Michigan Multipayer CPC+ Monthly Briefing

This briefing is authored by the Michigan Multipayer CPC+ Team (and not by CMS or a CMS contractor) and is made possible through support from BCBSM and Priority Health (our CPC+ commercial payer partners) to support CPC+ success in our state. 

To be added to the distribution list, email MichiganMultipayerCPCPlus@med.umich.edu with “Add Me to the MI CPC+ Newsletter Distribution” in the subject line.  You can find additional information and past briefings at https://cpcplusmichigan.org/

March 2020

Included in March’s Issue 

THANK YOU to Our CPC+ Practices!  You Are More Important Than Ever!

Primary care has always been the “go-to” for patients and a trusted source of advice and care.  In this special time as all work together to combat a national pandemic, we salute the hard-working CPC+ practices, providers and teams who are making an all-out effort to assist their patient populations.  Your response is humbling and admirable.  In a very special time, you are a voice of important wisdom for patients and their families. 

As you do so much to be available for your patients, taking some time each day for yourself is so key.  Whether it is a phone call to a friend, a walk in an open area as you obey social distancing guidelines, or reading for pleasure at night’s end, it is the sincere hope of the CPC+ community that you do something special for yourself as a balm for these special times.  Thank you for your passion and commitment to excellent care.  Thank you for always going above and beyond.  Michigan is so very proud of you!

This time also makes us mindful that multipayer coordination and partnership is more important than ever.  Reducing unnecessary administrative burden, supporting your needs with timely resources and sending clear, multipayer signals about requirements, metrics and guidelines becomes even more important, too.  The CPC+ Community is also proud of our CPC+ Payer Partners, BCBSM, Priority Health and CMS for leading the charge in multipayer coordination in Michigan and enabling us all to participate in CPC+.

Providing Care Management with Telephone and E-Visits:  IMPORTANT News

We have worked with our wonderful commercial payer partners, BCBSM and Priority Health, in their support of remote care management in this special time.  Many practices are transitioning in-person care management services to remote visits (e.g. phone, e-visits, other telehealth applications, etc.), especially in light of the Governor’s “Stay at Home, Save Lives” executive order.  Not only does remote care management help patients who are in special risk categories stay healthy and safe, but as we obey good social-distancing precautions, it lends the additional benefit of helping patients with the anxiety that they may be feeling. 

The topic came up on a Care Interventions Subcommittee round robin call last week.  We contacted our Payer Leaders that afternoon and within a day of beginning discussion with them, they worked with their organizations to share the following important updates:

Blue Cross Blue Shield of Michigan

Effective immediately, all PDCM codes can be billed when the service is performed remotely such as via a face to face video or over the telephone.   Also, HIPPA compliance requirements for telehealth visits have been relaxed during the COVID-19 crisis to make it easier for proivders to conduct health care visits remotely.  Through April 30, 2020, we’ve aligned our requirements with the Center for Medicare and Medicaid Services, as outlined in their Medicare Telemedicine Health Care Provider Fact Sheet .   Prior to April 30, we will re-evaluate this temporary alignment and if needed, extend it.

We will accept non-secure telemedine technologies such as Apple Face Time, Facebook Messenger, Google Hangouts video or Skype until the end of April 2020 as long as both of these occur:

  • You are actively working toward implementing a secure process
  • You take responsibility for communicating the shortcomings of the process to the patient and proceed only if the patient accepts those shortcomings

 Note that public-facing options are not acceptable.  Facebook Live, Twitch and TikKok are examples of technologies that aren’t acceptable.

In addition, Blue Cross Blue Shield of Michigan has released a corona virus member resource corona virus member resource  that outlines helpful information about BCBSM’s support to patients and providers.

Priority Health

Priority Health is encouraging members to use virtual care if they believe they have symptoms (coughing, fever, breathing trouble) to avoid overwhelming health care providers and prevent further spreading the virus. As a reminder of the options available for billing virtual visits, see telephone visits, e-visits and hosted visits .

Certain telehealth codes can only be billed by physicians, while other codes can be billed by physicians or qualified health professionals (QHPs). QHPs are credentialed by Priority Health. They include RNs, certified NPs, PA-Cs, licensed master’s social workers (LMSWs), psychologists (LLPs and PhDs), certified diabetes educators (CDEs), registered dieticians and Masters’- trained nutritionists, clinical pharmacists and respiratory therapists. Learn more about billable codes on our virtual visits billing page.

G9001, G9002, 99495 and 99496 can be provided virtually.  Billing these codes with the place of service (POS) Code 02 will apply towards the PCP IP care management measure billing requirement

For most members on non-health savings account (HSA) plans, virtual visits are covered in full. HSA members are responsible for the allowed amount of the virtual visit, ahead of their deductible.

In addition, please see the attached document describing Priority Health’s resources for providers and patients.

Resources for You in Dealing with COVID-19

We want to support your success in seeing your patient and your practice through this challenging time.  We will continue to develop and distribute material that is targeted to your needs, while balancing the flow of material to your inboxes. 

The Latest on Primary Care First in Michigan

Even as we work as a community to support each other and our practices through the special challenge of the Corona virus and everyone’s work toward containment and caring for patients, CMS staff are hard at work preparing 2021 operations for Primary Care First. 

We have worked with our CMS partners for an update to share on Michigan, as follows.  The practice application period for 2021 (“Round One” of Primary Care First (PCF)) has closed and CMS is processing applications. Round One was open only to non-CPC+ practices.   CPC+ practices can still file letters of intent for 2022. CMS has shared that 101 Michigan practices submitted applications for Round One.

CPC+ practices will be the only set that is eligible for Round Two of PCF which will begin in 2022.  Practices may still submit non-binding letters of interest for the 2022 start year.  This can be done by submitting a letter of interest to PrimaryCareApply@telligen.com.  Thus far, 220 CPC+ practices have submitted letters of interest for Round Two PCF participation.  In late 2020 or early 2021 CMS will open the formal application process for CPC+ practices to file applications for the program.   Though submitting a letter of interest is not required for CPC+ practices to be able to apply for the 2022 PCF start year, it is encouraged. 

Our CPC+ Commercial Payers, BCBSM and Priority Health have both stepped forward to submit statements of interest for PCF payer participation.  The payer solicitation period has been extended to 11:59 p.m. Pacific Time on May 1, 2020 to allow additional payers across the nation to design and submit proposals aligned with PCF.  Payers who have not yet submitted statements or applications and wish to may visit the PCF Payer Portal to begin the proposal process and contact PrimaryCareApply@telligen.com with any questions. 

May 28, 2020 CMS/TMF In-Person Learning Session

CMS has temporarily suspended in-person learning activities and we do not yet know yet whether the May 28th session will be held as planned, held remotely or rescheduled for a later date.  We are staying in touch with CMS about this and will relay any additional information we have. 

Multipayer CPC+ Dashboard Update from the Michigan Data Collaborative

The Michigan Data Collaborative (MDC) continues to make progress on the CPC+ Michigan Multipayer project.  Here is an update on recent work and developments: 

  • MDC continues to work towards the release of a CPC+ Michigan Multipayer Dashboard.
  • The CPC+ Dashboard release is expected Monday, April 20, 2020, with CMS Medicare and BCBSM data. Once contracting is complete, MDC will receive and integrate Priority Health data into the dashboards.
  • MDC has begun the process of onboarding users. First, reaching out to PO’s and Practices to confirm Acknowledgers, then following up with identified Acknowledgers to verify user access.  Access can be setup at the PO or Practice level.
  • Highlights of what you will find in the first dashboard include:
    • An overview of your population with demographic information like age, gender, community (rural or urban), payer, and chronic condition prevalence.  
    • The capability to analyze measure results including comparisons to the CPC+ Michigan performance average.
    • An insights page to easily identify areas for improvement, as well as bright spots in your organization’s CPC+ performance.
    • Drill downs to the provider and patient level.
    • Comparisons across Managing Organizations and Practices to support collaboration for improvement.
  • MDC has developed a CPC+ Dashboard training program that will include live monthly webinars, recorded webinars, and on-demand assistance with dashboard utilization and access.

Michigan Institute for Care Management and Transformation Educational Offerings

MICMT Upcoming Events

Many conferences and in person trainings across the US have been cancelled due to COVID – 19. The health and safety of our participants is our number one priority. Therefore, MICMT will be offering several virtual training opportunities in place of the physical Regional Meetings in April with registration details available on the website.  For up to date information about MICMT courses and the MICMT Regional Meeting, please check the Michigan Institute for Care Management and Transformation website  www.micmt-cares.org

We appreciate your flexibility and understanding during this time. Please do not hesitate to reach out with any questions or concerns:   micmt-requests@med.umich.edu

Contact Us! How Can We Help? Supporting CPC+ POs and Practices in Michigan

 The joint commercial CPC+ payers in Michigan are working together to support multipayer alignment with the University of Michigan. We advocate with CMS to emphasize the important role that POs play in supporting CPC+ and work with them as partners in the Michigan CPC+ community, work with all participating payers in Michigan to create consistency in payer policy and approach wherever possible, and work to remove roadblocks that practices and POs face in CPC+ implementation and operations. We are interested in your experience of what is going well and what your find challenging. Please contact the CPC+ Michigan Regional Convener, Diane Marriot (dbechel@umich.edu or 734 740 0511) at any time to share your ideas and experiences.

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