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Michigan’s medical home activity began with a 2008-2010 Improving Performance in Practice (IPIP) program sponsored by the Michigan Primary Care Consortium (MPCC), which combined learning sessions with coaching to implement components of PCMH and chronic illness care. MPCC has also created a patient-centered medical home toolkit.
 
Blue Cross Blue Shield of Michigan (BCBSM) has also played a large role in spurring medical home activity in Michigan, providing fertile ground to develop partnerships with public payers. As of August 2012, BCBSM has designated nearly 1,000 practices (over 3,000 physicians) as medical homes under its medical home program. Roughly 5,000 providers are working to implement at least one medical home initiative as part of the BCBSM Physician Group Incentive Program (PGIP), extending the program to nearly 2 million Michiganders.
 
Federal Support:
  • Michigan is one of the eight states selected to participate in the Medicare Advanced Primary Care Practice (MAPCP) demonstration program. Medicare has joined as a participating payer in the Michigan Primary Care Transformation (MiPCT) Project. The MiPCT project is building upon the provider infrastructure created through the BCBSM medical home designation program.
  • The Michigan Public Health Institute, in partnership with the state's Department of Community Health, won a $14 million Health Care Innovation Award in June 2012 to support primary care in two counties.The project will train and deploy about 90 community health community workers and will also develop community hubs that will link patients to needed services. Michigan discussed their plans to build community hubs on a NASHP webcast in April 2012; the presentation is available here.
  • Michigan has received a duals demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to “coordinate care across primary, acute, behavioral health and long-term supports and services for dual eligible individuals.”
Last Updated: August 2013
 
Forming Partnerships
The Michigan Department of Community Health leads the Michigan Primary Care Transformation (MiPCT) Project with guidance from the 18-member steering committee representing state agencies, primary care physicians, physician organizations, health plans, employers, and the Michigan Primary Care Consortium. The project is managed by the University of Michigan. The project has also formed a Patient Advisory Council to advise the steering committee.
Defining & Recognizing a Medical Home
Definition: A multi-stakeholder workgroup convened by the Michigan Primary Care Consortium adopted the Joint Principles of a Patient Centered Medical Home as the statewide consensus definition of “Medical Home,” with the inclusion of four Michigan-specific footnotes further defining ‘patient-centered’, ‘personal physician’, ‘quality and safety’, and ‘payment’.
 
Recognition:
The Michigan Primary Care Transformation (MiPCT) Project requires participating practices to meet either insurer-developed Physician Group Incentive Program (PGIP) standards or 2008 NCQA PPC-PCMH standards (Level 2 or 3 required).
 
Practices that are designated under the BCBSM Physician Group Incentive Program (PGIP) must meet guidelines within twelve “domains of function.” The specific domains are: patient-provider partnerships; patient registries; performance reporting; individual care management; extended access; test results tracking & follow-up; preventive services; linkages to community services; self-management support; patient web portals; coordination of care; and specialist referral processes.
Aligning Reimbursement & Purchasing
Since January 2012, participating practices and providers in the Michigan Primary Care Transformation (MiPCT) Project have received three per-member per-month (PMPM) payments for each attributed patient:
  • Care coordination payment – $3.00 PMPM ($4.50 for Medicare)
  • Practice transformation payment – $1.50 PMPM ($2.00 for Medicare)
  • Performance incentives – $3.00 PMPM
Supporting Practices

The Michigan Primary Care Transformation (MiPCT) Project will support physicians and practice transformation by providing educational opportunities, a Care Management Resource Center, and the Michigan Data Collaborative. The focus of support is on care management, self-management, care coordination and linking to community services. Educational opportunities include learning collaboratives, lean workshops, practice-based coaching, webinars, and seminars. The Michigan Data Collaborative will create a multi-payer claims database and generate metric feedback reports.

 
MiPCT will also provide clinical models, resources and support aimed at avoiding emergency room and inpatient use for ambulatory sensitive conditions, reducing fragmentation of care among providers and involving the patient in decision-making.
 
In June 2012, the Michigan Public Health Institute, in partnership with the state's Department of Community Health, won a $14 million Health Care Innovation Award to support primary care in two counties.The project will train and deploy about 90 community health community workers and will also develop community hubs that will link patients to needed services. Michigan discussed their plans to build community hubs on a NASHP webcast in April 2012; the presentation is available here.
Measuring Results
Reporting activity in the Michigan Primary Care Transformation (MiPCT) Project includes:
  • Quarterly narrative and financial reports submitted by each physician organization on progress in achieving MiPCT goals.
  • Semi-annual payer reports.
  • Financial reports
  • Standard audit procedures

 

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