BCBSM MiPCT Member Lists: Webinar

1. BCBSM MiPCT Member Lists: Webinar 7/24/12 and7/26/12

2. What is the memberlist? • Sent monthly to POs • POs will receive email each month once list is available in their EDDI folders • POs are responsible for distributing to all care managers working in participating practices as soon as possible • Patients on list are eligible for care management and are attributed to a MiPCT Physician based on BCBSM data. • List is “source of truth.” If a patient is included on the monthly list, practice unit staff can assume the patient has BlueHealthConnection, is part of a participating employer group, and is eligible to receive care management services. • If patient is not on list, cannot assume they will be eligible for care management services in the future • List is relatively stable and should not change that much from month-to-month. May see more movement in the 1st quarter of every year due to the renewal process

3. Member List, cont’d. • Note: Practice encouraged to use Web-DENIS or CAREN to check patient has active BCBSM coverage before delivering care. • Once POs have distributed the list of eligible patients to participating practices, the practices will review the list. • BCBSM is exploring ways to sort list prior to sending to POs. For more info on this or to provide feedback, please see the 7/23/12 edition of MiPCT Flash • List includes information about patients’ health status and recent health care use, such as emergency department visits • These data “flags” are used to indicate pertinent patient data • “Flags” of interest may include “high_deduct_plan” and “pharm_specialty,” e.g. • For more info, refer to data dictionary

4. Member List, cont’d. • List should be used in conjunction with the provider’s clinical information and knowledge of the patient to decide who should be offered care management. • Patients will be contacted by the practice to initiate care management process once they are determined to be eligible and a suitable candidate for outreach • Currently exploring possibility of Michigan Data Collaborative distributing all member lists for MiPCT by end of 2012; more info coming soon!

5. Where does member list data come from? • The information in the list is based on BCBSM’s Care Relationship algorithm. • Based upon a review of claims for eligible Blue Cross Blue Shield of Michigan members (“rendering provider” field is used) • Claims taken from an outpatient hospital or office setting with dates of service within the past 2 years (using a 2 month run out). • Filtered by specific procedure codes: • Base evaluation and management services, or • New procedure codes for preventive counseling, immunizations or consultations.

6. Resources • The following documents are available on the MiPCT web site: http://mipctdemo.wordpress.com/ • Data dictionaries for both Commercial and MA populations • A “Frequently Asked Questions” document • Instructions for importing the patient lists

7. MemberList Demo • Now we will go step-by-step through opening and using the patient lists …

8. Questions??