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Health Plan of Michigan rolls out PCMH incentives

Health Plan of Michigan has announced a patient-centered medical home incentive program that encourages providers to become PCMHs by providing financial assistance during the practice certification phase.

The new program is available to all contracted HPM primary care physicians who are open to and accepting new members and have a current membership of 100 or greater. It also rewards providers who have already received PCMH designation.

[See also: Meaningful use incentives included in new PCMH standards; New York BCBS launches patient-centered medical home pilot]

"This is a great opportunity for us to support providers who want to become PCMH-certified, and an equally good way for us to provide continued incentives to our providers who have already made the move to PCMH," said Sean Kendall, director of network development for Health Plan of Michigan.

The incentives are based on HEDIS quality scores, and reimbursements will increase as quality increases. Reimbursements include payments above the current Medicaid fee schedule and the existing HPM HEDIS bonus program. HPM also provides an additional per-member-per-month payment for providers participating in the program.

The HPM incentive program encourages providers to use the joint principles of a PCMH as developed by The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association.

These principles spell out the core properties of an effective patient-centered approach:

  • Each patient has an ongoing relationship with a personal physician
  • The personal physician leads a team of individuals responsible for ongoing patient care
  • The personal physician is responsible for providing for all the patient's healthcare needs or for appropriately arranging care with other qualified professionals.
  • Care is coordinated and/or integrated across all elements of the complex healthcare system and the patient's community.

Health Plan of Michigan is the state's largest managed Medicaid program, with more than 285,000 members. The HPM network consists of more than 3,300 PCPs, 8,200 specialists and 98 hospitals in 64 Michigan counties.

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