MiPCT - Care Management

1. MiPCT - Care Management BCBSM Medicare Advantage

2. Michigan Primary Care Transformation (MiPCT) • BCBSM Medicare Advantage (MA) is not a MiPCT participating health plan • BCBSM is covering the cost of care management services for BCBSM MA patients

3. MiPCT – BCBSM MA plan • Why is BCBSM paying for the care management services for MA patients? • BCBSM supports team based care • an effective way to improve care coordination and outcomes • decrease cost

4. BCBSM MA plan • CMS expects each eligible Medicare Advantage patient will have an annual Wellness visit with the PCP • MiPCT care managers will include BCBSM MA patients in their patient caseload • The Annual Comprehensive Assessment is completed by a care manager and is independent of risk status • Prioritize – first focus on patients with chronic conditions

5. MiPCT – BCBSM MA plan • Determining patient eligibility for care management by CCM, HCM or MCM • Verify eligible patients for care management by checking the monthly BCBSM list • Patients on this list are eligible for care management reimbursement through G codes, CPT codes • Must obtain a PCP order to complete the comprehensive assessment visit G9001

6. BCBSM MA Plan – care management reimbursement through G codes and CPT codes - G 9001 • Limit of one G9001 per patient per year • Patient visits via phone and face to face • mustadd up to a minimum of 30 min. of discussion with patient or family/care giver • At least one face to face patient visit • PCP must sign the comprehensive assessment visit note

7. MiPCT – BCBSM MA plan MiPCT care manager should review patient comprehensive assessment findings • If patient would benefit from moderate or complex care management, discuss findings with PCP • If PCP agrees, obtain written order from PCP for care management services

8. Questions. . . ?