This document outlines metrics and requirements for a pay for performance program for primary care practices in Michigan. It discusses six month metrics related to electronic health records, access to care, and care management. It also outlines one year clinical quality metrics and points allocation. The document provides information on care manager roles and responsibilities, codes for chronic care management services, and conditions for payment. It announces an upcoming training and a learning collaborative focused on behavioral health integration.

1. Michigan Primary Care
Transformation
Demonstration Project
September 5, 2012

2. Agenda
 Pay for Performance
 Care Manager
 Environmental Scan
 MiPCT Metrics Committee
 Behavior Health Representation
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3. Pay for Performance:
Six Month Metrics – eRegistry
1) Practice has electronic registry
2) Registry has interface capability
3) Incorporates evidence-based care guidelines
4) Identifies individual attributed practitioner
5) Information available and used by the practice
unit team at the point of care
6) Used to generate communications to patients
regarding gaps in care
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4. Pay for Performance:
Six Month Metrics - eRegistry
7. Used to flag gaps in care
8. Patient demographics
9. Registry identifies and tracks care for patients
with at least 2 of the following:
diabetes
asthma
cardiovascular disease
pediatric obesity
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5. Pay for Performance:
Six Month Metrics - eRegistry
 0 points for entire metric if no eRegistry
 1 point each for numbers 1-8
 Up to 2 points for number 9
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6. Pay for Performance:
Six Month Metrics - Access
 Extended access:
• 30% same day appointment (10 points)
 Appointments outside regular hours:
• 8 hours/week (10 points)
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7. Pay for Performance:
Six Month Metrics - Care Manager
 Number of Moderate Care Managers hired/
contracted by practices and/or PO
• 10 points
 Number of Moderate Care Managers within PO
that have completed the required training
• 10 points
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8. Pay for Performance:
Six Month Metrics - Care Manager
 Number of Complex Care Managers hired/
contracted by practices and/or PO
• 10 points
 Number of Complex Care Managers within PO that
have completed the required training
• 10 points
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9. Pay for Performance:
Year One
 Clinical Quality diabetes, hypertension, BP
(140/90), Asthma
 ACSC hospitalization metric for 18 years and older
 Asthma self management plans 5-64 years
 Adolescent well child visits replaced with
adolescent immunization measure
 CHF measures removed
 Additional points added for Family Medicine
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10. Pay for Performance:
Points
 Notification of hospitalizations 5 points
 Primary care sensitive ED visits 30 points
(NY algorithm)
 ACSC hospitalizations 10 points
 Readmissions 5 points
 Clinical metrics 50 points
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11. Care Managers
 Each practice has a Hybrid Care Manager assigned
and actively engaged
 Dietitian, Certified Diabetes Educator, Behavior
Health Specialist, Health Coach, Health Educator,
Certified Asthma Educator, Pharmacist (as
needed)
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12. PDCM Codes
CODE SERVICE
G9001 Initial assessment
G9002 Individual face-to-face visit (per encounter)
98961 Group visit (2-4 patients) 30 minutes
98962 Group visit (5-8 patients) 30 minutes
98966 Telephone discussion 5-10 minutes
98967 Telephone discussion 11-20 minutes
98968 Telephone discussion 21+ minutes
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13. General Conditions of Payment
 For billed services to be payable, the services must be
delivered and billed under the auspices of a practice
or practice-affiliated PO approved by BCBSM for
PDCM reimbursement.
• Based on patient need
• Ordered by a physician, PA or CNP within the
approved practice
• Performed by the appropriate qualified, non-
physician health care professional employed or
contracted with the approved practice or PO
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14. Registration for CCM Workshop
 Moderate Care Manager web based enhanced
training begins September 10 at 11:30am
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15. Learning Collaborative
 Focus on behavior health integration
 Recruitment for family medicine, internal
medicine and geriatric medicine practice teams
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16. Questions
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