Health Plans & Different PCMH Payments

December 8, 2016

MPCC helped Oakland Physician Network Services, MedNetOne Health Soultions, and United Physicians meet with the Michigan Department of Health and Human Services on September 29 regarding PCMH payment differentials.

 

Here are the takeaways:

  • Decision by some Medicaid Health Plans (MHPs) to financially reward practices at different levels based on PCMH designation impacts between 10,000 and 15,000 physicians in Michigan

  • Physician organization (PO) leaders strongly believe this decision by some MHPs forces practices to make a redundant misallocation of resources in order to maximize their PCMH designation payments across MHPs

    • For example, a practice may need to invest $6,000 per site and up to a 0.2 FTE employee for 12 months to receive NCQA PCMH designation despite already being certified as a BCBSM PCMH designated practice.

  • The MDHHS presented a crosswalk to MHP CEOs and Medical Directors that reviewed the similarities between PCMH designation programs. MDHHS cannot facilitate discussion regarding incentive agreements between MHPs and POs due to anti-trust requirements. The Michigan Association of Health Plans will also not facilitate this type of group discussion for the same reason.

  • The Michigan Primary Care Consortium (MPCC) is available to help PO leaders connect with individual health plans to further discuss PCMH payment differentials. MPCC is also available to help POs promote the impact of current PCMH designated practices to create more opportunities for meaningful dialogue with MHPs and other payers. 

 

Click here to download copy of the participants, takeaways, and other stakeholders interested in this topic.

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