Practices participating in the Michigan Primary Care Transformation Project (MiPCT) are required to meet several criteria including achieving and sustaining Patient-Centered Medical Home (PCMH) designation from either the National Committee for Quality Assurance (NCQA) or Blue Cross Blue Shield of Michigan's Physician Group Incentive Program. As such, practices are expected to uphold the central components of the medical home model, including the following:
- expanding access to care through extended hours
- accommodating same day scheduling
- using disease registries for population health management
Practices must also agree to address four selected focus initiatives of MiPCT, including the following:
- care management
- self-management support
- care coordination
- linkage to community services
The core component of the MiPCT model is delivering and paying for care management services. Participating providers are required to embed care managers in primary care practices and, once embedded, practices receive supplemental payments to support the care manager position.
Care managers work closely with the primary care team to manage patients with complex and costly conditions. Essential care manager responsibilities are evidence-based and include activities that support services such as medication reconciliation, care transitions, and developing comprehensive and coordinated care plans.
MiPCT has tailored the care manager position to serve pediatric populations by providing pediatric specific trainings through in-person meetings and webinars. The Pediatric Care Coordination Curriculum was presented to care managers at the first pediatric care managers MiPCT conference in 2012. Family leaders are invited to present at care manager trainings and facilitate group discussions to enhance implementation of family-centered and coordinated care.
Participating providers have access to an array of clinical tools and resources pertaining to care management and other key areas through the Michigan Care Management Resource Center. The resource center maintains a page for pediatric care managers that includes webinars, assessment tools, training work, and links to resources on best practices for delivering pediatric care.
Participating providers also have access to robust data sets on patient populations, quality measures, and utilization measures through a multipayer data warehouse that allows for retrospective, prospective, and incentive payment reports.