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The Michigan Primary Care Transformation (MiPCT) Project

The Michigan Primary Care Transformation (MiPCT) Project. The Business Case for Care Management Mary Ellen Benzik , MD Diane Marriott, DrPH. What Does Sustainability Mean?. To the Practice: Maintaining and growing CM staffing, processes and roles

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The Michigan Primary Care Transformation (MiPCT) Project

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  1. The Michigan Primary Care Transformation (MiPCT) Project The Business Case for Care Management Mary Ellen Benzik, MD Diane Marriott, DrPH

  2. What Does Sustainability Mean? • To the Practice: Maintaining and growing CM staffing, processes and roles • To the PO (and Practice) : Payment reform for CM • To the State and Patients: Servicing all patients, all payers with effective, efficient services

  3. Sustainability Variables • PRACTICE/POs: Success on key metrics; Funding to allow “margin to cover mission”; Change Management • ENVIRONMENT: Demonstration Extension; Refinement of CMS G Code; Evolving health reform/landscape; “Accountable System” performance • ROI/PAYER PARTICIPATION: Success on key metrics (by payer); Servicing members of all plans

  4. ?????Systems Level Payment The Evolution of Care Management Payment • Activity-Based Care Management G/CPT Codes • Population-Based PMPM • Acuity-Adjusted PMPM • PBPM (For Engaged Beneficiaries)

  5. All-Payer Billing (Through August 2014)Most and Least Frequently Used Codes

  6. MiPCT Resources to Support PO and Practice Business Cases • All-Payer Billing Collaborative • October 30 Morning Half Day In-Person Session • Focus on Care Managers, Billers, Coders, Office Staff • Special Webinar for Physicians • Follow-up Team Webinars • Three (3) Practice Learning Credits Granted • To join, just email mipctdemo@michigan.gov with the subject line: MiPCT BILLING COLLABORATIVE • 2015 Revenue Projections to POs Across Payers • All-Payer Resources on mipctdemo.org

  7. MiPCT Resources to Support PO and Practice Business Cases, cont. • Payer recruitment • Policy support on federal and state initiatives • MiPCT Demo mailbox queries

  8. What Happens After 2016? • Goal: Transition from demonstration to ongoing payment reform • Sustaining and growing of the gains The Work Starts Now……..

  9. One System’s Approach-Mary Ellen Benzik, MD

  10. MiPCT vs. Chronic Care Codes Alone ?

  11. Calculating Revenue Opportunity • Interactive excel spread sheet • System/practice specific characteristics are entered into calculator tool • Applicable to Transition of Care (TOC), Annual Wellness Visit (AWV), and Chronic Care Codes (CCC) • Factors in anticipated investment /expense to capture revenue • Allows modeling of necessary practice activity to budget targets

  12. Demonstration of Excel Sheet

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