pdcm_faq_draft - mipct demonstration project web viewprimary care providers who have been bcbsm...

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Provider Delivered Care Management

Frequently Asked Questions


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Table of Contents

Table of ContentsThe Basics..............................................................................................................................................................................3

Patient Lists...........................................................................................................................................................................4

Training.................................................................................................................................................................................5

Billing and Coding..................................................................................................................................................................6

Oncology.............................................................................................................................................................................10

Medicare Advantage...........................................................................................................................................................13

Pediatric Practices...............................................................................................................................................................14

Program Evaluation.............................................................................................................................................................15

BlueHealthConnection.........................................................................................................................................................15

Linkage to Interpretive Guidelines/PCMH...........................................................................................................................16

Additional Information........................................................................................................................................................17


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The Basics

What is Provider Delivered Care Management?

Provider Delivered Care Management enables patients to receive care management through the BlueHealthConnection® benefit from a trained clinician care manager in the physician office.

How did Provider Delivered Care Management start?

Provider Delivered Care Management was piloted with over 250 primary care providers across Michigan. The pilot started on April 1, 2010 and ended March 31, 2012. After the pilot ended, Provider Delivered Care Management became a program that is part of the Physician Group Incentive Program at Blue Cross Blue Shield of Michigan. Provider Delivered Care Management is also considered a subset of our award-winning Patient Centered Medical Home Program.

Does Provider Delivered Care Management Work?

Studies have found that care management delivered in-person, under the guidance of the patient’s primary care physician, is highly effective.1,2 In addition, an evaluation comparing Provider Delivered Care Management (PDCM) to Health Plan Delivered Care Management (HPDCM) suggests favorable outcomes. Specifically, results from an evaluation of our two-year PDCM pilot program suggest that:

PDCM targeted and engaged a broader group of patients, including patients who were at earlier stages of chronic disease than HPDCM targeted members. On average, PDCM engaged members had lower claim-derived risk scores and lower costs compared to HPDCM.

PDCM achieved higher engagement rates than HPDCM. Saving estimation directionally suggests extra savings from PDCM compared with HPDCM (this result is not statistically

significant).

What is MiPCT?

The Michigan Primary Care Transformation Project (MiPCT) is a three-year Center for Medicare and Medicaid Services (CMS) multi-payer demonstration project to test the Patient-Centered Medical Home model.

Is there overlap between Provider Delivered Care Management and MiPCT?

The terms “Provider Delivered Care Management” and “MiPCT” are synonymous for the purposes of the MiPCT pilot; when receiving information that says “PDCM” or “Provider Delivered Care Management,” know that it relates to the MiPCT program.

1 Brown, R. The promise of care coordination: Models that decrease hospitalization and improve outcomes for Medicare beneficiaries with chronic illness. (2009)2 Sochalski J, Jaarsma T., Krumholz, HM, Laramee A, McMurray JJV, Naylor MD, Rich MW, Riegel B, Stewart S. What works in chronic care management: The case of heart failure. Health Affairs, 28(1), 179-189.


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Who participates in MiPCT?

Primary care providers who have been BCBSM Patient Centered Medical Home Designated for four years in a row (2010, 2011, 2012 and 2013), and who retain their PCMH designation for the duration of the demonstration project. The MiPCT-participating providers are the only providers eligible to bill for Provider Delivered Care Management Services.

How many providers participate in MiPCT?

Nearly 1,600 providers in approximately 360 practices across the state.

What is the timeline for MiPCT?

The MiPCT program began on January 1, 2012 and will end on December 31, 2014. Provider Delivered Care Management will continue after the MiPCT program concludes.

Patient Lists

What is the Patient List?

A resource for additional information about a member that is eligible for Provider Delivered Care Management. Patient Lists are not produced for oncology practices participating in Provider Delivered Care Management.

How do I obtain the patient list?

Each month the Michigan Data Collaborative will provide Physician Organizations with a list of patients who are eligible for care management and are attributed to a MiPCT Physician based on BCBSM data.

What should be done with the list once the physician organization receives it?

Previously, physician organizations obtained the list from their Blue Cross Blue Shield of Michigan EDDI folders. In 2013 and beyond, physician organizations are sent a single, all-payer patient list once per month from the Michigan Data Collaborative. The data is no longer provided through EDDI folders. For more information about the distribution process, please email [email protected]. Once the list is received, it should be distributed to participating Primary Care practices within 10 business days.

What should the practices do with the patient list?

Once physician organizations have distributed the list of eligible patients to participating practices, the practices will review the list. The list will be used in conjunction with the provider’s clinical information and knowledge of the patient to decide which patients should be offered care management. We encourage the practice to use either Web-DENIS or CAREN to check that the patient has active BCBSM coverage before delivering care; as of 2013, Web-DENIS or CAREN can also be used to check if a patient is eligible for Provider Delivered Care Management.

mailto:[email protected]


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Once a patient has been identified as eligible for care management, they can be contacted by phone or mail to set up appointments for in-person meetings at the office and real time follow up the same day for patients who are scheduled for an office visit.

What kind of information is on the patient list?

The patient list includes information about patients’ health status and recent health care use, such as emergency department visits. “Flags” are also included, to indicate engagement with a BCBSM Case Manager, utilization of specialty pharmacy, and other information that may be helpful in determining whether outreach to a specific patient is appropriate.

Training

What are the qualifications of the providers delivering care management?

The providers delivering care management services are specially trained care managers and other clinical team members working under the direction of a physician.

Where does the care manager work?

The care manager works in the physician practice, or with the practice via their affiliated physician organization, to provide in-person and/or telephonic care management.

Who trains the care managers at the providers’ office?

The training for both Hybrid and Complex Care Managers is conducted by Master Trainers who are affiliated with the Care Management Resource Center at the University of Michigan. For oncology practices, training similar to Complex Care Management, with an oncology patient focus, is conducted by a team consisting of Blue Cross Blue Shield of Michigan and the Care Management Resource Center. Oncology patients are considered to be medically complex.

What types of training are available?

Care Managers receive either Complex Care Management or Moderate-Risk Care Management Training, depending on which type of patients they are working with. All care managers are also required to complete a MiPCT-approved self-management training course. A list of approved courses is available at mipct.org. Educational opportunities, tools and resources are available – please visit mipct.org and micmrc.org for more information.

For oncology practices, all care managers are also required to complete a Care Management Resource Center-approved self-management training course. A list of approved courses is available at the micmrc.org/oncology-care-manager website. Tools and resources are also available at this website.


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Billing and Coding

What are the interventions for Provider Delivered Care Management?

The interventions for Provider Delivered Care Management are a combination of individual and group face-to-face visits, with some telephone follow-up.

How do physician organizations ensure they can bill for Provider Delivered Care Management?

Physician organizations will need to obtain an NPI and register with Blue Cross Blue Shield of Michigan in order to bill for Provider Delivered Care Management. In addition, all physicians participating in Provider Delivered Care Management must also be registered with BCBSM.

Who should I contact to get more information on enrollment?

Please contact your BCBSM Provider Consultant for more information on the enrollment and registration process.

Which kinds of practitioners can bill for Provider Delivered Care Management?

Non-physician providers qualified to perform patient assessments and bill the initial patient evaluation code (G9001) are registered nurses, clinical licensed master’s social workers, certified nurse practitioners and physician assistants.

Non-physician providers who are qualified to bill all other care management codes are registered nurses, clinical licensed master’s social workers, certified nurse practitioners, physician assistants, licensed practical nurses, certified diabetes educators, registered dieticians, master’s of science-trained nutritionists, clinical pharmacists, respiratory therapists, certified asthma educators, certified health educator specialists (with a bachelor’s degree or above in health education), licensed professional counselors and licensed mental health counselors.

There are two categories of codes that can be billed for PDCM services: Codes billed for care management services delivered by the care management team Codes billed by and paid to physicians for care management activities that they perform


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The following chart summarizes the billable PDCM codes by who can bill for each service.

Provider TypeService Care Manager Other Care Team

MembersPhysician or Mid-level

provider*Initial Assessment G9001 -- G9008Face-to-face Encounter G9002 **Phone 98966, 98967, 98968 --Group 98961, 98962 **Team Conference -- G9007Complex Care Coordination 99487, 99489 --Advanced directives or end of life care planning

S0257 S0257

* This includes physicians and mid-level providers, such as CNPs and PAs, who are acting as the primary care provider. Mid-level providers will be reimbursed at 85% of the fee.**These encounters should be billed as E & M visits.

Who is eligible to receive Provider Delivered Care Management services?

Reimbursement for care management services is available for patients who meet the following criteria:

Active BCBSM coverage that includes the BlueHealthConnection® program Employer that has opted into the Provider Delivered Care Management Program One or more conditions that indicate that care management services have the potential to improve patient well-being A referral for care management services from a physician, certified nurse practitioner or physician assistant in a

participating Provider Delivered Care Management practice at which the patient has an established care relationship. Agree to actively participate in a Provider Delivered Care Management plan

What kinds of services are included in Provider Delivered Care Management?

Provider Delivered Care Management will provide services to patients based on their conditions and level of need: for moderately complex patients, services will include goal-setting, self-management support, and care transitions. Services for medically complex patients will also include care coordination and comprehensive care planning. Oncology patients are considered medically complex.

What is the reimbursement for Provider Delivered Care Management codes?

You can view the fees paid to physicians (net of the physician organization component) for each of the care management codes in our fee schedules on web-DENIS.

To view our fee schedules:

Log in to web-DENIS. Click on BCBSM Provider Publications and Resources. Click on Entire Fee Schedules and Fee Changes.


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PDCM services are included among the codes subject to fee uplifts (exception: G9008 is not subject to the fee uplift). The actual maximum allowed amount payable to the provider shall be determined based upon the credentials and designation status of the individual provider that is identified as the Rendering Provider on the claim.

Are there any specific criteria associated with the codes?

G9001 (initial patient evaluation for moderate or complex patients). May be billed only once per care manager, per practice, per patient, per year; may also encompass multiple visits, at least one of which must be face-to-face. There may be instances where a telephone call is made prior to completing the initial assessment (i.e. Care Transitions to Home).

G9002 (face to face follow-up visit for moderate or complex patients). May be billed more than once per year. It is not a requirement that G9001 be billed first.

G9007 (coordinated care for scheduled team conference). Billable by the physician for scheduled face-to-face meetings between the primary care physician and the care manager to formally discuss any changes in the patient’s care plan. Other team members, such as a pharmacist, dietician, mental health provider, etc., may also be present.

G9008 (physician-coordinated care oversight services). Billable by the physician at the initiation of care management as an “enrollment fee.”

1. Differs from G9001 because G9001 is the comprehensive assessment conducted by the care manager with the patient prior to enrollment in care management (and annually thereafter).

CPT codes 98961, 98962, 98966, 98967, 98968 (group education and telephone assessment for moderate or complex patients; may be billed more than once per year.

1. Billing telephone codes should take place for the total time per day per patient, and not each individual call.2. Billing group visits should be based on the number of patients at the session.

CPT codes 99487 and 99489 (complex chronic care coordination services). These codes may only be billed once per month1. Billing should be for the total time per month per patient spent on care coordination with other providers or

agencies in the medical neighborhood.2. The duration of communication time must be at least 31 minutes in a calendar month to be billable.3. 99487 is for the first 31-75 minutes of clinical staff time directed by a physician or other qualified health care

professional, per calendar month4. +99489 represents each additional 30 minutes of clinical staff time directed by a physician or other qualified health

care professional, per calendar month. (This is an add-on code that should be reported only in conjunction with 99487)

S0257 (end of life counseling). This code should be used to bill for individual face-to-face or telephonic conversations regarding end-of-life care issues and treatment options conducted by qualified allied health personnel on the care management team

For more detailed information about billing guidelines for the PDCM codes, please refer to the PDCM Payment Policies document.

Can providers continue to bill t-codes if they also bill MiPCT/PDCM codes?

MiPCT/PDCM codes are intended to take the place of “T-codes” for patients who are attributed to MiPCT- and PDCM-participating providers. Providers should not bill Provider Delivered Care Management codes and T-codes for the same patient.


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Are there different codes for moderate versus complex patients?

No. There are no differences in how a provider should bill for services for a moderate or complex patient.

What criteria must the provided services meet in order to be payable?

For Provider Delivered Care Management services to be payable by BCBSM, the services must be:

Based on patient need and tied to patient care goals Ordered by a physician, physician assistant or certified nurse practitioner in a practice that has been approved to offer

Provider Delivered Care Management (The practice must have an established relationship with the patient and be accountable for the clinical management of the patient.)

Billed by the approved practice or physician organization responsible for the care management team, in accordance with BCBSM billing guidelines

Performed by a qualified non-physician care management team member employed by or under contract with an approved Provider Delivered Care Management practice or its affiliated physician organization. Physicians will work with the qualified non-physician providers to ensure that patient care is integrated and well-coordinated.

How is patient eligibility determined?

Currently, BCBSM underwritten business is automatically included in Provider Delivered Care Management; Administrative Services Contract (ASC-self funded) groups pay their own claims, so they are not automatically included in the program, but have a choice about whether or not to participate. BCBSM Account Managers are reaching out to ASC groups to educate them about Provider Delivered Care Management.

Who pays for Provider Delivered Care Management services?

Provider Delivered Care Management is included for underwritten groups that have BlueHealthConnection®. For ASC (self-funded) groups, the employer group determines participation in Provider Delivered Care Management.

How is participation in Provider Delivered Care Management being recorded?

The services must be ordered by a physician, physician assistant (PA), or Certified Nurse Practitioner (CNP) and there must be documentation in the patient record indicating that the patient has agreed to participate (in the Electronic Medical Record, patient record, visit note, et cetera). The same mechanism that practices use for documenting the PCMH patient-provider partnership may also be used for indicating participation in Provider Delivered Care Management.

Can the reimbursement amount vary based on who bills the service?

The reimbursement amount will vary based on whether the “rendering” field on the claim indicates the provider is a physician or a qualified non-physician provider, as well as whether the provider is a MiPCT PCMH designee. BCBSM will reject Provider Delivered Care Management claims, as provider liable, for patients who do not have coverage for these services.


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Is there a cost to patients for the services?

There is no copay, coinsurance, or deductible cost to patients for the Provider Delivered Care Management services, so patients should not be billed for these services.

However, if a patient has a high-deductible health plan with a Health Savings Account, you may bill the patient for the care management services as you would bill any other patient with a high-deductible health plan, if their deductible requirement has not been met.

How will I know if a patient is in a high-deductible health plan?

To alert you to the presence of patients with a copay, patients with a high-deductible health plan will be flagged for “high_deduct_plan” on the monthly MiPCT patient list. This information is also available through web-DENIS and CAREN, and these systems should be used for oncology patients. However, we strongly recommend verifying with patients about whether or not they have this kind of plan, due to the manual nature of our data processes.

If the patient has questions about their coverage, please advise them to call the number on the back of their BCBSM ID card.

Do all relevant diagnosis codes need to be included when billing claims (including acute illnesses, such as strep throat or sinus infections)?

Yes, all relevant diagnoses at the time of visit should be reported.

What should I do if I’d like more information about billing and coding for Provider Delivered Care Management?

Please access the billing guidelines, available at http://mipct .org or http://micmrc.org/oncology-care-manager.

OncologyWhen will the program be expanded to other provider specialties?

The PDCM program expanded to select PGIP oncology PUs on November 1, 2013.

Who is eligible?

Oncology practices that are currently participating in the Physician Group Incentive Program (PGIP) and are members of physician organizations that participate in the Provider Delivered Care Management (PDCM) program.

http://mipct.org/


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What are the eligibility requirements?

PGIP oncology practices that are interested in participating in PDCM must have access to an oncology nurse that has completed nurse care management training through the Care Management Resource Center (CMRC) and completed a CMRC-approved self-management program.

Additionally, each oncology practice must have 50% of the identified “core” PCMH-N capabilities fully in place including capability 5.1, 24/7 phone access to a clinical decision-maker. The following table lists all the core PCMH-N capabilities.

2.0 Patient registryCapability 2.1 Patient registry for all chemotherapy patientsCapability 2.5 Attributed practitioner

Capability 2.8 Patient demographics and clinical parameters

3.0 Performance reportingCapability 3.4 Data validated

4.0 Individual care managementCapability 4.1 PCMH training

Capability 4.2 Integrated team of multi-disciplinary providers

Capability 4.3 Evidence-based care guidelines in use at point of care

Capability 4.5 Action plan and self-management goal-setting

Capability 4.6 Appointment tracking and reminders – one chronic condition

Capability 4.7 Follow-up for needed services – one chronic condition

Capability 4.8 Planned visits – one chronic condition

Capability 4.10 Medication review and management

Capability 4.16 Advance care planning

Capability 4.18 Palliative care

5.0 Extended accessCapability 5.1 24-hour access to a clinical decision-maker by phone with feedback

loop within 24 hoursCapability 5.4 All patients fully informed about after-hours care availability

Capability 5.9 Practice unit has telephonic or other access to interpreters for all languages common to practice's established patients


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13.0 Coordination of careCapability 13.1 Notified of each patient admission and discharge

Capability 13.2 Process for coordinating information exchange with other providers

Capability 13.3 Systematically track patients across all care settings

Capability 13.4 Flags for time-sensitive health issues

Capability 13.5 Transition plans

Capability 13.6 Coordination of care for patients with complex/catastrophic conditions

Capability 13.7 Coordination care process

14.0 Specialist referral processCapability 14.1 Defined parameters for referral process from PCPs

Capability 14.2 Documented procedures for referral process

Capability 14.3 Specialist directory

Capability 14.5 Makes specialist appointments on behalf of patients

Capability 14.7 Completion of referral by patient

Capability 14.8 Staff training on referral process

Capability 14.10 Physician to physician pre-consultation

How will BCBSM know which capabilities are fully in place for oncology practice units?

With the roll out of the BCBSM PGIP Self Assessment Data tool in August 2013, physician organizations are now able to report the capabilities of each of their oncology practice units.

What procedure codes will oncologists bill for PDCM services?

Please refer to the codes listed in the “Billing and Coding” section earlier in this document

What training is required for PDCM-Oncology nurses?

PDCM oncology nurses are required to complete a nurse care management training session offered through the Care Management Resource Center, and required to complete a CMRC-approved self-management program.


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Medicare Advantage

Will the program work the same way for Medicare Advantage members as it does for patients covered under our commercial plans?

If a patient is a BCBSM Medicare Advantage member with the BlueHealthConnection® benefit, the patient is eligible to receive Provider Delivered Care Management services from an approved provider, and BCBSM will pay for these services. However, if a Medicare Advantage member is not eligible for these services, any Provider Delivered Care Management claims will be denied as provider liable.

What is the reimbursement for Medicare Advantage patients who receive Provider Delivered Care Management Services?

You will be able to view the fees paid to physicians for each of the care management codes in our fee schedules on web-DENIS.

To view our fee schedules:

Log in to web-DENIS. Click on BCBSM Provider Publications and Resources. Click on Entire Fee Schedules and Fee Changes.

Note: Medicare Advantage claims are not subject to the physician organization component or the fee uplifts. Therefore, the fees are slightly different than those of the commercial plan.

Is there anything else I should know about G9001 for Medicare Advantage patients?

G9001, the initial Provider Delivered Care Management visit, should include the following components for Medicare Advantage patients in order to be compliant with the Medicare Star program:

Review of all active diagnoses with reporting back to BCBSM on the claim form Functional assessment Review of all medications Urinary Incontinence screen

Do the services provided differ for Medicare Advantage patients?

It is expected that Medicare Advantage patients will receive an annual Wellness Visit (code G0438), and a comprehensive assessment if needed.• The wellness visit (code G0438) is mandatory for MA patients for planning and preventive care purposes, regardless of whether

the members are eligible for Provider Delivered Care Management services who are no longer within the first twelve months of their first Part B coverage period. It may be performed by qualified non-physician practitioners who are members of the health care team: a physician (doctor of medicine or osteopathy), physician assistant, nurse practitioner, clinical nurse specialist or other medical professional (including a health educator, a registered dietitian, nutrition professional, or other licensed practitioner), or a medical professional team working under the direct supervision of a physician (doctor of medicine or osteopathy).


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Note: The listing of eligible annual wellness visit providers is an update to the BCBSM Medicare Advantage Provider Delivered Care Management Billing Guidelines webinar presented on June 2012, in which we stated the AWV can only be offered by a physician.

The comprehensive assessment (code G9001) is optional for MA patients. It is performed by a non-physician care manager to determine whether care management is appropriate for the patient

CMS’ Initial Preventive Physical Exam and Annual Wellness Visit Frequently Asked Questions document contains a link to a quick reference documents for the annual wellness visit and defines:

Who is eligible for AWV How to find out if a beneficiary has previously had

o An AWV o When these services were performed

Required elements of the exam

Do all relevant diagnosis codes need to be included when billing claims for Medicare Advantage patients (including acute illnesses, such as strep throat or sinus infections)?

Yes, all relevant diagnoses at the time of visit should be reported.

Are all Medicare Advantage patients eligible for the comprehensive assessment, regardless of their eligibility for PDCM, or are they only eligible if they show up on the MiPCT patient lists?

Only the patients who are on the monthly MiPCT patient list are eligible for the comprehensive assessment.

Pediatric PracticesIf I work in a pediatric practice, is there anything I need to do differently?

The Michigan Care Management Resource Center works with a pediatrician in the state to develop training curriculum for care managers in pediatric practices. Educational opportunities, tools and resources are available – please visit mipct.org and micmrc.org for more information. For oncology practices, pediatric curriculum is included in the self-management support training.

Does the child need to be present at their appointment?

When evaluating pediatric patients, the child must attend at least a portion of the initial assessment, regardless of their age.

http://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/IPPE-AWV-FAQs.pdf


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Program Evaluation

Are there any results from the Provider Delivered Care Management Pilot?

Preliminary results of the two-year Provider Delivered Care Management pilot program show that patients were more likely to engage with a nurse care manager aligned with a practice. That means that they were more motivated to improve their health.

In addition: PDCM targeted and engaged a broader group of patients, including patients who were at earlier stage of chronic disease than HPDCM targeted members. On average, PDCM engaged members had lower claim-derived risk score and lower cost compared to HPDCM.

PDCM achieved higher engagement rates than HPDCM. Saving estimation directionally suggests extra savings from PDCM compared with HPDCM (this result is not statistically

significant).

How will Provider Delivered Care Management be evaluated?

BCBSM will track patient experience in the program based on claims submitted by providers for care management/care coordination services. Reporting on program activity was available starting in 2012; program results, including impact on use and cost, will be available in late 2014

How will PDCM Oncology be evaluated?

Although the evaluation plan for PDCM oncology is not yet complete, the following summarizes a preliminary outline:• Track use of all PDCM codes• Track use of S0257 for advanced care planning conversations (total volume and percent of members receiving the service)

and evaluate patients that received one or more S0257 service and its impact on hospital deaths, chemotherapy use in the last two weeks of life, and IP use

• Exclude inpatient admissions for cancer care that is commonly rendered in an inpatient setting • Review scheduled/planned vs. unscheduled/unplanned inpatient stays • Review data based on distance traveled for care (i.e., greater distances may result in hospital stays)• Chemotherapy in the last 14 days of life when not used for palliative care purposes • Symptom frequency and functional status

BlueHealthConnectionWhat is BlueHealthConnection®?

BlueHealthConnection® is Blue Cross Blue Shield of Michigan’s suite of wellness and care management programs. The disease management piece of BlueHealthConnection® focuses on adults with one or more of the five most common chronic conditions and provides primarily telephonic services.


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How does Provider Delivered Care Management differ from BlueHealthConnection®?

Provider Delivered Care Management is intended for anyone with a condition that would benefit from care management services, including children, and includes group and in-person interventions delivered in the physicians’ office.

Is there overlap between Provider Delivered Care Management and BlueHealthConnection®?

In some cases, individuals receiving care management through Provider Delivered Care Management may also receive care or case management services through BlueHealthConnection®. These patients will be “co-managed,” and their Provider Delivered Care Management provider and BlueHealthConnection® Case Manager will ensure that interventions are coordinated. How will I know if a patient is being co-managed?

If a patient is already being managed by a BlueHealthConnection® Case Manager, they will be flagged as “bcbsm_cm” or “bcbsm_dm” on the monthly MiPCT member list. For oncology patients, the patient can provide this information or the provider can contact BlueHealthConnection®.

If a patient is in Provider Delivered Care Management, can they still receive BlueHealthConnection® services?

Individuals who are engaged in Provider Delivered Care Management are still eligible to receive other BlueHealthConnection® services, including wellness, Quit the Nic, and Complex Care Management. In addition, individuals who need extra-contractual benefits will receive services through BlueHealthConnection® as they do today.

Linkage to Interpretive Guidelines/PCMHHow does Provider Delivered Care Management fit with Patient Centered Medical Homes?

Provider Delivered Care Management is a core component of the Patient-Centered Medical Home model.

What is the Patient Centered Medical Home Program?

BCBSM’s award-winning Patient Centered Medical Home (PCMH) program is a collaborative effort with physician organizations and providers across Michigan. Our program is the largest in the country, with approximately 6,000 primary care physicians participating, of which over 4,000 are PCMH designated.

What is the goal of the Patient Centered Medical Home Program?

The Patient Centered Medical Home Model transforms primary care practices in Michigan; providers focus on improving quality and patient care.


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Does the Patient Centered Medical Home Model Work?

A growing number of studies report that the PCMH model reduces inpatient admissions (16-40%) and emergency department use (29-50%).3 In 2013, PGIP PCMH Designated providers had 19% fewer ambulatory care sensitive condition admissions compared to non-designated providers. In addition, a recent analysis indicates that the BCBSM Patient Centered Medical Home program saved $155 million over its first three years, from 2008-2011.

What are the Interpretive Guidelines?

The Interpretive Guidelines contain collaboratively developed, detailed information about how to implement 140 Patient Centered Medical Home capabilities. The guidelines are available at www.bcbsm.com.

Additional InformationWhere can I learn more?http://mipct.org - This is the website for the Michigan Primary Care Transformation Project. You can sign up for care management training, link to the Care Management Resource Center, sign up for the weekly Flash emails, obtain payment updates, and access all the latest information about the program.

Information on PDCM for oncology practices can be obtained through the website http://micmrc.org/oncology-care-manager.

3 Kevin Grumbach, MD, Paul Grundy, MD, MPH; Outcomes of Implementing Patient-Centered Medical Home Interventions: A Review of the Evidence From Prospective Evaluation Studies in the United States; Updated November 16, 2010

http://micmrc.org/oncology-care-manager

http://mipct.org/

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