2017-18 PCMH IG Updates
Lesson 1
Program Evolution
- The PCMH program must evolve to meet the needs of BCBSM, our customers and their members.
- This will require substantive changes to the program over time.
- Existing capabilities will change, substantially in some instances.
- We recognize that the modification of existing capabilities may be frustrating. Nonetheless, these changes are necessary to ensure that the program remains relevant.
Application to ALL Capabilities
Any capability reported to BCBSM as “in place” must be in place and in use by all appropriate members of the practice unit team on a routine and systematic basis, and, where applicable, patients must be able to demonstrate use the capability.
ALL must be able to demonstrate the capability is currently in use versus “can do”.
Capabilities Demonstration
- All capabilities must be proven
- POs should inform practices that demonstration will be required for certain capabilities. Examples: of proofs are
- If the practice is asked to show the field team how patient contacts were tracked in the practice system for abnormal test results, the practice should have patient examples identified ahead of time and be prepared to discuss them with the field team during the site visit.
- 5.2 – After hours – must have example in EHR or chart
- Registries – must demonstrate active outreach via worksheets, medical record notes, contact log, tickler file, etc.
NO DOCUMENTATION EXAMPLES CAN BE PROVIDED AFTER THE SITE VISIT
Summary of Changes
- IG Layout Changes
- Required Capabilities (6)
- Retired Capabilities (6)
- New capability (1)
Changes to the IG Layout
- The Interpretive Guidelines continue to evolve, and in this version we are including “PCMH Validation Notes,” which are examples of the ways in which a practice may be asked to demonstrate that capabilities are in place during the site visit validation process. Please note that these are just illustrative examples; during the actual site visit a practice may be asked different or additional questions.
- Example: 4.2 – What the Changes Look Like
Required Capabilities
- In 2018 we plan to begin requiring that practices have six core capabilities implemented in order to qualify for PCMH designation.
- These six core capabilities are relevant to all PCP practices and are central to a patient’s PCMH experience. Requiring them for designation will enable us to assure customers that every BCBSM PCMH-designated practice in Michigan has the foundational care processes that they and their employees expect from a high-value primary care practice.
Retired Capabilities
- Starting in 2018, capabilities are retired when they no longer require substantive time and or resources to implement, due to the evolution of practice transformation.
New Capability
- 12.14 - Practice routinely uses patient portal to prepare patient for planned visits, alerting patients to needed tests that can be done in advance, gathering information about questions and issues patients would like to discuss
2018 PCMH IG Updates
Lesson 1
Welcome back to Patient Centered Medical Home and Neighborhood. Here are the major updates for 2018. Please see the Full Lesson below for all 2018 changes. We also have further attachments in the Documents section, so please review those as well. This section includes Interpretive Guideline updates.
Program Evolution
- The PCMH program must evolve to meet the needs of BCBSM, our customers and their members.
- This will require substantive changes to the program over time.
- Existing capabilities will change, substantially in some instances.
- We recognize that the modification of existing capabilities may be frustrating. Nonetheless, these changes are necessary to ensure that the program remains relevant.
Application to ALL Capabilities
Any capability reported to BCBSM as “in place” must be in place and in use by all appropriate members of the practice unit team on a routine and systematic basis, and, where applicable, patients must be able to demonstrate use the capability.
ALL must be able to demonstrate the capability is currently in use versus “can do”.
Capabilities Demonstration
- All capabilities must be proven
- POs should inform practices that demonstration will be required for certain capabilities. Examples: of proofs are
- If the practice is asked to show the field team how patient contacts were tracked in the practice system for abnormal test results, the practice should have patient examples identified ahead of time and be prepared to discuss them with the field team during the site visit.
- 5.2 – After hours – must have example in EHR or chart
- Registries – must demonstrate active outreach via worksheets, medical record notes, contact log, tickler file, etc.
NO DOCUMENTATION EXAMPLES CAN BE PROVIDED AFTER THE SITE VISIT
Summary of Changes
- IG Layout Changes
- Required Capabilities (6)
- Retired Capabilities (6)
- New capability (1)
Changes to the IG Layout
- The Interpretive Guidelines continue to evolve, and in this version we are including “PCMH Validation Notes,” which are examples of the ways in which a practice may be asked to demonstrate that capabilities are in place during the site visit validation process. Please note that these are just illustrative examples; during the actual site visit a practice may be asked different or additional questions.
- Example: 4.2 – What the Changes Look Like
Required Capabilities
- In 2018 we plan to begin requiring that practices have six core capabilities implemented in order to qualify for PCMH designation.
- These six core capabilities are relevant to all PCP practices and are central to a patient’s PCMH experience. Requiring them for designation will enable us to assure customers that every BCBSM PCMH-designated practice in Michigan has the foundational care processes that they and their employees expect from a high-value primary care practice.
Retired Capabilities
- Starting in 2018, capabilities are retired when they no longer require substantive time and or resources to implement, due to the evolution of practice transformation.
New Capability
- 12.14 - Practice routinely uses patient portal to prepare patient for planned visits, alerting patients to needed tests that can be done in advance, gathering information about questions and issues patients would like to discuss
We hope you enjoyed these 2018 updates and please ensure any changes or protocol are taking place in your practice.
Gain knowledge on the 2018 program updates for PCMH.
No reference links associated with this module.
PGIP - Physician Group Incentive Program
An innovative incentive program through BCBSM that brings together physician organizations from across Michigan, to encourage information sharing about various aspects of health care. Program participants, including both primary care physicians and specialists, collaborate on initiatives designed to improve the health care system in the state.
PO - Physician Organization
An organization that partners with physicians or is a group of physicians that works with health plans on contracts and other mutual interests (i.e. incentive programs, transition programs, etc.) of their organization.
PHO - Physician Hospital Organization
An organization that partners with physicians and hospitals in order to obtain payer contracts and to further mutual interests (i.e. incentive programs, transition programs, etc.) within integrated delivery systems.
MPP - Physician Partners
An organization that is 50% owned by physicians and 50% owned by the Health System to negotiate payer contracts, assist with health plan enrollment, and provide guidance and support in mutual interests that promote evidence based care and overall well being of their customers "the patient".
SRD - Self Reporting Data
Twice a year (summer and winter) BCBSM requires PO/PHO to conduct assessments for PGIP participating offices which include review of office demographic information, office technology and PCMH initiative implantation within the office. This data is linked to PCMH nomination, PCMH designations and PGIP incentive monies.
PU - Practice Unit
The identification of a practice within the PGIP program.
PCMH Nomination
An office in PCMH nomination status is requesting review by BCBSM for PCMH Designation. An office can be nominated through their PGIP participating PO/PHO during the BCBSM Winter SRD submission.
Denominator
Total number of "current" patients in the practice.
Numerator
Total number of patients in the denominator with whom conversations have been held and partnerships established at any point in the past
4P or Pay for Performance
Claim payments based on quality and utilization scoring determined by the health plan. (Quality based payment structure)