Provider Delivered Care Management
Engrained in the Blue Cross Blue Shield of Michigan (BCBSM) Patient-Centered Medical Home (PCMH) program, Provider-Delivered Care Management (PDCM) is a model where care management is provided within the primary care practice by trained care managers.
Provider-Delivered Care Management is open to all PCMH practices. PDCM helps better support patients with complex needs and chronic disease management. By strengthening care coordination, PDCM providers demonstrate lower rates of emergency department visits and utilization measures and higher quality scores.
There are three levels of reimbursement for PDCM providers:
- Reimbursement for delivering the 12 care management codes for eligible members (paid via claims).
- PDCM value-based reimbursement (VBR) provides care management, measured via billing codes, to a percentage of attributed members.
- VBR for performance and/or improvement on a number of clinical quality/use metrics.
Care managers and care team members are the cornerstone of PDCM practices. They provide patient education, care coordination, and support services to the patients in collaboration with physicians.
Extra support in your practice
To help practices improve their care management delivery, The Physician Alliance has partnered with Gap Healthcare Solutions to enhance care management services. Gap Healthcare Solutions can help improve patient outcomes and reduce administrative burden by providing a focused suite of care management services designed to support Medicare patients and the providers who care for them:
- Transitional Care Management (TCM) driven by ADT
- Remote Patient Monitoring (RPM), a diagnosis-driven monitoring program
- Provider-Delivered Care Management (PDCM) proactive outreach
- RN-led Annual Wellness Visit (AWV) telehealth model
The workflows are designed to support the practices without adding burden. Medicare and commercial guidelines are followed to ensure compliance and quality.
View flyer here.
For more information on Gap Healthcare Solutions’ patient-centered care management service offerings and to schedule a meeting, go to www.gaphealthcaresolution.com.
