1. Michigan Primary Care
Transformation
Demonstration Project
May 16, 2012
Webinar #7

2. Agenda
 Financial Template
 Medicaid Payments
 Medicare Payments
 Metrics
 Care Managers
 Participating MNO MiPCT Quarterly Team Meeting
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3. Why Financial Reporting
 Financial reporting ensures accountability for the
funds received
 Reporting will reconcile revenue collected and
expenses

4. Reporting Templates
 There are 4 reporting templates:
Revenue and Membership
Care Coordination
Practice Transformation
Incentive

5. Basic Components of All
Templates
 Revenue (cash collected)
 Membership ( corresponds to cash collected)
 Expense

6. Payers Included in Reporting
 Blue Cross Blue Shield of Michigan
 Blue Care Network
 Medicare
 Medicaid Managed Care

7. Reporting Deadlines
 Reports submitted on a quarterly basis for Care
Coordination and Practice Transformation
 Incentive reporting is for a 6 month period
 Data will be submitted electronically.
 Details on electronic transmission will be
communicated to PO/PHO’s

8. Reporting Deadlines
 PO/PHO’s will be given 30 days after the quarter end
to submit reports
 Due dates:
• May 1, 2012
• July 31, 2012
• October 31, 2012
• January 31, 2013
 Data will be submitted electronically
 Details on electronic transmission will be
communicated to PO/PHO’s

9. Summary of Payer Member
Months and Revenue
 Worksheet used to summarize all payer revenues
 Care Coordination payments are made directly to
PO’s for Medicare and Medicaid Managed Care
 Care Coordination payments are made to Practices
for BCBSM and BCN
 Practice Transformation payments are made to
practices for all payers

10. Medicaid Transformation
Payment
 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
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11. Dual Eligible
 CMS is providing funding and technical assistance
to fifteen states to develop person‐centered
approaches to coordinate care across primary,
acute, behavioral health and long‐term supports
and services for dual eligible individuals.
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12. States Selected for Dual Eligible
Project
 The states selected to receive design contracts are
California, Colorado, Connecticut, Massachusetts,
Michigan, Minnesota, New York, North Carolina,
Oklahoma, Oregon, South Carolina, Tennessee,
Vermont, Washington, and Wisconsin
 Each state awarded up $1 million to develop a
model describing how the state would structure
and implement its planned intervention
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13. Period of Performance
 The period of performance of the design contract
will be a total of 18 months
 The first 12 months are designated as the design
period, at which time the demonstration proposal
is due
 The final six months of the contract will be used by
CMS to review demonstration proposals and to
enter into discussions with states about possible
implementation.
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14. Dual Choice Population
 This population represents individuals with some
of the most complex needs, yet they are currently
subject to episodic and fragmented care as they
navigate two programs with distinctly different
rules. The proposal that is presented here has
been developed following an extensive
stakeholder process.
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15. Who’s Included…
 Change financing model for ~200,000 persons who
are dually covered by Medicare and Medicaid
 Move from the current Fee for Service model to
an organized system of care
 Dually eligible persons include:
• Frail elderly
• Mentally ill
• Developmentally disabled
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16. The Goal of Integration
 Organized and coordinated service delivery system across
all service domains
 Seamless delivery of services
 Reduction of fragmentation
 Reduce barriers to home and community‐based services
 Improve quality of services
 Simplify administration for beneficiaries and providers
 Cost effectiveness aligning financial incentives
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17. Quarterly MNO MiPCT
Team Meeting
 Review progress of all practice teams to date
 Provide blinded quality reports for all health plans
 Provide un‐blinded quality reports for all health
plans
 Best practice presentation
 Guest speaker from MiPCT
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18. Care Managers
 Each practice has a Hybrid Care Manager assigned
and actively engaged
 A full compliment of fully Moderate Care
Managers assigned (Dietitians, Certified Diabetes
Educator, Behavior Health Specialists, Health
Coaches, Health Educator, Pharmacist, Certified
Asthma Educator)
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19. Questions
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