM course schedule, is CCMs and HCMs will not be off site, away from their practice location for the 5 consecutive days.

CCM Course Dates for Oct./Nov., 2012-Sessions I & II
–    Session I    Lansing: October 24, 25, 26
–    Session II    Lansing: November 8 & 9, 2012

The MiPCT CCM course registration is available online at: https://jodyooo.wufoo.com/forms/mipct-complex-care-manager-training-in-lansing/

Dates and locations for CCM courses after the October/November-2012 sessions will be determined based on need.

Eventually, we will plan to offer the CCM course via a combination of live and recorded webinars.  This will occur when the number of CCMs and HCMs to train becomes very small.  For questions, please submit a message to mipctdemo@michigan.gov.

MiPCT Care Manager Training Requirements Necessary for PDCM-MiPCT Billing* per BCBSM, BCN, BCBSM Medicare Advantage

Services provided by MiPCT Care Managers are billable once MiPCT Care Managers complete the following training requirements:

a.    Moderate care managers must complete a MiPCT-approved self-management program.
b.    Complex care managers and Hybrid care managers must complete a MiPCT-approved self-management program, and either complete the MiPCT Complex Care Management (CCM) course, or be registered online for the MiPCT CCM course.

MiPCT HCMs and CCMs can provide care management for moderate risk patients once they have completed a MiPCT-approved self-management training course.

*PDCM MiPCT Billing refers to G-Code and CPT-Code  billing per BCBSM, BCN, BCBSM Medicare Advantage.

A summary of the MiPCT-approved self-management programs may be found on http://www.mipctdemo.org:

https://mipctdemo.wordpress.com/care-management-resource-center/mipct-approved-training-programs-self-management-support-mcm-program-summary-32712/

Learning Collaboratives:  The Waves Are Filling Up!

Please be sure to visit http://www.mipctdemo.org and click on the Learning Collaboratives tab.  There, you will find a link to a recording of an informative webinar all about the Learning Collaboratives, as well as a link to the online registration form for Learning Collaboratives Teams.

Please note, Wave One, Track A is FULL.  If your team has not already done so, please register for one of our upcoming Learning Collaboratives today to ensure the dates and locations most convenient to your practice team will still be available to you.  Here is the link to sign up online:  https://jodyooo.wufoo.com/forms/new-mipct-learning-collaborative-team-application/

Here is a recap of the Learning Collaborative Dates:

Wave One/Track A – LANSING:  FULL/CLOSED
 -November 13, 2012
    -January 29, 2013
    -March 25, 2013

Wave One/Track B – LANSING:
-November 16, 2012
-January 30, 2013
-March 26, 2013

Wave Two – GRAND RAPIDS:
-December 5, 2012
-February 4, 2013
-April 17, 2013

Wave Three – NEW HUDSON:
-January 8, 2013
-March 6, 2013
-May 7, 2013

Wave Four/Track A – LANSING:
-February 26, 2013
-April 9, 2013
-June 18, 2013

Wave Four/Track B – LANSING:
-February 27, 2013
-April 10, 2013
-June 19, 2013

Spaces are limited and applications that are complete will be accepted on a first-come, first-served basis.

Next Issue, October 1, 2012

 

 

September 17, 2012

Medicare Care Coordination Payments Received in August

The payments that POs received in July from UMHS were quite a bit lower than in previous months because a large number of care coordination payments for the July 1, 2012 date of service were received by UMHS from CMS in early August.

UMHS processes the care coordination payments on a monthly basis—we pay out everything that was received (i.e. using paid date) in the previous month, regardless of the service date.  The care coordination payment typically gets paid toward the end of the month for the month of service, so your payments will usually be consistent (and have begun to stabilize over time).

Your payment at the end of September, which will include paid dates through August 31st, will essentially be the money you were ‘missing’ from July, plus the typical payment for August.  UMHS is only able to pay out the money that it receives from CMS every month, so if the payment to UMHS is ‘delayed’, that will be reflected in what is paid to each PO.

Please refer to the Medicare Care Coordination Payment FAQ sheet posted on the MiPCT website for additional information about the Medicare Care Coordination payments and why you may not be receiving payment for 100% of your attributed population.

Pediatric Care Manager Training Update

MiPCT will hold an all-day Pediatric Care Manager training session at Lyon Meadows Conference Center, 53200 Grand River, New Hudson, Michigan, 48165.  The training will be held on Thursday, September 20, from  9:30 a.m. to 4:00 p.m.

This training is designed for complex care managers and hybrid care managers working in pediatric offices.  If you have not signed up already, please register now at https://jodyooo.wufoo.com/forms/registration-for-inperson-pediatric-cm-training.

We will offer the same training at the same location on October 30 for complex and hybrid care managers working with children and youth in family practice settings. If you are working in a pediatric office, and cannot attend the September 20 session, you are welcome to sign up for the October 30 training. Use the link above to register for either training session.

Remember to complete the homework prior to your training session.  A link to the homework, as well as a recording of the webinar in which the homework was assigned, can be found on the mipctdemo.org website.  Go to the Care Management Resource Center tab and select “Pediatric Care Manager” page from the drop down menu, or go to this link:  https://mipctdemo.wordpress.com/care-management-resource-center/pediatric-care-manager-page/

For those attending on October 30, we will offer another live webinar with the same content on Friday, October 19, at 10:00 a.m.

Thank you for your participation!  Hope to see you at one of our training soon!

Care Management Corner: Stories of Success!
Mary Kramer, Hybrid Care Manager
UPHP, Marquette, MI

Mary Kramer is a Hybrid Care Manager at Marquette General Family Medicine, an Upper Peninsula Health Partners practice.  One of her patients is a 63 year old male with congenital cervical spine abnormalities and a right shoulder pressure ulcer.  He sleeps on his right side.
This is a patient who had fallen through the cracks. His pressure ulcer had increased in size since his last visit, and a special bed pad which had previously been prescribed was not in place on his bed at home.
To make matters worse, this patient was overwhelmed with many of his own medical conditions, and those of his 90 year old mother, with whom he lives, and whose health is failing.  He was referred to health psychology, but refused to go.
Mary helped her patient navigate the medical system by referring him to resources that were available to him to address both the problem with his wound, and the stress from his other ailments and caring for his elderly mother.   Mary collaborated and communicated with the wound care specialist on his behalf, assisted with getting the appropriate bed mattress and sheets ordered and delivered for his bed at home, and encouraged the patient to keep his health-psychologist appointments.
At his last appointment at the wound clinic, this patient showed good signs of healing.  Mary continues to collaborate with the wound care clinic on his behalf.  Mary’s care has helped this man avoid adverse events such as infection, an emergency room visit, hospitalization and surgery.
After Mary’s intervention, the patient said, “I will go to the first appointment with the health psychologist and see how it goes.  I feel less overwhelmed.”  That’s quite an improvement!
Do You Have a Care Manager Success Story to Share With Us?  

We would love to hear from you!  Please go to https://jodyooo.wufoo.com/forms/stories-of-your-care-management-success/ to share your success story, and we hope you enjoy reading Mary Kramer’s submission in the adjacent column.

In the Literature:
Extended Office Hours and Health Care Expenditures: A National Study

A recent article in the Annals of Family Medicine found that individuals with access to extended office hours over a two-year period had 10% lower health care expenditures than those who had no access to extended hours.

The authors found that the lower expenditures were due to decreased prescription medication and office visit–related expenditures. Further research is needed to determine causality.
You can find the full article here:

Anthony Jerant, MD, Klea D. Bertakis, MD, MPH, Joshua J. Fenton, MD, MPH, Peter Franks, MD. Extended Office Hours and Health Care Expenditures: A National Study, Ann Fam Med. 2012;10:388-395.

Plans for Future Complex Care Management Course

Starting  October 2012, the Complex Care Management Course will be split into two sessions.

▫    Session I  –  3 consecutive days
▫    Session II –  2 consecutive days to be
offered the following month

▫    Completion of session one and two are required

A benefit to this CCM course schedule is CCMs and HCMs will not be offsite, away from their practice location for the 5 consecutive days.

CCM Course Dates for Oct/Nov 2012 –
Sessions I and II

▫    Session I  –  Lansing;   Oct 24, 25 and 26, 2012
▫    Session 2 –  Lansing;   Nov 8 and 9,  2012

CCM course registration is available Monday 9/17/12;    Please use this link for online registration:  https://jodyooo.wufoo.com/forms/mipct-complex-care-manager-training-in-lansing/

Dates and locations for the CCM course post Oct./Nov.,  2012 session will be determined, based on need.

The MiPCT team recommends CCMs and HCMs who need this training to register for the Oct./Nov. CCM course.

Eventually, we plan to offer the CCM course via a combination of live and recorded webinars.  This will occur when the number of new CCMs and HCMs becomes very small.

MiPCT Geisinger Comprehensive Assessment Tool – Webinar

The Geisinger Comprehensive Assessment tool has been newly formatted. The format of the tool has been redesigned to gain efficiency in documentation.  MiPCT provided a  webinar to introduce the newly formatted  tool on September 12, 2012.  The Webinar will be repeated on September 25, 2012, from 2:00 to 3:00 p.m. A  Save The Date for the September 25 webinar has been sent to PO leaders and complex and hybrid care managers.

POs and practices may be in the process of placing the care management documentation tools into an EMR.  MiPCT leadership is requesting POs/practices utilize the evidence-based Geisinger documentation tools.     The care managers will need to seek guidance from PO leadership regarding next steps on implementing this documentation tool.

Note:   POs who have not signed a Geisinger attestation letter and would like to receive the Geisinger  tools, including an electronic copy of the newly formatted   MiPCT/Geisinger Comprehensive assessment docu-mentation tool, please complete the following steps:

•    Sign the Geisinger attestation letter and submit an electronic copy via e-mail to mipctdemo@michigan.gov, and

•    Mail a hard copy to the Michigan Department of Community Health, at:

MiPCT Project
PO Box 30195
Lansing MI  48909
ATTN.:  Linda Pappas

•    Upon submission of the signed Attestation letter, send an e-mail with request for Geisinger tools to   mipctdemo@michigan.gov

A copy of the attestation letter was sent via e-mail to PO leaders on September 11, 2012.  If you have any questions, please submit to mipctdemo@michigan.gov.

Next Issue, September 24, 2012

September 10, 2012

  • 09102012 MiPCT Monday FLASH V1 i17 FINAL

    Registry Data Update

    We have received questions from POs regarding the data format for sending registry data to the Michigan Data Collaborative (MDC).  We will be asking for test data files in mid-December.  A communication will be sent within a week from the MDC regarding format and data to send.  In the meantime, please send questions to MiciganDataCollaborative@umich.edu.  All questions are welcome; please keep them coming!

    Introduction to the Physician Organization Advisory Council (POAC)

    MiPCT is establishing a Physician Organization Advisory Council (POAC) to assist with the efforts of transforming our primary care delivery systems.   We understand the importance of physician engagement in this transformation process and look forward to involving our POAC members to assist in this process.

    The goals of the POAC include:
    •    Provide oversight of MiPCT initiatives from key provider leaders in MiPCT
    •    Receive input and course corrections in developing MiPCT Programs
    •    Provide a forum to address concerns and issues identified by MiPCT providers
    •    Provide a means to communicate MiPCT initiatives
    •    Develop a collegial network of providers across MiPCT to support the ongoing transformation process

    We are pleased to announce the membership of the POAC includes:
    Kevin Taylor, Chair
    Mary Durfee, IHA
    Deborah Withrow, United Physicians
    Ruth Clark, IHP
    Charlie Carpenter, CIPA
    Diane Donley, NPO
    Stacy Brummel, Spectrum
    Connie Standiford, U of M
    Richard Dryer, Henry Ford
    Gina Buccalo, St. John Health Partners
    Susan Wakefield, West Michigan Physician Network

    The first of our quarterly meetings will be held on Friday, September 21st in Okemos. Thank you in advance to all of our POAC committee members!

    Learning Collaborative Dates Set!

    We are now accepting applications for practice teams to participate in MiPCT Learning Collaboratives (LCs).

    Wave One will begin in November 2012.  The facility in Lansing is small, therefore we will offer two tracks in Lansing in Wave One, and another two in Lansing in Wave Four.

    Each Wave consists of 3 meetings, every other month.  Your entire team is expected to attend each of the in-person meetings.

    Following is a list of all LCs, sorted by wave:

    Wave One/Track A, LANSING Meeting Dates:
    -November 13, 2012
    -January 29, 2013
    -March 25, 2013

    Wave One/Track B, LANSING Meeting Dates:
    -November 16, 2012
    -January 30, 2013
    -March 26, 2013

    Wave Two, GRAND RAPIDS Meeting Dates:
    -December 5, 2012
    -February 4, 2013
    -April 17, 2013

    Wave Three, NEW HUDSON Meeting Dates:
    -January 8, 2013
    -March 6, 2013
    -May 7, 2013

    Wave Four/Track A, LANSING Meeting Dates:
    -February 26, 2013
    -April 9, 2013
    -June 18, 2013

    Wave Four/Track B, LANSING Meeting Dates:
    -February 27, 2013
    -April 10, 2013
    -June 19, 2013

    Here is the link to register for one of the Learning Collaborative Waves:

    Register Online for Learning Collaborative Teams
    Learning Collaborative Q&As

    Q.    Our team doesn’t have previous experience in learning collaboratives or QI.  Can we still participate in MiPCT’s Learning Collaboratives?

    A.    Yes!  No previous experience is necessary.  All that is required is a willingness to change and a little pre-work.  There is a time commitment involved.

    Q.    What is the total commitment for practice teams?

    A.    Three full days spread over 6 months, a 1-hour conference call for pre-work, 1-hour monthly team meetings, and a 1-hour conference call for Learning Collaborative teams in months they are not attending an in-person collaborative.

    Q.    How much CME will the Learning Collaboratives training provide?

    A.    Six to eight hours; but probably 6 hours, given food and breaks.

    Q.    How relevant is the Learning Collaborative training to those serving pediatric patients?

    A.    The training is applicable to pediatrics.  Model elements are process changes, and are applicable, regardless of the age of the patient.  They’re not disease-specific.  It’s about process- and team-change; quality improvement strategies are still applicable.

    Q.    Who attends the Learning Collaboratives?

    A.    The entire team must attend the Learning Collaboratives.  A team consists of a physician, an RN, a complex care manager and a moderate care manager, OR a hybrid care manager, a non-clinical support staff, such as an office manager, and a representative from the PO.  It is important that the team go through the Collaborative together.

    Q.    Is mileage reimbursement covered?

    A.     The conferences are free, and MiPCT will hold different Waves of Learning Collaboratives in geographic regions of Michigan, such as Lansing (central), Grand Rapids (west) and New Hudson (southeast), in order to keep the driving time to a minimum, and costs low for our participants.  Unfortunately, the MiPCT cannot reimburse travel costs.

    Q.    What time are the Collaboratives held?

    A.    We anticipate holding these in-person meetings from 8:30 AM to 5:00 PM, all day, three times over the course of 6 months.  For example, if your team participates in Wave 1-Track A, you would have an in-person, all day meeting on November 13, January 29 and March 26, as well as attend conference calls, webinars, and participate in meetings with your team, in-house.

    Q.    Who do we contact with questions?

    A.    You can send questions to the MiPCT mailbox at mipctdemo@michigan.gov.  If you would like, we would be happy to set up a call with you.

    For more information on the MiPCT Learning Collaboratives, please visit the mipctdemo.org website and look for the Learning Collaboratives tab.  There, you will find information and the link for your practice team to register online for one of the upcoming Learning Collaborative Waves.

    Care Management Corner:  Stories of Success!

    Kelly Yero,
    Complex Care Manager
    Henry Ford,
    Woodhaven, MI

    My patient had asthma that was not well-controlled. She was in the ER multiple times every year and could not afford her medication. She also had a history of depression and anxiety. I knew that with care management I could help this patient to obtain asthma medication. I also knew that working with her doctor to support changes in her treatment would allow the patient to better manage her depression and anxiety, which would in turn allow her to cope with her chronic condition.
    While the patient was in the hospital, I coordinated with the social work department to obtain a 30-day supply of Advair at no cost. I called the patient the next morning after discharge; she sounded terrible and I was able to get her in to her doctor for a same-day appointment. I stayed with her during the appointment and made sure her prescription was filled ahead of the other waiting patients. I reviewed her asthma action plan with her and also included a plan for family support and anxiety reduction. Our on-site pharmacy was wonderful and filled her prescription right away. She was able to take her first dose of oral steroids before leaving our facility.
    The patient’s physician told me that had case management not been involved, she would have sent the patient right back to the emergency room. Instead, the patient successfully stayed out of the hospital during the next 30 days.

    Do you have a Care Manager Success Story to share with us?  We would love to hear from you!  Please go to CLICK HERE to tell us your Care Management Success Story!

    Next Issue, September 17, 2012.

    August 27, 2012

    082712 MiPCT Monday FLASH V1 i16 FINAL

BCBSM Update

PGIP Quarterly Meeting (9/14) Update:  

The MiPCT session from 11:30 – 12:30 pm will be combined with a BCBSM-specific PDCM session that will extend an extra half hour through lunch. The purpose of the session is to address BCBSM-specific questions and issues, including those related to G-code billing and member lists, and to make plans for one or more follow-up meetings focused on strategies for increasing the number of members receiving care management under the PDCM program.  We will have a brief break at 12:30 p.m. for attendees to bring lunch back to the MiPCT/PDCM session.

POs and Practices:

Please submit questions and issues to BCBSM to be answered during the session by e-mailing Kristin Vogelei at KVogelei2@bcbsm.com.

Claims Announcements:  

We discovered that a portion of our Individual Business customers’ benefits were not updated to include MiPCT/PDCM.  Therefore, even though they are appropriately on the patient lists, the claims will deny.  We are updating our systems and will reprocess any claims that denied between 4/1/2012 and the date the system is fixed.  Please continue to engage and render services to these members.  Attached is an Excel spreadsheet named “BCBSM IBU Groups Missed for 8.27 FLASH,” which lists the group numbers for these members.  We apologize for any inconvenience, and appreciate your patience while we resolve this issue.

In addition, although MESSA, U of M, and BCBSM members are on the monthly patient lists, claims are being rejected.  This is because MESSA has not yet completed its internal review process, and U of M and BCBSM have an effective date of 1/1/2013.  Providers may continue to deliver care management to these patients.  All claims for these groups will be made whole from the reward pool until their effective date. Group numbers for these plans are:

U of M:      68712 and 68714

BCBSM:     (which includes Accident Fund): see attachment

MESSA:      07054, 07068, 66572-66586; 66237, and 66232-66236

Updated Fees:

PDCM fees changed as of 7/1/2012.  The fees in the above chart include the incentive (PGIP PO Component) amount.

Wanted! Members for the MiPCT Performance Incentive Subcommittee

The Performance Incentive Subcommittee is seeking nominations in the following categories:

1.    PO Medical Director

2.    Physician from an MiPCT Practice

3.    Data person from a PO/practice, knowledgeable about EHR/registry functionality

4.    Individuals with expertise in performance incentive programs/metrics

The Performance Incentive Subcommittee is charged with identifying the 2013 and 2014 metrics for inclusion in the MiPCT Incentive Performance Program.  The committee has been meeting 1-2 times per month at MPHI in Okemos, Michigan.  Meeting frequency should decrease to quarterly, or every 6 months, once the set of 2013 and 2014 metrics are completed this fall.

Please use the following link and complete the online nomination form by August 31 for yourself or another candidate who agrees to be nominated:

Register Online for Performance Incentive Nominations HERE

Contact Dana Watt through the MiPCT Demo mailbox MIPCTDEMO@michigan.gov or (517) 373-4246 for further information about the Performance Incentive Committee.

Medicare Care Coordination Payments

Checks for Medicare Care Coordination Payments for CMS Remittance Advice dates as of July 31, 2012 will be processed at UMHS on August 27th, 2012.  You should expect to receive the Explanation of Payment and the supplemental Excel workbooks by August 31st, and a check by September 7th.

Please note that UMHS received many payments for July in early August, which means that the July payment may be lower than previous payments.  The funds received in August will be paid with the next payment (CMS Remittance Advice dates as of August 31, 2012) in late September.

Mipctdemo@michigan.gov Mailbox

You may have recently received an invitation to participate in a LinkedIn care manager networking group.  Please be advised that this networking group is not sponsored/endorsed by the MiPCT project.   Please continue to submit any questions regarding MiPCT care management procedural or billing questions to the MiPCT demo mailbox.”

NEXT ISSUE:

Monday, September 10, 2012

Click here for the GCODE CHART

August 20, 2012

Master Trainer and Clinical Lead Assignments

Last week an e-mail was sent to all Master Trainers, Clinical Leads, and CCM/HCMs with notification of the Clinical Lead and Master Trainer assignments for all Hybrid and Complex Care Managers. The assignment of Master Trainer, Clinical Lead and HCM/CCMs is designed to promote regionalization, HCM/CCM peer-to-peer networking, as well as coaching and mentoring by the Clinical Lead for the HCM/CCM.

How is the Master Trainer – Clinical Lead – HCM/CCM assignments determined?

  1. Each Clinical Lead has designated practices and the CCM/HCM at each practice is assigned to the Clinical Lead. The Master Trainer is assigned to Clinical Leads.
  2. The assignments are based on geography and also trying to keep, as much as possible, the Physician Organization aligned with a Clinical Lead (the premise is to avoid splitting up a Physician Organization’s practices across several Clinical Leads).
  3. We utilized the current CCM/HCM hiring status data to form these assignments. We recognize the HCM and CCM data we used to develop the Clinical Lead CCM/HCM assignment is not 100% complete. Our MiPCT team is currently entering the Care Manager data from the 2nd Quarter MiPCT reports, which includes details of the hiring status of the CCM/HCMs through 6-30-12.

Our goal is to enter all CCM/HCM data as reported by the Physician Organizations from the 2nd Quarter MiPCT report as soon as possible and update the Master Trainer-Clinical Lead-CCM/HCM assignments as needed. We will have ongoing updates and will do our best to minimize the changes in the Master Trainer-Clinical Lead-CCM/HCM assignments. If you have questions, please contact Marie Beisel at mbeisel@umich.edu.

Wanted! Members for the MiPCT Performance Incentive Subcommittee

The Performance Incentive Subcommittee is seeking nominations in the following categories:

  1. PO Medical Director
  2. Physician from an MiPCT Practice
  3. Data person from a PO/practice knowledgeable about EHR/registry functionality
  4. Individual with expertise in performance incentive programs/metrics

The Performance Incentive Subcommittee is charged with identifying the 2013 and 2014 metrics for inclusion in the MiPCT Incentive Performance Program. The committee has been meeting 1-2 times per month at MPHI in Okemos, Michigan. Meeting frequency should decrease to quarterly or every 6 months once the set of 2013 and 2014 metrics are completed this fall.

Please use the following link and complete the online nomination form by August 31 for yourself or another candidate who agrees to be nominated: Performance Incentive Nomination Form

Contact Dana Watt through the MiPCT Demo mailbox MIPCTDEMO@michigan.gov or (517) 373 4246 for further information about the Performance Incentive Committee.

August Medicaid Managed Care Patient Lists

A file of Medicaid managed care patients attributed to MiPCT-participating practice units for August 2012 will be available to each participating MiPCT PO on August 20th. If someone from the PO does not pick up the file from the MiShare system within 4 days, the file will expire. If this occurs, please contact the Michigan Data Collaborative so the file can be reposted for pick up. As always, please contact the Michigan Data Collaborative at MichiganDataCollaborative@umich.edu with any questions regarding the file retrieval process or the Attributed Patient Lists.

NEXT ISSUE:

Monday, August 27, 2012

August 13, 2012

Reminder: Register for the September 20th Pediatric Training

This training is designed for Complex Care Managers and Hybrid Care Managers working in pediatric offices and will be held September 20th from 9:30 a.m. – 4:00 p.m. at the Lyon Meadows Conference Center, 53200 Grand River, New Hudson, MI 48165. Online registration is now open. Click on the following link to register: https://jodyooo.wufoo.com/forms/registration-for-inperson-pediatric-cm-training// Please register by September 6. Stay tuned for information about webinars that will be held prior to the above in-person meetings.

Sign Up for user Accounts on the MDC Web Portal

To access the MiPCT dashboards and reports via the MDC MiPCT Dashboard web portal, PO users will need to have a user account established by the Michigan Data Collaborative (MDC). This week, MDC will email a request to your PO inviting your organization to start registering portal users. Each user will need to request his/her own user account to access the PO’s reports and dashboards. PO Authorizers at each organization will authorize these accounts. Please watch for this e-mail to arrive soon.

If your organization has not designated two PO Authorizers, please contact MDC at MDC-Accounts@med.umich.edu. User accounts cannot be processed without a PO Authorizer confirming each account application from that PO.

LOOKING AHEAD:

MDC is planning to launch the MDC MiPCT Dashboard web portal in September with a webinar for instructing users on how to navigate the dashboards and reports. More specific dates will be coming soon.

Complex Care Manager Course

To date, the Complex Care Manager one-week course has been completed by over 216 complex and hybrid care managers (CCMs/HCMs).

If you have CCMs/HCMs hired that have not completed the MiPCT Complex Care Management one-week course, there will be a final, scheduled CCM course offered from August 20-24, 2012. The CCMs/HCMs hired prior to August 20, 2012 are expected to enroll in the August 20-24 CCM course. To enroll your care manager, please go to https://jodyooo.wufoo.com/forms/82012-care-manager-training-in-lansing/ to register. Please note: There are just a few spaces left, and will be given on a first-come, first served basis.

The MiPCT team is planning to provide a modified CCM curriculum for the CCMs/HCMs hired after August 20, 2012. The modified CCM curriculum will be available Fall 2012, however, dates have not yet been finalized. Online registration for the CCM course is available at http://www.mipctdemo.wordpress.com/ccm-online-registration-page/.

NEXT ISSUE:

Monday, August 20, 2012

August 6, 2012

Learning Collaboratives

Our first webinar about our Care Management Collaborative occurred this last Monday. Over 40 participants called in to discuss the opportunity to collaborate on increasing the effectiveness of embedding Care Managers. We already have several teams registered but are looking for many more additional teams. Our next webinar will be Aug 21st at 3pm (see login information below). The slides are available on http://www.mipctdemo.com under Resources > Learning Collaboratives. When you and your team are ready to submit your application to participate in an upcoming Learning Collaborative, please use this link to apply:  https://jodyooo.wufoo.com/forms/mipct-learning-collaborative-team-application/

Log-in Info for the August 21st Learning Collaborative Webinar:

Time: 3:00 pm

Event number: 661 743 333

Event password: mipct

Website:  https://mphievents.webex.com/mphievents/onstage/g.php?d=661743333&t=a

Call-in toll-free number (US/Canada):  1-855-244-8681

Call-in toll number (US/Canada):  1-650-479-3207

Access code: 661 743 333

MiPCT Practice Invitations

Due to PGIP PCMH designation losses, a small number of MiPCT practices have become ineligible for participation. Other practices have merged, creating consolidations in the number of unique practice units. At their July 2012 meeting, the MiPCT Steering Committee supported offering a limited number of invitations to the program to practices in the original 2010 PCMH cohort who elected not to participate at that time, but have maintained PCMH designation. At this time we are unable to extend invitations beyond this cohort. Thus, only the practices sent invitations are eligible for this opportunity.

Important Dates:

8/07         STEERING COMMITTEE NOMINATIONS DUE

8/20-24   MIPCT CCM TRAINING, LANSING (LAST SCHEDULED CCM TRAINING SESSION)

8/21           WEBINAR: LEARNING COLLABORATIVES,  3:00-4:00 PM (REPEAT OF 7/31 WEBINAR)

9/06          PEDS CCM/HCM TRAINING REGISTRATION DUE

9/20          PEDIATRIC CCM/HCM TRAINING

10/30       FAMILY MEDICINE CCM/HCM PEDIATRIC TRAINING

Your Suggestions Put into Action: Easier to Use BCBSM

Thanks to our BCBSM partners for putting into action the feedback provided to our all-PO query for suggestions on simplifying BCBSM MiPCT member lists that identify the patients eligible for care management services. We are happy to report that the September lists from BCBSM will arrive to you sorted first by practice unit ID and name, then provider last name and NPI, and finally by member last name. This is a great example of your ideas being translated into meaningful improvements. In particular, this particular effort was aimed at easing the amount of work that POs have been doing prior to transmitting the lists to care managers in the practices. Timely transmission of the lists from POs to practices and care managers is not only essential to the success of POs and practices, but is an expectation of participation in the MiPCT.

Patients are Receiving Medicare Summary Notices for February

Over the past several months, some patients have received paper Medicare Summary Notices for MiPCT Care Coordination, Incentive and Administration payments made to the University of Michigan on February 1st, 2012. Medicare has identified the issue and further summary notices should be suppressed. However, practices may receive patient calls and questions about the program. We encourage you to take this opportunity to assess patient understanding of MiPCT and develop a communication plan for increasing patient awareness of MiPCT.

As you may remember earlier in the year, there was a similar issue with electronic Medicare Summary Notices, which Medicare subsequently suppressed. They did not anticipate the transmission of paper notices and understand that it is confusing to patients. Again, they are working on resolution and apologize for the inconvenience.

NEXT ISSUE:  Monday, August 13, 2012

July 30, 2012

Payment Updates

BCBSM: We recently discovered that some of our Individual Business Groups claims are denying in error for members you engaged in MiPCT care management. We are working to update our systems and will reprocess any of the claims that were incorrectly denied. Members of the groups in the attachment are eligible for MiPCT care management services and are included on your Patient Lists. Please continue to work with these members. We appreciate your patience while we work through any issues associated with this ground-breaking program.

Here is an example of the denial:

Message code: N402

This patient’s health care plan doesn’t let us pay for this service when performed by a doctor in our Provider Delivered Care Management Program. No amount is due from us. We don’t expect the member to pay this charge either.

Please keep in mind that we still have members of groups where the employer has not chosen to participate and those denials will be the same as above.

Medicare: No change.

Medicaid: No change.

BCN: No change.

Moderate Care Manager Emails Needed

PO Leaders: Please email a list of all of your MODERATE Care Managers, along with a valid email address to: fishjody@umich.edu so we can ensure they are receiving communications about upcoming trainings and other important information they will find of interest.

Complex Care Management Training Update

We are in the early planning stages for the Complex Care Management (CCM) training course that will be offered after the 8/20/12 course. Post the August 20, 2012 Complex Care Management Course, the first offering of the course in a modified format will be dependent on class size. The modified version of the CCM Course is being designed to meet the training needs when the class size of HCMs/CCMs is very small.

At this time, we are still gathering information regarding the number of HCM/CCMs that need to take the CCM course. The MiPCT quarterly report due 7/31/12 has details of the hiring status of the CCMs and HCMs and this will be our most accurate source of individuals that still need the training.

At this time, we will offer the CCM course in Fall 2012. A date for the Fall 2012 training is pending based on identification of the number of CCM/HCMs in need of training. We recommend enrolling all HCMs/CCMs currently hired in the 8/20/12 CCM course in Lansing. https://jodyooo.wufoo.com/forms/82012-care-manager-training-in-lansing/

PO Quarterly Expectations

MiPCT has developed a list of PO and Practice Quarterly Expectations to assist our partners in organizing requests and due dates (attached). If you have any questions, please contact Amanda First at afirst@umich.edu.

Steering Committee Nominations

MiPCT is soliciting nominations for two slots for PO representatives on the Steering Committee. The purpose of the Steering Committee is to provide strategic direction to MiPCT Leadership and monitor progress toward the goals and objectives of MiPCT. Please submit nominations to Jody Fisher at fishjody@med.umich.edu by August 7th.

Child Health Care Manager Training

Registration is now open for All Day, In Person Pediatric Care Manager trainings, either in September or October. The general content will be the same for the two meetings, but the target audience differs.

The September 20, 2012 training is designed for Complex Care Managers and Hybrid Care Managers working in pediatric offices.

The October 30, 2012 Training is designed for complex and hybrid care managers working in family practice settings that serve children.

The trainings will be held 9:30 a.m. – 4:00 p.m. at the Lyon Meadows Conference Center, 53200 Grand River, New Hudson, MI 48165.

Online registration is now open. Click on the following link to register: https://jodyooo.wufoo.com/forms/registration-for-inperson-pediatric-cm-training/

Please register by September 6. Stay tuned for information about webinars that will be held prior to the above in-person meetings.

PCMH Quality Specialist Opening

The Michigan Department of Community Health, Medical Services Administration (Medicaid) currently has a position posted for a Patient Centered Medical Home (PCMH) Quality Specialist. The program specialist position is responsible for maintaining the necessary subject-matter expertise to manage complex projects involving PCMH program development and implementation as a result of health care reform and federal innovation/demonstration initiatives. Interested applicants may view the position description and apply for the position at MDCHVacancies@michigan.gov.

MDC is Asking for PO Authorizers from your Organization

The Michigan Data Collaborative is working diligently to collect and process the data and build reports from the MiPCT multi-payer data repository. Individual users will need to request their own user accounts in order to access the reports and dashboards produced for each PO via our web portal. As mentioned in a previous Flash, we will ask each PO to designate two individuals to act as PO Authorizers prior to allowing users to request accounts.

At this time, MDC is only asking for POs to register their Authorizers and does not have the user account process open. The PO Authorizers must be registered before any user accounts can be activated.

PO Authorizers will approve all user requests for access to the reports to ensure that each PO’s reports are accessed by the appropriate people. The PO Authorizers will also be responsible for confirming that existing user accounts remain active and that accounts of people no longer with your organization are promptly deactivated. We are asking for two PO Authorizers to make sure that there is coverage if someone is out of the office or changes positions. The responsibilities are not time-consuming, but the PO Authorizers need to be responsive in a timely fashion to requests for validating user access to the portal. For more information regarding the PO Authorizer role, including a list of FAQs, check out our website (www.MichiganDataCollaborative.org), under the Support tab.

This week, your organization will receive an e-mail from the Michigan Data Collaborative to designate two people to act as PO Authorizers. Please look for the e-mail which will request specific information for each PO Authorizer. We’re hoping to have all PO Authorizers designated by August 10th and we anticipate starting the user account request process the week of August 13th.

Reminder:  Learning Collaborative Webinar this Tuesday

An informative Learning Collaborative Webinar will take place this Tuesday, July 31, 2012, and will be repeated on Tuesday, August 21, 2012 for your convenience.

Date/Time:  July 31, 2012, 9-10 AM

Repeat Date/Time:  August 21, 2012, 3-4PM

Website:  https://www.webmeeting.att.com

Meeting #:  8882421836

Code for Participants4511756

Conference Call #:  (888) 242-1836

Access:  4511756

Please use the link below for your team to apply to participate in the Learning Collaboratives. Applications have already arrived, and new applications will be accepted on a first-come, first-served basis.

https://jodyooo.wufoo.com/forms/mipct-learning-collaborative-team-application/

New Publication Coming: We’d Like Your Feedback!

Please follow the link to the following short survey at https://jodyooo.wufoo.com/forms/practicelevel-flash-survey/ to provide your input by Friday, August 3.

Many thanks!

July 23, 2012

Payment Updates

BCBSM: MiPCT BCBSM Patient List Webinars are scheduled for this Tuesday, 7/24 from noon-1 pm and this Thursday 7/26 from 9-10 am (repeat session). It is important for PO leads, care managers, billing staff, and other team members who work closely with the patient lists to participate. This is a great opportunity to learn the basics about Patient Lists and to have your questions answered. See login instructions, right column.

Medicare:    The third Medicare Care Management Payment is being processed.  PO’s should receive their checks the week of July 30, 2012.

Medicaid:    Second quarter care coordination and practice transformation payments for the period April –June  2012 are scheduled to process on July 26, 2012.

BCN:              No change.

July Medicaid Managed Care Patient Lists

A file of Medicaid managed care patients who are attributed to their MiPCT-participating practice units for July 2012 was sent to each participating MiPCT PO on July 16th. If someone from the PO did not pick up the file from the MiShare system, please contact the Michigan Data Collaborative so the file can be reposted for pick up (the files expire after 4 days). As always, please contact the Michigan Data Collaborative at Michigan DataCollaborative@umich.edu with any questions regarding the file retrieval process or the Attributed Patient Lists.

Quarterly Report Difficulties 

Several people have experienced difficulty opening the Quarterly Narrative Report. Microsoft Excel requires you to click the ENABLE CONTENT button upon opening the file. If you have further trouble, please send an email to the mipctdemo@michigan.gov email address.

Webinars on BCBSM MiPCT Patient Lists

Participants:     Care Managers, MiPCT Team,

PO Leads, Billing Specialists

Date:                  Tuesday, July 24, 2012

Time:                 Noon to 1:00 PM

–OR–

Date:                  Thursday, July 26, 2012 (repeat session)

Time:                 9:00 to 10:00 AM

Website:            https://www.webmeeting.att.com

Meeting#:          8668360844

Code for

participants:     739674

Conference

Call number:    866-836-0844

Provider File Updates to be Sent this Week

Tyrrell Jarrett, the new Project Associate with MiPCT, will be sending you the most recent data we have for your PO’s participating practices and physicians respectively. Please look over these files for accuracy and/or any corrections. Thankfully, we are no longer required to collect the Rendering Provider information for each practice, which will make the provider file process easier. Please look for an email from Tyrrell this week and return the forms by August 3, 2012 for inclusion in the October attribution. Tyrrell can be contacted at: tyrrellj@umich.edu.

PO Feedback Wanted:  

What Would Make It Easier for You to Distribute the MiPCT BCBSM Patient Lists?

In the quest to get the BCBSM member lists to care managers in a timely way, we would greatly value feedback from POs. For example, several POs have told us that there is a significant amount of sorting that they must do before they can distribute the lists in a way that is useful to care managers.  BCBSM is willing to presort to make it easier for MiPCT POs and practices.  We need to know more about specifically how you would like the lists from BCBSM to be sorted.   Please provide any comments you have by July 30 to dbechel@umich.edu with the subject line:   Preferences for Sorting of BCBSM MiPCT Lists.

 Applications Now Being Accepted for MiPCT Learning Collaboratives!

Applications are being accepted now for the practice teams that would like to participate in the first wave of MiPCT Care Management Embedment Learning Collaboratives.

What is a Learning Collaborative? 

The Learning Collaborative is a modified version of the Institute for Healthcare Improvement’s Breakthrough Series Methodology (www.ihi.org).  The Collaborative will consist of 3 one-day in-person sessions, spread over 6 months.  There will be approximately 30-40 practice teams involved in the Collaborative.  A typical practice team includes a physician, MiPCT complex and moderate care managers or hybrid care manager, RN, LPN, medical assistant, and front office person, but is not limited to these personnel.  Between each in-person session there will be teleconference calls to support practices, as well as a number of other supports to facilitate and accelerate change.

What Will the MiPCT Collaboratives Focus On? 

The MiPCT learning collaboratives will focus on the “how to’s” of embedding care managers within practices to manage chronically ill patients with moderate and complex care needs.  The emphasis of the care manager intervention is to ensure high quality transitions of care, implementation of advanced directives and consistent, accurate medication reconciliation.  There will be four waves of collaboratives (so that all interested practices may participate).  The later three waves will cover the same content material, and will kick off one to 6 months after Wave One:

WAVE ONE        November 2012

WAVE TWO        January 2013 (tentative start)

WAVE THREE        March 2013 (tentative start)

WAVE FOUR        May 2013 (tentative start)

How Will My Practice Teams Benefit?  

In addition to learning and developing best practices for embedding care managers, practice teams will get valuable, applied training on developing and fostering a culture of quality improvement, including clarification of team members’ roles and responsibilities.

As explained above, the MiPCT Care Manager Embedment Collaborative will follow a modified IHI Breakthrough Series Collaborative methodology.  Integration of care managers will lead to improvement in three areas – transition of care, medication reconciliation and advanced directives. Transitions of care include enhanced communication across the care system, with seamless handoffs, and recognition of the importance of the patient’s health experience. Medication reconciliation will ensure the medication list will be accurate and complete at hospital transitions. Patients will be actively engaged to ensure the medication list is correct at all care provider encounters. Advanced directives will be discussed with the patients.  When obtained, they will be identified and accessible by the care team.

There is no participation fee or cost to participate in the Learning Collaborative. Meals will be provided.   Travel expenses will be borne by participating organizations, however.  CME will be available and physicians may qualify for the CQI component of their board recertification. Additionally, nurses can apply it toward their requirements.

What is Required and Expected? 

Commitment and enthusiasm! The practice team must attend three all-day meetings over a period of six months.  Webinars and conference calls will occur between in-person meetings.

How Can My Practice Team Apply?

Please go to our MiPCT Learning Collaborative Application link at https://jodyooo.wufoo.com/forms/mipct-learning-collaborative-team-application/

Applications will be accepted on a first-come, first-served basis, so please apply by August 31.

A Learning Collaborative Webinar will be held on July 31 to further answer any questions you may have.  The login instructions and details follow:

WEBINAR:  Learning Collaboratives

Participants:     Potential MiPCT Practice Teams, (E.g. Physician, care managers, RNs, LPNs, medical assistants, administrative personnel)

Date:                  Tuesday, July 31, 2012

Time:                 9:00 to 10:00 AM

Website:            https://www.webmeeting.att.com

Meeting#:          (888) 242-1836

Code for

participants:     4511756

Conference

Call number:    (888) 242-1836

Access:             4511756

NEW! 

MiPCT Monthly Publication in Development for Practices

We have received positive feedback about the MiPCT Monday FLASH.   Since the material is positioned for a PO audience, as you pose a crucial role in enabling success for the project, we are also preparing for the development of a monthly publication for practices.  We have several questions that we would value your feedback on as a PO community.   Care managers might have especially helpful perspectives and are also invited to share their ideas.

Please follow the link to the following short survey at https://jodyooo.wufoo.com/forms/practicelevel-flash-survey/  to provide your input by July 30.

Many thanks!

July 16, 2012

Payment Updates

BCBSM:

The names of BCBSM Blue Health Connection (BHC) care managers are now included on the monthly member lists for those members who are currently engaged with a BHC care manager. Please note that only about 4% of commercial members and 28% of Medicare Advantage members will have a care manager’s name listed. A blank or null value indicates the member is not currently working with a BHC care manager.

Medicaid:

Second quarter (April-June 2012) care coordination and practice transformation payments are scheduled for processing on July 26, 2012.

BCN:

No change.

Medicare:

No change.

Complex Care Management Course

To date, the Complex Care Management one week course has been completed by 216 complex and hybrid care managers (CCMs/HCMs).

If you have CCMs/HCMs hired that have not completed the MiPCT Complex Care Management one week course, there will be a CCM course offered on August 20, 2012. The CCMs/HCMs hired prior to August 20, 2012 are expected to enroll in the August 2012 CCM course.

The MiPCT team is prepared to provide a modified CCM curriculum for the CCMs/HCMs hired after August 20, 2012. The modified CCM curriculum will be available Fall 2012. Online registration for the CCM course is available at https://mipctdemo.wordpress.com/ccm-online-registration-page/.

Link for the August Complex Care Management one week course session:

https://jodyooo.wufoo.com/forms/82012-care-manager-training-in-lansing/

In the Literature: Building Patient-Centeredness in the Real World: The Engaged Patient and the Accountable Care Organization

Strong patient-centered medical homes are key building blocks of Accountable Care Organizations (ACOs). This article by Millenson captures both the promise of patient-centered approaches and the challenges of making this concept a reality in the current healthcare delivery system.

For patient-centeredness t achieve its potential within a health care organization, the point of view of the patients and/or their family members must be considered in an ACO’s: 1) governance and policies, 2) quality and improvement activities and 3) individual patient-clinician interactions.

The paper briefly features five healthcare organizations producing strong evidence of improvements in quality, safety and cost after their healthcare system was transformed and modified towards a patient-centered approach.

The full article can be found as a .pdf attachment (SEE LINK ABOVE FOR FULL ARTICLE), and is entitled: Millenson ML. Building patient-centeredness in the real world: The engaged patient and the Accountable Care Organization. Health Quality Advisors; National Partnership for Women & Families. 2012 May 30.

NEXT ISSUE:

July 9, 2012

Payment Updates

BCBSM: No change.

BCN: No change.

Medicare: No change.

Medicaid: No change.

Quarterly Report Template Updates

On Friday, all PO/PHOs should have received updated templates for both the Financial Report and the Narrative Reports. As a reminder, quarterly reporting has two components:

1) submission of financial documentation for the PO/PHP, the Financial Report); and

2) a narrative report on accomplishments and plans (Narrative Report).

Please note that the templates for both reports have been updated. We realize that you may have alreadystarted filling out the Financial Report using the template from the previous quarter; if so, you may submit the Financial Report using the previous template. In this case, MiPCT will contact you to gather additional care management detail asked for in the Q2 Financial Report Template.

Please note that the Q2 Narrative Report Template must be used for the Narrative Report, as it gathers needed documentation for the 6-month incentive metrics.

INSTRUCTIONS:

• Focus on the current quarter – you need not repeat information about the previous quarter.

• For all open-ended questions, please write at least 1-2 sentences in response, unless instructions note otherwise.

• Save the file with PO/PHO name in the file name.

• Return both the Financial Report andNarrative Report by email to: mipctdemo@michigan.gov.

• The due date for both reports is July 31, 2012.

Michigan Data Collaborative (MDC) Sends Out Medicare FFS Patient Lists

On Friday, all PO/PHOs should have received anemail with a link to securely download an Excel file of Medicare FFS patients who are attributed to your MiPCT-participating practice units for July-September 2012. If you picked up files from MiShare recently, you will receive an automated email from MiShare at the University of Michigan Health System Notification Service with the subject “New Package is Waiting”. You may follow the link in the email to log in (using the password you created when you picked up your files a few weeks ago) and download the file. If you have forgotten your password, you can reset it at the bottom of the MiShare login page. If you haven’t picked up a file from MiShare recently, you will receive two emails from the MiShare system—the first will allow you to sign on to the system and change the password for the account that has been created for you, and the second will contain a link to log into the system to pick up the package. You must retrieve the file within 4 days of receiving the notification email or the package will expire.

Because of the holiday and the weekend, if you do not have a chance to pick up your files before they expire next Tuesday, MDC will repost the files automatically (You do not need to contact MDC).

We will only repost the files for those POs that did not have anyone in their organization pick up the files. If someone in your organization picked up the files, but you still need the file reposted, please contactthe MDC. Please feel free to contact the MDC at MichiganDataCollaborative@umich.edu with any questions regarding the file retrieval process or the Attributed Patient Lists.

Patient Success Stories

The potential of care management to improve patients’ lives, care experiences, and outcomes is powerful. For example, we recently spoke to a patient who recognized the MiPCT program and said that she and her husband were both losing weight as a result of their interaction with their Care Manager. Their doctor described the program to the couple and referred them to the Care Manager because one had diabetes and the other needed to lose weight. She said they are both very happy with the program!

A tool has been created to capture care managers’ stories of success with patients as they occur.

The tool is available at:

Care Management Success Stories.

Please encourage your Care Managers to “share their success”!

Operations User Group

The MiPCT Operations User Group will be starting again August 1, 2012. The purpose of the group is to provide a forum for POs and practices to discuss barriers and solutions in the implementation of the MiPCT Project. If you would like to participate but are not already on the Operations User Group email list, please contact Amanda First, Project Associate, at afirst@umich.edu.

Six Features of Medicare Coordinated Care Demonstration Programs that Cut Hospital Admissions of High-Risk Patients

In an article recently released in Health Affairs, researchers at Mathematica Policy Research found that four of eleven programs participating in the Medicare Coordinated Care Demonstration weresuccessful, reducing hospitalizations up to 33% while maintaining budget neutrality. Those programs that were successful in reducing hospitalizations had six common characteristics:

1) Frequent in-person contact between the care manager and the patient (about once a month).

2) Frequent contact between the care manager and the physician.

3) The care manager relayed key information to theprimary care physician, keeping him or her up to date on the patient’s condition. For example, the care manager would inform the physician if a patient failed to adhere to medications or if the patient’s condition worsened.

4) Patient education programs were evidence-based,focusing on both knowledge and behavior change.

5) Care managers had reliable information on patient’s medications and were able to effectively teach their patients how to take medications properly. The care managers were also able to quickly contact a pharmacist or a physician with questions.

6) Care managers received timely notification of patient hospitalizations. In addition, they communicated with hospital staff, visited the patient in the hospital, reviewed discharge instructions, and followed up with  the patient after discharge.

The full article can be found here: Randall S. Brown, Deborah Peikes, Greg Peterson, Jennifer Schore and Carol M. Razafindrakoto. Six Features of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions of High-Risk Patients. Health Affairs, 31, no.6 (2012): 1156-1166.

 

June 25, 2012

Payment Updates

Medicare: No change.

Medicaid:

We are receiving many inquiries regarding Medicaid practice transformation payment status. As we research the payment issues, we have discovered some erroneous payments were made, we are correcting and processing payment adjustments. Please carefully review your remittance advice and compare your first quarter payment with the Medicaid attribution list provided by your PO. Please report any payment discrepancies to MIPCTdemo@michigan.gov.

PLEASE REPORT PAYMENT DISCREPANCIES BY JULY 6, 2102 TO ENSURE ACCURATE PROCESSING OF SECOND QUARTER MIPCT PAYMENTS, SCHEDULED FOR MID JULY.

PLEASE DO NOT CALL THE CHAMPS PROVIDER HELP LINE WITH MIPCT PAYMENT QUESTIONS, PLEASE CONTACT THE MIPCT MAILBOX.

Please note that your MIPCT practice transformation payments are issued quarterly (not monthly) and sent to the corresponding location of the Tax ID or NPI as currently entered in the Medicaid CHAMPS system. The location in the CHAMPS system may not be specific to your practice. If your practice transformation payment does not come to your practice location and you wish to direct the payment to your practice location, you must change your provider enrollment information in the CHAMPS system. If you change your provider enrollment information in CHAMPS, it will direct all of the payments issued from Michigan Medicaid to your practice location.

BCBSM: No change.

BCN: No change.

Care Manager Training Requirements for BCBSM PDCM Billing

Hybrid Care Managers (HCMs) and Complex Care Managers (CCMs) can provide care management and are able to bill for the visit per BCBSM MiPCT care coordination for moderate risk patients once they have completed MiPCT approved self-management training. Moderate Care Managers (MCMs) must compete a MiPCT approved self-management program to bill for the visit per BCBSM MiPCT requirements.

Training requirements for the CCM includes completion of:

a) MiPCT Self-Management Program, and

b) MiPCT Complex Care Management one week course.

Requirements for 6-Month Incentives: What defines a “trained” care manager?

Moderate Care Managers:

Completion of a MiPCT approved Self-Management program is required. A course certificate or CE document will serve as evidence of completion of the MiPCT approved self-management training. The documentation to verify course completion is to be maintained by the PO or practice.

Complex Care Managers (CCMs) and Hybrid Care Managers (HCMs):

  1. ) Completion of a MiPCT approved Self-Management program is required. A course certificate or CE document will serve as evidence of completion of the MiPCT approved self-management training. The documentation to verify course completion is to be maintained by the PO or practice.
  2. ) Completion of the intensive one week MiPCT Complex Care Management (CCM) training program OR registered online for an upcoming MiPCT CCM course meets the requirement of “trained”. The Michigan Care Management Resource Center will verify CCM course completion and on line CCM course registration for upcoming dates.

How do I calculate the number of care managers needed?

To calculate the number of complex care managers (CCM), moderate care managers (MCM) and/or hybrid care managers (HCM) required for the MiPCT 6 month incentives, please use the MiPCT attribution counts as of March 2012. Actual counts should be used for BCBSM, Medicare and Medicaid. For BCN, please use the latest MiPCT beneficiary listing or estimate available to you.

The required ratio is 1 CCM and 1 MCM per every 5,000 attributed MiPCT patients. For example, if a practice had the attribution count listed below, they would have 10,000 MiPCT attributed patients in total.

  • • 5,000 BCBSM
  • • 2,000 Medicare
  • • 1,000 Medicaid
  • • 2,000 BCN

In this example four full time equivalent (4 FTEs) care managers are required to reach full MiPCT staffing. A staffing model that could be used in this example is 2.0 FTEs MCMs and 2.0 FTEs CCMs. At least 80% of the 4.0 FTE care manager total must be hired and have met the HCM, CCM, MCM training requirements as described above, to receive full credit for this measure on the 6-month metric.

Clarification: Upcoming MiPCT Approved Self-Management Training:

The 6/18 FLASH “Important Dates” included upcoming MiPCT approved self-management training programs, and the dates for each training. The training programs listed are available for MCMs, CCMs and HCMs that have not completed a MiPCT approved self-management training, and are in process of reviewing the MiPCT approved self-management programs. The MiPCT approved Self-Management Training programs listed in the “Important Dates” section of the 6/18 FLASH included: PTI Moderate Care Manager training, Empowerment Based Care Management and Skills Training Level 1, Health Navigator Care Manager Support.

Details of the MiPCT approved self management programs can be found on mipctdemo.org. Click on the “Care Management Resource Center” tab, and select the document “MiPCT Approved Training Programs Self-Management Support.”

Upcoming MiPCT Approved Self-Management Training:

Title: Empowerment based case management and skills training Level 1:

Location:  Ann Arbor, MI

Contact: Cecilia Sauter, csauter@umich.edu

Schedule: July 23 and July 30 from 8 AM to 12 noon

Title: Health Navigator Care Management Support program

Location: Baker College – Flint, MI

Contact: Patti Dubie, pdubie@genesys.org

Schedule: August 9, 16, 23, 2012 8:30am-4:30pm

Title: Learning Action Network Moderate Care Management Program

Location: Holiday Inn, Battle Creek, MI

Contact:  Ruth Clark, clarkru@bronsonhg.org; 269-245-3852

Schedule: Five full-day sessions and 6-7, two hour webinars; Dates to be determined; need minimum class of 12 to hold sessions

Title: Practice Transformation Institute, Moderate Care Management Training

Summer Series A 2012:

Contact: Mike Mellor at mmellor@transformcoach.org or 248-475-4867

Schedule: July 24, 25, 31 & August 1;

8:30am- 4:30 pm

Location: Madison Heights, MI

Title: Practice Transformation Institute, Moderate Care Management Training

Summer Series B 2012:

Contact: Mike Mellor at mmellor@transformcoach.org or 248-475-4867

Schedule:

July 21, 28 & August 4, 11; 8:30am-4:30pm

Location: TBD, East Lansing, MI

Care Manager Training Requirements necessary for G-Code Billing* per BCBSM, BCN, BCBSM Medicare Advantage

Services provided by Care Managers are billable once Care Managers complete the following training requirements:

  1. a. Moderate care managers must complete a MiPCT approved self-management program.
  2. b. Complex Care Managers and Hybrid Care Managers must complete a MiPCT approved self management program and either complete the Complex Care Management (CCM) course or be registered on line for the CCM course.

HCMs and CCMs can provide care management for moderate risk patients once they have completed a MiPCT approved self-management training.

*Note: G code billing is also referred to as PDCM billing.

Pediatric and Family Medicine Care Manager Training:

SAVE THE DATE!

Pediatric complex and hybrid care managers:

Save Thursday, September 20, 2012, for a full day of pediatric-specific training. We will send more details (time and place) soon.

Pediatric moderate care managers:

Specific training for pediatric moderate care managers is in the works.

Family medicine care managers: Stay tuned – we are working on training to meet your needs as you work with children and youth.

EHR User Groups

Several practices have asked to be involved in EHR User Groups in order to determine how to best solve some of the technical problems associated with their EHR.

MiPCT does have information on the EHRs used by each practice, so we would like to know your thoughts

on whether we can share this information with other practices in MiPCT in order to facilitate these groups.

Please send comments to mipctdemo@michigan.gov.

G-Code Reminder

G-codes should only be billed for BCBSM and BCN. Please do not bill Medicare for G-Codes, as these will be denied, likely with an N365 remark.

Learning Collaborative:

Embedment of Care Managers

Training of care managers – moderate, hybrid and complex, has been a critical first step in the MiPCT initiative. To date, we have trained 202 care managers. Research has demonstrated that effectiveness of care management correlates to its close relationship to the primary care delivery team. Embedded care managers have demonstrated improved outcomes with associated decreased cost. This is a critical step to reaching budget neutrality.

The process of embedding care managers will require redesign of the practice team. At the June BCBSM PGIP meeting, physician organization leadership discussed this process of embedding care managers. Participants responded to the following question:

“On a scale of 1- 10, how effectively embedded are your care managers in your primary care offices?”

MiPCT will be conducting regional learning collaboratives in late Fall 2012 to facilitate the transformation of practices to effectively embed care managers into primary care practices. These collaboratives will follow the proven IHI Breakthrough Series Methodology for quality improvement. Practice teams will be composed of providers, clinical staff, front desk clerks and care managers from the practice. These teams will participate in three in-person sessions, with supportive webinars between sessions over a six-month period. There will be no cost for participation in the collaborative – only the time, energy and passion for change will be required of the teams.

When queried on what are key issues needed to be addressed for successful embedding of care managers, the following topics were discussed:

1. Getting PCP engagement

2. Educating office staff on the role of the care manager; creating clear roles/responsibilities for care management

3. Making sure that backfilling happens when care managers are selected from existing staff

4. Getting discharge notifications from hospitals

5. Making sure that care managers get member lists from POs

6. Finding and using resources in the community (community linkages)

Ninety six percent of organizations present expressed interest in being involved with the learning collaboratives, and fifty seven percent of them were very interested. If you would like more information, or have feedback on the issues to be addressed, please contact us at mipctdemo@michigan.gov.

June 18, 2012

Michigan Primary Care TransformationPayment Updates

Medicare: No change.

Medicaid: No change.

BCBSM: No change.

BCN: No change.

Medicaid Attribution Lists

A file of Medicaid managed care patients who are attributed to their MiPCT-participating practice units for June, 2012 was sent to each participating MiPCT PO on June 12. Each PO should have received an automated email from MiShare at the University of Michigan Health System Notification Service withe the subject, “New Package is Waiting.” The email contained a link to follow to download the file.

If the email from the MiShare system was not received, check your “Spam” mailbox, as we have heard from a few people that the email hit their spam filter. If someone from the PO did not pick up the file from the MiShare system after 4 days, please contact the Michigan Data Collaborative so the file can be reposted for pick up (the files expire after 4 days).

As always, contact the Michigan Data Collaborative at MichiganDataCollaborative@umich.edu with any questions regarding the file retrieval process or the Automated Patient Lists.

Clarification on Status of Mid-Level Providers

Last week’s FLASH referenced that mid-level providers (e.g. NPs, PAs) are not included in MiPCT at this time. To clarify, though mid-level providers are certainly eligible to serve as care managers, they do not, in MiPCT thus far, have patients directly attributed to them as primary care providers.

Mid-levels play a critical role in the care process, and can function as care managers and provide services in the model. As you may already know, the G-Code billing allows for services to be provided under a physician at 100% of the G-Code, or under an NP or PA at 85%.

 Pediatric Care Management Training Update

MiPCT is providing additional training for care managers working with pediatric patients. We started with a pediatric breakout session during the Complex Care manager training. We are planning a face-to-face meeting in September, as well as some web-based modules. We are designing a program that will meet the needs of complex and moderate care managers. More information will be shared soon.

Physician Organization Advisory Council (POAC) Update

In last week’s edition of the FLASH, we reported on the creation of a new advisory council to facilitate collaboration between the MiPCT Steering Committee and our primary care providers in the transformation of our primary care delivery systems across the state.

The council would meet quarterly in a central location, likely Okemos or Lansing.

Ideal POAC candidates would either be physician leaders from participating MiPCT POs, or non-physician PO leaders with the ability to influence physician practice, and facilitate desired MiPCT outcomes. Proposed candidates will be reviewed by the Steering Committee this summer.

Please use the following link to fill in the online form to nominate a candidate for this important council:

https://jodyooo.wufoo.com/forms/poac-nomination-form/

We are accepting nominations for the POAC through Monday, June 25.

Literature Links

Attached to the FLASH email, you will find a link to a new Commonwealth Fund Issue Brief exploring the benefits of practice coaching, entitled: Facilitating Improvement in Primary care: The Promise of Practice Coaching, (Grumbach/BainBridge). We will include this link on the http://www.mipctdemo.org website’s FLASH page as well, for your convenience.

June 11, 2012

Paul Grundy, MD, Director of Healthcare Transformation at IBM and president of the Patient-Centered Primary Care Collaborative (PCPCC), lauds MiPCT practices and physician organizations for their hard work at the MiPCT Update session of the June 8 PGIP Quarterly Meeting.

Payment Updates

Medicare: No change.

Medicaid: Please note that Medicaid has decided to continue to send MiPCT payments on a quarterly basis.

BCBSM: No change.

BCN: No change.

Open Registration for MiPCT Complex Care Management Training Begins Today

 MiPCT is moving to an open registration process for Complex Care Management (CCM) training beginning today after 5 pm. Please direct CCMs and HCMs that have not previously registered online for the CCM course to the section of the MiPCT website entitled “CCM Online Registration Page.”

Once the CCMs/HCMs register online, they will receive an email confirmation which will include the address and details regarding the training session. The remaining training slots will be available on a first-come, first-served basis, so early registration is encouraged.

NOTE: CCMs and HCMs who were confirmed for a specific training session as of last week should have received an email from Jody Fisher, MiPCT Project Assistant, with instructions to register online by Friday June 8, 2012. A “confirmed” seat will no longer guarantee a spot in the training – the CCM/HCM must be “registered.” The online registration by the HCM/CCM by the 8th was the final important step to ensure the session date is reserved for the HCM/CCM. If a CCM/HCM with a confirmed seat did not register online, their seat may be lost once the open registration begins after 5 today.

New Physician Organization Advisory Council

The MiPCT Steering Committee understands the importance of collaborating with our primary care providers in the transformation of our primary care delivery systems across the state. MiPCT will establish a Physician Organization Advisory Council (POAC) to assist with this collaboration. Important programs and initiatives within MiPCT will be communicated to the POAC with intent of receiving feedback, consultation and course corrections as needed. This will also be a forum to discuss challenges to implementation experienced by the participating providers, and will augment feedback from MiPCT Steering Committee PO representatives.

It is anticipated that the statewide POAC meetings would occur quarterly in a central location, likely in the Okemos/Lansing area. Regional subgroups may also be formed to disseminate the recommendations of the group.

The MiPCT Steering Committee will decide membership for the POAC. We request Physician Organizations submit nominations for the POAC from members of the PO who demonstrate leadership and decision-making authority. The selection process will ensure geographic representation on the POAC. Please review the attached POAC Charter. If you are interested in submitting the name of someone in your organization for membership in the POAC, please complete the attached form and submit to the MiPCT mailbox (mipctdemo@michigan.gov) with the subject heading “POAC membership request.” Thank you for your support of this important initiative.

Status of Mid-level Providers

Mid-level providers are a valuable asset to primary care and the patient-centered medical home, and Medicaid and Medicare are exploring the possibility of adding them to the MiPCT Demonstration Project. However, please note that they are not included at this time. MiPCT will update you if and when this changes.

Clinical Subcommittee Seeks Expertise in Pharmacy, Behavioral Health, Care Management, Operations

The MiPCT Clinical Subcommittee, charged with development of the clinical model and identification of interventions to improve clinical processes and outcomes, is seeking nominations (self-nominations are okay) for members with the following skill sets:

  1. Pharmacy
  2. Behavioral Health
  3. Adult Care Management (RN and social worker)
  4. Pediatric Care Management (RN and social worker)
  5. PO Operations

The Clinical Subcommittee meets the third Monday of the month from 3:00 to 5:00 p.m. at the Michigan Public Health Institute in Okemos, Michigan. A call-in option is available.

Please provide the nominee’s name, degree, contact information, employment information and a brief description of the experience/skills they would bring to the Committee to the MiPCT mailbox (mipctdemo@michigan.gov). MiPCT leadership will review the nominations and send invitations to the selected individuals.

June 4, 2012

Payment Updates

Medicare: Medicare care coordination payments have been distributed to POs for February and March. Please keep in mind that the amount distributed was dependent on the amount received from CMS for your attributed patients. A frequently asked questions (FAQ) document is attached to this update as a helpful tool. Hereafter, to speed payments to POs, distribution will be on a monthly basis.

Medicaid:  Medicaid also successfully distributed care coordination payments.

BCBSM:  At the June 8th PGIP Quarterly meeting, an MiPCT update session will be held. The update will focus on care management and the clinical model. A special guest speaker will also be featured, along with an interactive session to obtain your input on learning collaboratives for the MiPCT.

BCN:  To provide assistance in understanding how to identify BCN attributed members, the MiPCT session of the PGIP Quarterly Meeting on June 8th will also include a segment on using BCN Health e-Blue.

New, Easier MiPCT Complex Care Manager (CCM) Training Registration Process Begins Monday, June 11, 2012

To date, approximately 73 Complex Care Managers (CCMs) and Hybrid Care Managers (HCMs) have been trained, and an additional 125 are in the registration process for the MiPCT Complex Care Manager Training.

For the current process of CCM course registration, the Master Trainers to date have communicated with PO Leaders. The Master Trainer and PO leader worked together to identify names and email addresses for CCMs and HCMs, and confirmed the course date for each Care Manager. This week, each CCM and HCM for the CCM or HCM, so they do not lose it once open registration begins on June 11.

For the CCMs or HCMs who are not yet trained and do not have a confirmed course date, please note that a new CCM course registration process will begin on Monday, June 11, 2012. On this date, Complex Care and Hybrid Care Managers will be able to go directly to the “CCM Training Registration” option on the CMRC tab of the MiPCT project website (www.mipctdemo.org), register for an upcoming training session, and receive an email confirmation which will include important information, such as the address of the training session.

All open slots for the remaining sessions will be posted. This will eliminate the need for POs or Care Managers to email availability, request a date, then be assigned to a training date. The new process of self-registration means that remaining session slots will be available on a first come-first served basis, so early registration is encouraged.

Please note that:

  • Care Managers should carefully consider their availability, verify that their PO and/or practice supports their selected training session date, and ensure that they have no personal calendar conflicts for their preferred training session, as only one registration per Care Manager is permitted, and registrations are final.
  • Multiple registrations by the same person for multiple session dates are not permitted, and are subject to cancelation and rescheduling after others have completed training.
  • In the event of an emergency, if a Care Manager needs to cancel their registration, they must contact Jody Fisher (fishjody@umich.edu) as soon as possible via email with “CCM Training Registration Issue” in the subject line. Jody will manually remove the registration, reopening the slot for others. Please note, though, that the Care Manager’s rescheduling for another session can only be accommodated after others have completed training.

Important Dates:

  • 6/08  PGIP Quarterly Meeting with an MiPCT update session on care management and the clinical model.
  • 6/11  Open Registration Begins for CCM Training Sessions!

DCG Risk Scoring Information

As you may have seen, the slides from the 5/1/2012 webinar on DCG Risk Scoring were posted on the project website under the “Resources” tab in the “Presentations” section. A Q&A document has also recently been posted there summarizing the questions posed during and after the webinar. Contact the Michigan Data Collaborative at MichiganDataCollaborative@umich.edu if you have additional questions about this topic.

Medicaid Patient List Distribution

Last week, all MiPCT participating POs received a file of Medicaid managed care patients who are attributed to their MiPCT-participating practice units for May 2012. Each PO should have received an automated email from MiShare at the University of Michigan Health System Notification Service with the subject “New Package is Waiting”; the e-mail contained a link to follow to download the file. If you did not receive the email from the MiShare system check your ‘Spam’ mailbox, as we have heard from a few people that the email has hit their spam filter. If someone from your organization did not pick up the file last week from the MiShare system, please contact the Michigan Data Collaborative so the file can be reposted for pick up (the files expire after 4 days). As always, please contact the Michigan Data Collaborative at MichiganDataCollaborative@umich.edu with any questions regarding the file retrieval process or the Attributed Patient Lists.

Do Your Care Managers Have Success Stories to Share?

The potential of care management to improve patients’ lives, care experiences, and outcomes is powerful. A tool has been created to capture care managers’ stories of success with patients as they occur.

The tool is available for your Care Managers at: https://jodyooo.wufoo.com/forms/stories-of-your-care-management-success/. Please share this with your Care Managers and encourage them to “share their success”!

May 21, 2012

Payment Updates

Medicaid: Medicaid care coordination payments to POs should be issued on May 24th.

Medicare: Medicare February and March care coordination payments to POs are on track for distribution in June. After this, distribution will be distributed on a monthly basis to speed timing of receipt for POs. CMS is also developing a summary report for practice transformation payments. They do not yet have a delivery date for the report. When a date is available, it will be relayed.

BCBSM: BCBSM has an upcoming PGIP quarterly meeting on June 8. There will be a segment on MiPCT for interested participants. Additional updates from BCBSM include: Some PDCM claims are being denied because the patients are in self-funded groups that have not yet elected to participate in PDCM. Please ensure that practices check their monthly patient lists for eligibility before providing services to patients. Special reminder to PDCM Pilot POs that some patients covered under the pilot may not be covered as of April 1, 2012—so please check your PDCM monthly patient lists.

The MiPCT Complex Care Management training is offered in June, July and August 2012. To date, capacity for training is being met by sessions that are scheduled through July 16, 2012. Complex Care Managers and Hybrid Care Managers who have completed self-management training and have registered on line or on a wait list for the MiPCT Complex Care Management training may begin billing BCBSM for PDCM codes effective immediately. This will enable BCBSM to avoid making another payment from the PGIP incentive pool to support PDCM services. Please note that MiPCT will provide BCBSM with a list of CCMs and HCMs who registered on line for the MiPCT Complex Care Management Training and will update BCBSM when the individual CCM/HCM has completed this training. This information will be used by BCBSM audit staff during post-payment reviews.

BCN: BCN will provide a briefing on how to use the BCN MiPCT patient listings at the PGIP meeting on June 8th.

Disregard Email from RTI: On May 9th, RTI (CMS’ national evaluator) inadvertently sent an email to Michigan POs regarding access to RTI’s MAPCP portal. You may ignore that email. RTI intended to send the email only in states who do not intend to send integrated reporting across payers. In Michigan, all MiPCT reporting available through a single source which will be the web portal provided by the Michigan Data Collaborative (MDC). MiPCT project leadership and analysts reviewed the reports that RTI designed for their Medicare-only portal, and incorporated the elements relevant to the MiPCT project into the MiPCT reports. This is one way we are working to try to keep the MiPCT information overload to a manageable level.

Reminder to POs: Please Distribute MiPCT Member Listings to Care Managers — Care managers were asked in CCM training whether or not they receive the MiPCT member listings for each payer. Several indicated that they do not. For the care managers to perform services, they require the lists. Please ensure that they are distributed by your PO to practices.

Complex Care Management Training Updates:  To date, three MiPCT Complex Care Management (CCM) courses have been provided regionally in Michigan during April and May, 2012. To date, 73 CCM/HCMs have completed the MiPCT Complex Care Management Course.

Upcoming Complex Care Manager Training Dates

6-4-8, 2012 CCM Training* Grand Rapids

6/4-8, 2012 CCM Training* New Hudson

6/18-22, 2012 CCM Training* Lansing

6/18-22, 2012 CCM Training* Madison Heights

7/9-13, 2012 CCM Training* Lansing

7/16-20, 2012 CCM Training* Okemos/Marquette

8/20-24, 2012 CCM Training* Lansing

* The course is a full-week, Monday through Friday, 8:00 a.m. to 5:00 p.m. CCMs and HCMs must attend the entire week of training in order to participate. Master Trainers are currently working with POs to register CCMs and HCMs for the Complex Care Management training dates. If you have questions regarding CCM training, please submit via e-mail to mipctdemo@michigan.gov.

Geisinger Licensed Complex Care Management Tools for MiPCT-Update: As part of the MiPCT Complex Care Management course, CCMs and HCMS receive training on the Geisinger licensed tools which include Care Manager and Patient encounter visit documentation templates and Self-Management Action Plans for 10 clinical topics.

Documentation templates include:

  • a) Comprehensive Assessment
  • b) Transitions of Care
  • c) Return Visit Note

Self-Management Action Plans (SMAPs) are chronic condition/diagnosis-specific patient handouts. An example of content includes monitoring symptoms, eating right plan, medications, who to call, and when to call. SMAP topics: After surgery, Asthma, COPD, HF, Diabetes, HTN, Osteoporosis, Stop Tobacco Use, Urinary Tract Infection, General complex care management.

Legal information regarding Licensure of the Geisinger Tools

Attached please find the “Geisinger Licensed Tool FAQ” document, which specifies the basic legal requirements.

Also attached, is the Physician Organization Attestation letter. This is an agreement statement between Geisinger and the Physician Organizations related to utilization and licensure of the Geisinger Licensed Complex Care Management Tools.

How will the Geisinger Licensed Complex Care Management Tools for MiPCT be distributed?

Tools may be accessed by the Physician Organization using the following process:

Physician Organizations may request the Geisinger Licensed Complex Care Management tools using the following steps:

  • Sign the Geisinger Attestation Letter and submit an electronic copy via e-mail to mipctdemo@michigan.gov, and send a hard copy to the Michigan Department of Community Health by mailing it to:

MiPCT Project,PO Box 30195,Lansing MI 48909,ATTN: Linda Pappas

  • Upon completion of the Attestation letter, and receipt of request for tools, the MiPCT team will send the PO the Geisinger Licensed tools.
  • POs may request and receive these tools, prior to CCMs/HCMs completing the MiPCT CCM course.

Tools may be accessed by the MiPCT CCMs/HCMs:

  •  CCMs/HCMs receive a hard copy of the Geisinger Tools during the MiPCT CCM course.

Coming Soon:  Once CCMs/HCMs complete the MiPCT CCM course, they will receive a user name and password to access a password protected section of the Michigan Care Management Resource Center website. The tools may be accessed by MiPCT CCMs/HCMs via the micmrc.org website. MiPCT team will provide further details regarding the website in the near future. The planned “go live date” for the Michigan Care Management Website is 6/4/12. For additional details, please refer to the recorded MiPCT Webinar 5.17.12 “Integrating Care Managers within Practices” on mipctdemo.org.

Do Your Care Managers Have Success Stories to Share? The potential of care management to improve patients’ lives, care experiences, and outcomes is powerful. A tool has been created to capture care managers’ stories of success with patients as they occur. The tool is available for your care managers at: https://jodyooo.wufoo.com/forms/stories-of-your-care-management-success/. Please share this with your care managers and encourage them to “share their success”!

Provider/Staff Experience Survey  THANK YOU for the Great Response to the Provider Survey — POs have been contacted by MPHI to provide an update on the number of responses from each of your practices to the provider/staff experience survey. We really appreciate the work you have done to promote the survey. As of Sunday, we have received a total of 2,303 responses (out of over 4000 expected responses).

Some POs need additional time, and in response we have extended the deadline to Tuesday, May 29. As a reminder, the survey is to be filled out by the following categories of providers and staff within practices: physicians, NPs, PAs, RNs, MAs, LPNs, practice managers, referral coordinators, care managers, social workers, RDs, clinical diabetes educators, receptionists, and other members of the primary care team. The goal is to have enough respondents to be able to provide PO-feedback reports, while scrupulously protecting the confidentiality of the respondents.

The link is http://www.surveymonkey.com/s/F98XJP8. If electronic submission is problematic for your practices and you require paper copies and return envelopes, or if you have other questions, please contact Clare Tanner at: ctanner@mphi.org, (517) 324-7381.

Have a Change in PO Contact Information? If you have a change in any of your contact information, and haven’t already reported this on your Quarterly Report, please email Linda Pappas (pappasl1@michigan.gov), or Jody Fisher (fishjody@umich.edu) to ensure you will continue receiving important information from the MiPCT.

About the MiPCT Monday FLASH  The MiPCT Monday FLASH is a publication which compiles important information all in one place for your convenience. The information in the FLASH will be posted on the MiPCT website (www.mipctdemo.org) as it is published, and historical issues will be kept there for your easy reference.

If you have a question about the information in this publication, please email mipctdemo@michigan.gov.

May 14, 2012

Payment Update

BCN: We have received questions about how BCN MiPCT patients can be identified. Please note that BCN is in process of outreach to their self-insured groups, and so to obtain BCN MiPCT patient counts, use the Health e-Blue web tool and exclude the groups with “self-funded” in their name. As BCN completes its outreach to the self-insured groups, additional members will be added for the self-funded groups that agree to participate.

BCBSM: According to CMS guidelines, all Medicare Advantage (MA) patients should have the Wellness visit annually (billed under G0438). Many MA members may also benefit from a Care Coordination assessment (billed under G9001 and provided by an RN, PA, CNP, or MSW care manager). The MiPCT care manager should bill all G9001 MA comprehensive assessments under the ordering provider in order to meet CMS requirements for MA patients.

Medicaid: The first quarter (Jan- March 2012) Medicaid Practice Transformation Payments processed successfully on May 3, 2012. Each payment has a comment indicating it is a MIPCT payment and the associated quarter. This information is reflected on the remittance advice.The first quarter care PO coordination payments did not process successfully. The error has been identified and the programming fix is in production. PO Payments are expected to process on May 25, 2012. We apologize for the delay and inconvenience.

Medicare: The quarterly provider file was submitted to CMS on May 11th. Practice and provider changes that were reported have been incorporated. Practices should receive practice transformation payments from CMS by May 23rd.

The CMS care coordination payment distribution to POs is targeted to begin in June. The June payment will include the amounts received for February and March, 2012. (The January payment for care coordination was withheld for complex care coordination training.) To speed flow of funds to POs in the future, subsequent payments to POs will be made monthly (approximately every 4-6 weeks).

Important Dates:

  • 5/15/12:   Look for an email with the dates available to each PO to schedule care managers for CCM Trainings occurring June through August, 2012, (see article in this issue, page 2).
  • 5/17/12:  4:00-5:00 PM, Webinar: “Integrating Care Managers within Practices: Useful Tools and Checklists for POs, Practices and Care Managers”. Look for a reminder email this week with dial-in information for the webinar.
  •  5/21/12: Provider/Staff Experience Survey Due, (see article in this issue, page 2).
  • 5/23/12:  Practice Transformation Payments from CMS should be received by this date.

Physician Outreach Opportunity

The MiPCT Clinical Leadership Team extends an offer to meet with physician leaders, POs and practices to explore barriers and solutions to practice change. If you are interested in scheduling a session, please contact Jody Fisher (fishjody@umich.edu) and supply her with preferred dates and timeframes, as well as whether you prefer an in-person or phone discussion.

Upcoming Complex Care Manager Training Dates

6/4-8, 2012 CCM Training* Grand Rapids

6/4-8, 2012 CCM Training* New Hudson

6/18-22, 2012 CCM Training* Lansing

6/18-22, 2012 CCM Training* Madison Heights

7/9-13, 2012 CCM Training* Lansing

7/16-20, 2012 CCM Training* Okemos/Marquette

8/20-24, 2012 CCM Training* Lansing

*You will be contacted by 5/15/12 with the dates that are available for your organization to schedule Complex Care Managers (CCM) and Hybrid Care Managers (HCM) for the Complex Care Manager Training course. The course is a full-week, Monday through Friday, 8:00 a.m. to 5:00 p.m. CCMs and HCMs must attend the entire week of training in order to participate.

Do Your Care Managers Have Success Stories to Share?

The potential of care management to improve patients’ lives, care experiences, and outcomes is powerful. A tool has been created to capture care managers’ stories of success with patients as they occur. The tool is available for your care managers (here). Please share this with your care managers and encourage them to “share their success”!

Provider/Staff Experience Survey

Thank you for the great response many of you have shown for the provider/staff experience survey. As of Sunday, May 13, 2012, we have received 731 responses (out of over 4000 expected responses).

As a reminder, please be sure that the survey link is disseminated to the following categories of providers and staff within practices: physicians, NPs, PAs, RNs, MAs, LPNs, practice managers, referral coordinators, care managers, social workers, RDs, clinical diabetes educators, receptionists, and other members of the primary care team. The link is (here). Practice staff should test their ability to access the survey soon – one office has found that their computer settings do not allow them to access the survey. In this case we are making alternative arrangements. The survey is due Monday, May 21.

If you have any questions, please contact Clare Tanner (ctanner@mphi.org), (517) 324-7381.

Have a Change in PO Contact Information?

If you have a change in any of your contact information, and haven’t already reported this on your Quarterly Report, please email Linda Pappas (pappasl1@michigan.gov), or Jody Fisher (fishjody@umich.edu) to ensure you will continue receiving important information from the MiPCT.

About the MiPCT Monday FLASH

The MiPCT Monday FLASH is a publication which compiles important information all in one place for your convenience. The information in the FLASH will be posted on the MiPCT website (www.mipctdemo.org) as it is published, and historical issues will be kept there for your easy reference.

If you have a question about the information in this publication, please email mipctdemo@michigan.gov.

May 7, 2012

G-Code Clarification for G9001

Initiation of Care Management (Comprehensive Assessment) G9001  Coordinated Care Fee, Initial Rate (per case)

This code should be used to bill for the comprehensive assessment and care plan development activities conducted with patients prior to enrollment in care management (and annually thereafter). Information is collected through interaction and communication with the member or member’s representative/caregiver for the purpose of developing a goal-based care management plan tailored to the patient’s unique personal needs, interests and capabilities. Assessment and planning encounters may be by phone and/or face-to-face, and multiple contacts may be required. In order to bill the G9001 code, at least one of these encounters must be in-person. This code is inclusive of the totality of contacts necessary to complete the full assessment and develop the individualized care plan for the patient, including consultations with the patient’s PCP, other professionals, and/or care-givers, etc.

Due Soon! Important Upcoming Dates:

5/8/12 Quarterly Reports for January starters are due on Tuesday, May 8, 2012.

A Reminder for Providers

BCBSM member lists may not always be 100% accurate in identifying members with high deductible plans.

To avoid any member sticker shock, please ask providers to be sure and tell members (before they begin receiving care management services) that “IF” they have a HDHP/HSA they will still be responsible for their deductible.

Medicare EOB Update

The Center for Medicare and Medicaid Services advised earlier in the year that these payments had been included on the EOB statements that beneficiaries can access online. In an effort to decrease patient confusion, CMS has notified that they have successfully suppressed the MiPCT payments on Medicare EOBs. They implemented this “fix” to their system the weekend of April 28-29, 2012.

Care Manager Staffing for MiPCT 6-Month Incentive Metric Staffing Calculations

To calculate the number of complex care managers (CCM), moderate care managers (MCM) and/or hybrid care managers (HCM) required to serve MiPCT patients at the practice site, please use the MiPCT attribution counts as of March, 2012. Actual counts should be used for BCBSM, Medicare and Medicaid. For BCN, please use the latest MiPCT beneficiary listing or estimate available to you.

For example, if a practice had:

  • 5,000 BCBSM,
  • 2,000 Medicare,
  • 1,000 Medicaid, and
  • 2,000 BCN patients attributed to the MiPCT,

they would have 10,000 MiPCT attributed patients in total. At the required ratio of 2 care managers per every 5,000 attributed MiPCT patients, four (4) care managers would be required to reach full MiPCT staffing. At least 80% of this total must be hired with training scheduled or completed to receive full credit for this measure on the 6-month metric.

News From the Michigan Data Collaborative (MDC)

-Medicare and Medicaid Attribution Lists

The MDC sent each PO their attribution lists for Medicare and Medicaid patients last week. You should have received an April attribution list for Medicaid patients, and an April-June attribution list for Medicare patients. The files do not stay on the server for more than a couple days, and then they are automatically deleted. If you did not have a chance to download them when they were originally made available, please contact the MDC via e-mail at MichiganDataCollaborative@umich.edu and we will re-load your files to the secure server.

-Looking for PO “Authorizers”

We know you are anxiously awaiting reports from the multi-payer claims database, and we are working diligently to collect the data and build the reports. The reports will be distributed via a web portal which will require individual users from each PO to create user accounts.

This will allow us to be sure each PO receives only their data. To assist us with validating user account requests, we will ask each PO to designate 2 people from their organization to act as “Authorizers” for all users who register a user account to access their PO’s data. We’re asking for 2 people from each PO for this role to be sure we have coverage if someone is out of the office, or there are staffing changes at the PO.

The responsibilities of this role will be to verify new accounts and confirm existing accounts to remain open and active.

It will not be time consuming, but we will need you to be responsive to requests for validation. We will provide more detailed information about the requirements for this role when we are closer to creating user accounts. Please begin considering who you might designate from your organization for this role; they do not necessarily need to be the same staff who will access MiPCT reports for your PO. Thank you in advance for your help in protecting this data and ensuring it is only shared with the appropriate people.

Reminder from the MiPCT Evaluation Team

By now you should have received an MiPCT Provider and Staff Experience Survey from Clare Tanner.

There is a link to this survey on the MiPCT website (www.mipctdemo.org) on the FLASH page. This is a web-based survey designed to measure work life experience and satisfaction. Per the message, please remember to send the survey instructions with the survey link to all of your MiPCT-participating practices’ lead contacts; your participation is crucial to disseminating the survey. If you determine that staff at a practice are unable to access email and/or web-based surveys (e.g. Survey Monkey), please contact Clare Tanner at ctanner@mphi.org or (517) 324-7381 to discuss alternative administration protocols. The final date to submit surveys is Monday, May 21, 2012, and submitted surveys will be used by the MiPCT Evaluation Team to create aggregate reports tailored to your PO.

Upcoming Complex Care Manager Training Dates

  • 5/7-11, 2012 CCM Training* Ann Arbor
  • 6/4-8, 2012 CCM Training* Grand Rapids
  • 6/4-8, 2012 CCM Training* New Hudson
  • 6/18-22, 2012 CCM Training* Lansing
  • 6/18-22, 2012 CCM Training* Madison Heights
  • 7/9-13, 2012 CCM Training* Lansing
  • 7/16-20, 2012 CCM Training* Lansing/Marquette
  • 8/20-24, 2012 CCM Training* Lansing

*You will be contacted by 5/15/12 with the dates that are available for your organization to schedule Complex Care Managers (CCM) and Hybrid Care Managers (HCM) for the Complex Care Manager Training course. The course is a full-week, Monday through Friday, 8:00 a.m. to 5:00 p.m. CCMs and HCMs must attend the entire week of training in order to participate.

Directory Updates

If you have a change in any of your contact information, please email Linda Pappas (pappasl1@michigan.gov), or Jody Fisher (fishjody@umich.edu) to ensure you will continue receiving important information from the MiPCT.

About the MiPCT Monday FLASH

The MiPCT Monday FLASH is a publication which compiles important information all in one place for your convenience. The information in the FLASH will be posted on the MiPCT website (www.mipctdemo.org) as it is published, and historical issues will be kept there for your easy reference.

If you have a question about the information in this publication, please email mipctdemo@michigan.gov.