Primary Care Physician - 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.

PDCM is the mechanism used by BCBSM to reimburse for care management and care coordination activities for BCBSM members through the billing of care management codes. The Physician Alliance aims to provide the necessary support to practices to ensure success in mainstreaming the integration of care managers into primary care practices, billing of the 12 PDCM codes and 3 PDCM-related codes to increase revenue and improve quality of care and patient satisfaction.

Multi-year studies demonstrated positive outcomes with care manager engagements within the practices. For example, those patients who engaged with care managers had reductions in costs, risk scores, and readmissions.

Click here to learn about the payment methodology, value-based reimbursement opportunities and more about PDCM.

 

BENEFITS OF PARTICIPATION IN PDCM:

  • More money – earn additional PDCM VBR’s Population Management VBR (potential 5% VBR) and PDCM Outcomes VBR (potential 6% VBR) and PDCM (PCMH designated practices only).
  • Increased revenue through reimbursement for care management services
  • Improve quality and increase the capture of pay for performance dollars
  • Reduce cost with care being provided in the lower cost settings
  • Add a trained care manager to expand the practice’s care team
  • Prepare your practice to manage risk

 

Resources:

Provider Delivered Care Management information presentation
Care management/PDCM billing and coding webinar (2019) presentation
BCBSM PDCM data dictionary information
PDCM updates and eligibility information (2019)
How to open and reply to an encrypted email tip sheet

*Training information PDCM-PCP can be located here.

 

For more information on the Provider Delivered Care Management program, contact Fran Burley, MSN, RN, CPHQ at (586) 498-3588 or email This email address is being protected from spambots. You need JavaScript enabled to view it..