This document summarizes updates from the Michigan Primary Care Transformation Demonstration Project webinar on November 14, 2012. It discusses adding nurse practitioners and physician assistants as primary care providers, collecting success stories from care managers, enhancing eligibility checking capabilities, finalizing care management reporting requirements, and introducing community care team enhancements including new clinical and operations leads. Upcoming events mentioned include a practice meeting in December and the Mackinac Learning Collaborative in early December.
2. MiPCT and Mid‐level Providers
NPs/PAs that serve as PCPs and bill separately
have been added to the file.
The same billing information needed for
physicians is needed for NPs/PAs.
To receive Medicaid payments, the NP/PA must be
the PCP of record for Medicaid managed care
members and must be enrolled in CHAMPS.
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3. Documented Success Stories
Robert Wood Johnson video submitted
• Debby Kobayashi, LMSW
• William Porter, RN
Interviews by national research organization
completed
• Monroe Medical Associates: Tedd March, MD
• William Porter, RN
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4. Documented Success Stories
Care Managers were asked to provide a narrative
of a patient/family success story
Six submissions from care managers
Awaiting pediatric success story
Narratives will be sent to MiPCT for publication in
newsletter
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5. Enhanced Eligibility Capability
Providers can currently check whether a patient
has active BCBSM/BCN coverage using the Web‐
DENIS or CAREN IVR system
Pending functionality in Web‐DENIS that will allow
providers to check whether a patient is eligible for
PDCM/MiPCT
The process will be finalized in the next few
months
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6. Pay for Performance
The data for six month incentive distribution has
been secured
MiPCT is in process of rechecking each element to
ensure accuracy
Data collaborative at U of M is providing the
expertise to verify the data
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7. Pay for Performance
If incomplete information is submitted by a PO
follow up occurs
Incomplete information may be on a data element
or is in conflict with care manager training
completion
If this occurs, POs will receive their scores and will
review them during a one‐week appraisal period
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8. Care Management 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
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9. Care Management Reporting
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
Did referral to outside agency occur
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10. Community Care Team
Enhancements
Community Care Teams
• Community Care Travel Team
• Community Care Permanent Team
Bill Porter, RN: Community Care Clinical Lead
Erica Ross: Community Care Operations Lead
Dave Johnson, MSW: Behavior Health Consultant
Lori Zeman, PhD: Behavior Health Expert
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11. Community Care Team
Enhancements
Bill Porter, RN: Community Care Clinical Lead
Monitor clinical activities at all practice sites
Oversee case reviews with practice team and care
manager
Design quality improvement activities with practice
team and care manager
Work with Erica Ross to determine appropriateness
of care manager assignments
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12. Community Care Team
Enhancements
Erica Ross: Community Care Operations Lead
Monitor care manager assignments at practice sites
Working with Bill Porter and practice team to
determine appropriateness of care manager
assignments
Create and oversee satisfaction surveys and meet
with practice teams and physicians to include them in
pertinent assessments of care managers
Reviewing overall productivity statistics of care
managers
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13. Community Care Team
Enhancements
Erica Ross: Community Care Operations Lead
MNO Care Managers assignments and schedule
Monitor care manager assignments at practice sites
Working with Bill Porter and practice team to
determine appropriateness of care manager
assignments
Create and oversee satisfaction surveys and meet
with practice teams and physicians to include them in
pertinent assessments of care managers
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14. Community Care Team
Enhancements
Erica Ross: Community Care Operations Lead
Review overall productivity statistics of care
managers
Review statistics of care managers employed by
practices
Review requests from practice units for additional
assistance with various activities
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15. Upcoming Event
MNO MiPCT practice meeting on December 12,
2012 at the Polish Cultural Center Discuss Care
Manager integration
• Current payments
• Quarterly financial report
• Billing and coding
• Quality scores and all practice metric selection
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16. Upcoming Events
Mackinac Learning Collaborative IV
• December 5, 2012
• Kevin Taylor, MD and Lori Zeman, PhD co chair
• Topic focused on integrated, collaborative or co‐
located behavior health
• Currently behavior health specialists are integrated
into several adult and pediatric practice
• Hoping 100% participation from MiPCT Teams
Mini Learning Collaboratives
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