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 physicians’ practice by trained care managers.

The Blue Cross Blue Shield of Michigan PDCM program is part of the Patient-Centered Medical Home (PCMH) model. According to BCBSM, PDCM is care management delivered in the physician’s office by trained care team members in coordination with the physician.

Provider-Delivered Care Management is open to all PCMH practices. PDCM providers demonstrate lower rates of emergency department visits and utilization measures and higher quality scores.

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.

There are three levels of reimbursement for PDCM providers:

  1. Reimbursement for delivering the 12 care management codes for eligible members (paid via claims).
  2. PDCM VBR provides care management, measured via billing codes, to a percentage of attributed members.
  3. VBR for performance and/or improvement on a number of clinical quality/use metrics.