The Michigan Primary Care Transformation (MiPCT) Project All-Payer MiPCT Billing Collaborative May 2015

Agenda 8-8:15 Introduction/Welcome 8:15-9:00 What the Data Tells Us, Updates and New Tools 9:00-10:00 Best Practice Sharing and Q/A 10:00-10:10 Break 10:10-11:15 Making the Good Better 11:15-11:50 World Café and Report Backs (with prizes!) 11:50-NOON Wrap Up and Next Steps

8-8:15 Introduction/Welcome

Thoughts for the Day (and for the Project!) The day is about solution-finding Why this workstream is different than all the rest! ▫ It depends on the entire practice working together ▫ It is the closest direct contributor to sustainability Everyone can contribute to its success Relax, No Pressure, You Are Among Friends!, Having a Can-Do Attitude, Finding Joy in Creative Solutions, Knowing What CAN Happen

Practice Learning Credits 4 Practice Learning Credits are available to practices who participate in the billing and coding collaborative group work including: ▫Participating in the in-person May 12 session and submitting evaluations ▫Having a physician from the practice participate in the Physician Billing and Coding Webinar ▫Participating in the continuing virtual group work that results from the May 12 th discussion

So Share Your Story….. What is your quirkiest/funniest/best/most memorable vacation….? What happened? What made it spectacular?

8:15-9:00 ▫What the Data Tells Us  Care Management Code Analysis ▫Updates and New Tools  Payer Updates  Multipayer G and CPT Code Grid  New G and CPT Code Detail Report

Medicare 8

All Commercial Payers 9

BCBSM 10

BCN 11

Priority Health 12

Just In! Latest PO BCBSM Volumes

Just In! Latest PO Priority Volumes

The Evolution of Care Management Payment Population- Based PMPM Acuity- Adjusted PMPM Activity-Based Care Management G/CPT Codes Value- Based/ Shared Risk and Reward Payment Structure PBPM (For Engaged Beneficiaries)

The World of “Now” Opportunity to demonstrate that: ▫ Members from payers are served appropriately, effectively and efficiently ▫ Payers, purchasers and plans obtain value from the important work of care coordination Notable improvements already! Let’s review the current state across payers

Payer Partner Updates

BCBSM & BCN Tips Always verify the patient has an active BCBSM or BCN contract. For BCN the patient list is your determining factor for MiPCT eligibility. For BCBSM you also need to check webDENIS or PARS for MiPCT eligibility. Use the practices existing processes to check eligibility. Questions: log an issue on the PGIP Collaboration site or

Priority Health PCP Incentive Program – Care management incentive $3.25 pmpm All plans – FF and SF Commercial, Medicare and Medicaid RN, RD, MSW, CDE, CAE, Pharmacist, PA or NP

Priority Health PCP Incentive Program – Care management incentive Attestation due June 1 Self reported data – June and December 2% unique member claims target - includes G, telephone and TCM codes

Multipayer G and CPT Code Grid

Multipayer G and CPT Code Grid, cont What It Is: A user-friendly guide to each G and CPT care management code (it is not intended to be and should not be construed as an exhaustive guide to payer documentation) Where It (and All Other Billing/Coding Material) Will Be Posted: ▫Look under the “Resources” tab ▫Click on the dropdown for “Billing and Coding” ▫OR go directly to Updating Process ▫On a quarterly basis (Jan, March, June, Sept) the grid will be updated to reflect payer changes to G and CPT code policies ▫Next quarterly update published in Sept 2015

New Report: G and CPT Code Detail Report Purpose: Allows you to view G-Code and CPT code claim detail included in the aggregate reports. Accessing the Report ▫Starting with the November 2014 reports, you can find the Detail reports in the G-code zip file for your PO, which you can access on the Download PO Reports page of the MiPCT Dashboard. Inside each PO’s zip file is a Detail Report file for each practice. The Detail Reports have the following naming convention: _ _G-Code_Report_ _.xls All Payers are include on the same tab, with the claims initially sorted alphabetically by Payer and then by Patient Last Name. Each report contains all Care Management claims received by MDC (starting from April 2012 for BCBSM and BCN and from July 2013 for Priority Health) up to the “Claims Paid Through” date listed in the header of the report. The reports include both paid and rejected claims (but do not include details about why a claim was rejected). More Details in: G-Code Reports Quick Reference document.G-Code Reports Quick Reference document Year of the Report Data Most Recent Month of Paid Claims in Report

New Report: G and CPT Code Detail Report

9:00-10:00 Best Practice Sharing and Q/A

10:00-10:10 Break

10:10-11:15 Making the Good Better: A Process Mapping Exercise

Process Mapping Focus: Patients Likely to Benefit from Care Management But it is not the risk score alone; The greatest opportunity is in combining: Patient information (risk, etc.) Clinical judgment Registry and electronic information (ADTs, etc.) To identify patients that may benefit from care management MiPCT Population Risk Overview (Calendar Year 2013)

Process Mapping Exercise Getting to know the “G and CPT Code Process Master Map” ▫ Copies are at your tables ▫ Reflects the best of the October process maps and the results of collaborative sharing to date Identifies the beginning point and the end points (the “start” and “stop” of the process) ▫ Start Point: Identifying patient who would benefit from CM ▫ Stop Point: Paid claim

Process Mapping Exercise, cont. How does your practice’s process compare? Do you have any thoughts about making the map even better? Use the large maps posted on the walls and the three colored dots (with your practice name on each) and place them on your: ▫ Your most successful step (Green) ▫ Your most challenging step (Red) ▫ The step that you have focused improvement on the most over the last six months (Blue)

11:15-11:50 World Café and Report Backs

World Café Priority Health Blue Cross and Blue Shield of Michigan/Blue Care Network What Do You Want Covered in the Physician Webinar? Checking Eligibility: Creative Solutions! Delivering Care Management: Right Person, Right Time What You Want Next in Billing and Coding Support? Other Topics? (Audience suggestions)

e.g.) Engaging Patients Opportunity for finding creative approaches to engage patients who are challenging to engage The actively working Those with many life challenges Those who may not identify with the provider or Care Manager May be in the wording we use; in how much we listen; in what can be done (and understanding that improvement is incremental)

World Café, cont. Do you want to be the facilitator for any additional table topics? From 11:15-11:25 ▫Pick a table: Spend 10 minutes ▫Name a “reporter” ▫Capture your group’s outcomes on a post-it for sharing From 11:30 – 11:40 ▫Pick a different table: Spend 10 minutes ▫Etc. (from above)

11:50-NOON Wrap Up and Next Steps

Remember to: Complete and turn in your evaluation forms The best “one stop shopping” place for your billing and coding MiPCT resources and all updates is:  Look under the “Resources” tab  Click on the dropdown for “Billing and Coding”  OR go directly to

We Are the MiPCT…. Together We Can Make Care Better!