MiCCSIWhat’s in the wind, next steps?

One Approach

Many Steps

Payment Redesign Continue to Support Care Management

The Mi-CCSI Board of Directors approved the formation of a group of partner organizations and others to:

• Explore developing specific clinical model elements that build on the concepts of MiPCT and COMPASS

• Review the best way of paying for that model

• See “Executive Summary” document for details

Formation of the QI Council

QI Council: Expedite development of a model to build pricing around• Medical and behavioral conditions to be included• Personnel to be included in the care team• Tasks and activities of the care team that would be

considered “new work” and part of care management

• Measure sets (HEDIS plus a handful others) and how to report on progress and outcomes, as well as cost

Clinical Model Sub-committeeSub-committee role:Review evidence and establish consensus

Mi-CCSI—All rights reserved

The “CASE” for Case Review• Studies are mixed on the effectiveness of the medical home or

care management as deployed thus far• It appears that care managers need additional structure, input

and clinical-behavioral guidance to provide relevant input to treating PCPs• Evidence is low to moderate on impact on cost savings and

QOL for a “care management” only approach• Other elements required, including improved identification

methods, better assessments (including social determinants) and regular review of complex patients by physicians and other clinical consultants• This model has been used effectively by health plans and in

other clinical settings and models for some years5

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Billing and Coding Sub-committee

• Research available and established codes

• Establish clarity and understanding of new codes

• See “Billing and Coding Guideline”

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Formation of a financial template for input